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Gray L, Sindall P, Pearson SJ. Does resistance training ameliorate cancer-related fatigue in cancer survivors? A systematic review with meta-analysis. Disabil Rehabil 2024; 46:2213-2222. [PMID: 37345506 DOI: 10.1080/09638288.2023.2226408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/12/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Cancer-related fatigue (CRF) is unrelenting. As neither rest nor sleep ameliorates cognitive, emotional, and physical symptoms, quality of life is diminished. This study examines resistance training (RT) effectiveness on CRF in cancer survivors. The secondary aims were to identify the dose-response relationship of RT frequency, intensity, and volume on CRF in different cancer survivor populations. MATERIALS AND METHODS Systematic searches via numerous databases for RCTs were performed in June 2022. Patient-reported outcome measures (PROM), were analysed, pre-to-post intervention, using a random-effects model. The Physiotherapy Evidence Database (PEDro) scale informed methodological quality assessment. RESULTS Eight studies were included (cancer survivors: breast (BCS) = 5; endometrial (ECS) = 1; prostate (PCS) = 2). Overall, RT interventions ≥ 6 weeks elicited large significant reductions in CRF for FACIT-F (SMD = 0.932, p = <0.001) and moderate significant reductions in CRF for PFS-R (SMD = -0.622, p = 0.004). CONCLUSION Main findings indicate that RT ameliorates CRF, especially in BCS; however, individualised approaches should be advocated. Supervised training elicited the greatest positive outcomes, thus should be a pivotal part of the cancer rehabilitation pathway. Future studies should be adequately powered, undertake discrete analyses of different cancer types, and investigate chronic RT effects.
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Affiliation(s)
- Luke Gray
- Department of Health and Social Care, University of Salford, Salford, UK
| | - Paul Sindall
- Department of Health and Social Care, University of Salford, Salford, UK
| | - Stephen J Pearson
- Department of Health and Social Care, University of Salford, Salford, UK
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Zeilinger EL, Zrnic‐Novakovic I, Oppenauer C, Fellinger M, Knefel M, Unseld M, Wagner T, Lubowitzki S, Bartsch R, Zöchbauer‐Müller S, Raderer M, Staber PB, Valent P, Gaiger A. Prevalence and biopsychosocial indicators of fatigue in cancer patients. Cancer Med 2024; 13:e7293. [PMID: 38819432 PMCID: PMC11141333 DOI: 10.1002/cam4.7293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/29/2024] [Accepted: 05/05/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Symptoms of cancer-related fatigue (CRF) can have a significant impact on patients' quality of life and treatment adherence. We aimed to investigate the relationship between CRF and multiple psychosocial and somatic indicators within a large mixed cancer sample. METHODS In this cross-sectional study, N = 1787 outpatients with cancer were assessed for CRF, pain, anxiety, and depression using validated screening instruments. We further obtained clinical parameters (Hb, CRP, creatinine, leukocytes, ASAT, and ALAT), sociodemographic data (age, gender, income, education level, marital status, parenthood, and living area), and lifestyle factors. Multivariate linear regression models were applied to estimate the impact of each indicator on CRF. RESULTS Overall, 90.6% of patients experienced some CRF, with 14.8% experiencing severe CRF. No gender difference was found in the prevalence of CRF. Patients with higher levels of pain, depressive symptoms, and lower Hb levels had significantly higher levels of CRF (ps <0.001). Lower levels of CRF were observed in patients who had children (p = 0.03), had less education (p < 0.001), and were physically active for more than 2 h per week before their oncological diagnosis (p = 0.014). The latter was only a significant indicator in the male subsample. CONCLUSION The present results demonstrate a high prevalence of CRF and highlight that not only somatic and psychosocial factors, but also lifestyle factors prior to diagnosis appear to be associated with the etiology and persistence of CRF. To effectively treat CRF, a biopsychosocial, personalized approach is recommended.
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Affiliation(s)
- Elisabeth L. Zeilinger
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
- Department of Clinical Research SBGAcademy for Ageing Research, Haus der BarmherzigkeitViennaAustria
- Department of Clinical and Health Psychology, Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Irina Zrnic‐Novakovic
- Department of Clinical and Health Psychology, Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Claudia Oppenauer
- Division of Clinical Psychology, Department of Psychology and PsychodynamicsKarl Landsteiner University of Health SciencesKremsAustria
| | - Matthäus Fellinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and PsychotherapyMedical University of ViennaViennaAustria
- Second Department of Psychiatry and PsychotherapyClinic Hietzing, Vienna Healthcare GroupViennaAustria
| | - Matthias Knefel
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
- Department of Internal MedicineLandesklinikum Baden‐MödlingBadenAustria
| | - Matthias Unseld
- Department of Clinical Research SBGAcademy for Ageing Research, Haus der BarmherzigkeitViennaAustria
| | - Theresa Wagner
- Department of Clinical and Health Psychology, Faculty of PsychologyUniversity of ViennaViennaAustria
| | - Simone Lubowitzki
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
| | - Rupert Bartsch
- Division of Oncology, Department of Internal Medicine IMedical University of ViennaViennaAustria
| | - Sabine Zöchbauer‐Müller
- Division of Oncology, Department of Internal Medicine IMedical University of ViennaViennaAustria
| | - Markus Raderer
- Division of Oncology, Department of Internal Medicine IMedical University of ViennaViennaAustria
| | - Philipp B. Staber
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
| | - Peter Valent
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute for Hematology and OncologyMedical University of ViennaViennaAustria
| | - Alexander Gaiger
- Division of Hematology and Hemostaseology, Department of Medicine IMedical University of ViennaViennaAustria
- Ludwig Boltzmann Institute for Hematology and OncologyMedical University of ViennaViennaAustria
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3
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Trudel G, Lebel S, Stephens RL, Leclair CS, Leach CR, Westmaas JL. Afraid and tired: A longitudinal study of the relationship between cancer-related fatigue and fear of cancer recurrence in long-term cancer survivors. Cancer Med 2024; 13:e7313. [PMID: 38845458 PMCID: PMC11157147 DOI: 10.1002/cam4.7313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVE Cancer-related fatigue (CRF) and fear of cancer recurrence (FCR) are two common concerns experienced by cancer survivors. However, the relationship between these two concerns is poorly understood, and whether CRF and FCR influence each other over time is unclear. METHODS Data were from a national, prospective, longitudinal study, the American Cancer Society's Study of Cancer Survivors-I (SCS-I). Surveys were completed by 1395 survivors of 10 different cancer types at three time-points, including assessment 1.3 years (T1), 2.2 years (T2) and 8.8 years (T3) following their cancer diagnosis. CRF was assessed using the fatigue-inertia subscale of the Profile of Mood States, and FCR by the FCR subscale of the Cancer Problems in Living Scale. Multiple group random intercepts cross-lagged panel models investigated prospective associations between CRF and FCR. RESULTS For younger participants (at or below median age of 55 years, n = 697), CRF at T1 and T2 marginally and significantly predicted FCR at T2 and T3, respectively, but no lagged effects of FCR on subsequent CRF were observed. Cross-lagged effects were not observed for survivors over 55 years of age. CONCLUSION Both CRF and FCR are debilitating side effects of cancer and its treatments. Given that CRF may be predictive of FCR, it possible that early detection and intervention for CRF could contribute to lowering FCR severity.
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Affiliation(s)
| | - Sophie Lebel
- School of PsychologyUniversity of OttawaOttawaOntarioCanada
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Asakitogum DA, Nutor JJ, Pozzar R, Hammer M, Alismail S, Kober KM, Miaskowski C. Multidimensional Model of Energy in Patients With Cancer. Semin Oncol Nurs 2024; 40:151644. [PMID: 38692969 DOI: 10.1016/j.soncn.2024.151644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES Evidence suggests that energy is a distinct symptom from fatigue in patients with cancer. The purpose of this paper is to present the Multidimensional Model of Energy in Patients with Cancer (MMEPC) that is based on emerging evidence and to make recommendations for clinical practice and future research. METHODS The literature was reviewed to determine various factors associated with variations in energy in patients with cancer. In addition, some of the emerging evidence in the model is supported by studies of energy in the general population and in patients with other chronic conditions. RESULTS Based on a review of the literature, specific concepts in the MMEPC include: person factors, clinical factors, cancer-related factors, biological factors, factors associated with energy balance, and co-occurring symptoms. The evidence to support the association between each of these factors and variations in energy levels in patients with cancer is described and synthesized. CONCLUSION This article provides emerging evidence on factors that influence variations in energy levels in patients with cancer. While the fundamental biobehavioral and biologic mechanisms that underlie variations in energy levels are not well understood, the model can be used to design pre-clinical and clinical studies of energy in patients with cancer. In addition, while emerging evidence supports the hypothesis that fatigue and energy are distinct symptoms, additional research on common and distinct risk factors and underlying mechanisms is warranted to be able to develop and test precision interventions for one or both symptoms. IMPLICATIONS FOR NURSING PRACTICE The risk factors (eg, being female, sleep quality) associated with variations in energy levels in patients with cancer identified in this paper have important clinical implications. Clinicians can use the identified risk factors to guide their assessments; identify high-risk patients with decrements in energy decrement; and develop targeted energy conservation interventions for the patients.
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Affiliation(s)
| | | | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | - Marilyn Hammer
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA
| | | | - Kord M Kober
- School of Nursing, University of California, San Francisco
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco; School of Medicine, University of California, San Francisco
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5
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Ng ML, Majid AMSA, Yee SM, Natesan V, Basheer MKA, Gnanasekaran A, Al-Suede FSR, Parish C, Dalal M, Ming LC, Nazari V M, Khan SS, Stn Hameed Sultan SB, Babu KG, Majid ASA, Abdul Aziz MAS. A phase II randomized, double-blind, placebo-controlled study of Nuvastatic (C50SEW505OESA), a standardized rosmarinic acid-rich polymolecular botanical extract formulation to reduce cancer-related fatigue in patients with solid tumors. Support Care Cancer 2024; 32:331. [PMID: 38710920 DOI: 10.1007/s00520-024-08536-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/30/2024] [Indexed: 05/08/2024]
Abstract
AIM We evaluated the efficacy and safety of Nuvastatic™ (C5OSEW5050ESA) in improving cancer-related fatigue (CRF) among cancer patients. METHODS This multicenter randomized double-blind placebo-controlled phase 2 trial included 110 solid malignant tumor patients (stage II-IV) undergoing chemotherapy. They were randomly selected and provided oral Nuvastatic™ 1000 mg (N = 56) or placebo (N = 54) thrice daily for 9 weeks. The primary outcomes were fatigue (Brief Fatigue Inventory (BFI)) and Visual Analog Scale for Fatigue (VAS-F)) scores measured before and after intervention at baseline and weeks 3, 6, and 9. The secondary outcomes were mean group difference in the vitality subscale of the Medical Outcome Scale Short Form-36 (SF-36) and urinary F2-isoprostane concentration (an oxidative stress biomarker), Eastern Cooperative Oncology Group scores, adverse events, and biochemical and hematologic parameters. Analysis was performed by intention-to-treat (ITT). Primary and secondary outcomes were assessed by two-way repeated-measures analysis of variance (mixed ANOVA). RESULTS The Nuvastatic™ group exhibited an overall decreased fatigue score compared with the placebo group. Compared with the placebo group, the Nuvastatic™ group significantly reduced BFI-fatigue (BFI fatigue score, F (1.4, 147) = 16.554, p < 0.001, partial η2 = 0.333). The Nuvastatic™ group significantly reduced VAS-F fatigue (F (2, 210) = 9.534, p < 0.001, partial η2 = 0.083), improved quality of life (QoL) (F (1.2, 127.48) = 34.07, p < 0.001, partial η2 = 0.243), and lowered urinary F2-IsoP concentrations (mean difference (95% CI) = 55.57 (24.84, 86.30)), t (55) = 3.624, p < 0.001, Cohen's d (95% CI) = 0.48 (0.20, 0.75)). Reported adverse events were vomiting (0.9%), fever (5.4%), and headache (2.7%). CONCLUSION Nuvastatic™ is potentially an effective adjuvant for CRF management in solid tumor patients and worthy of further investigation in larger trials. TRIAL REGISTRATION ClinicalTrial.gov ID: NCT04546607. Study registration date (first submitted): 11-05-2020.
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Grants
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
- KP/ITTP/S/1/367-1 Jld.2 (91) The Malaysian Ministry of Agriculture, Malaysia
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Affiliation(s)
- Mei Ling Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amin Malik Shah Abdul Majid
- EMAN Research Ltd, Symonston, Australia
- College of Health & Medicine, Australian National University, Canberra, Australia
| | - Siew Mei Yee
- Faculty of Pharmacy, SEGi University, Petaling Jaya, Malaysia
| | - V Natesan
- EMAN Research Ltd, Symonston, Australia
| | | | - Ashok Gnanasekaran
- Department of Pharmacology, Faculty of Medicine, Quest International University, Ipoh, Malaysia
| | | | - Christopher Parish
- College of Health & Medicine, Australian National University, Canberra, Australia
| | - Meena Dalal
- Notrox Research Private Limited, Hospital & Health Care Bangalore, Bangalore, Karnataka, India
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Sunway City, Malaysia
| | - Mansoureh Nazari V
- EMAN Biodiscoveries Sdn. Bhd, Sungai Petani, Malaysia
- School of Pharmacy, Universitas 17 Agustus 1945 Jakarta, Jakarta, Indonesia
| | | | - Siti Balkees Stn Hameed Sultan
- EMAN Biodiscoveries Sdn. Bhd, Sungai Petani, Malaysia
- Integrative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Penang, Malaysia
| | - K Govind Babu
- HCG Cancer Centre-Double Road, Bengaluru, Karnataka, India
| | - Aman Shah Abdul Majid
- Department of Pharmacology, Faculty of Medicine, Quest International University, Ipoh, Malaysia.
- EMAN Biodiscoveries Sdn. Bhd, Sungai Petani, Malaysia.
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Montgomery KE, Basha M, Nyholm L, Smith C, Ananiev G, Fedorov A, Kapoor A, Brown R, Capitini C, Kwekkeboom K. Exploring Inflammation and Stress as Biological Correlates of Symptoms in Children With Advanced Cancer: A Longitudinal Feasibility Study. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:157-171. [PMID: 38588659 DOI: 10.1177/27527530231214544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Background: Few studies have examined biomarkers of stress and inflammation as underlying mechanisms of symptoms in adolescents and young adults with cancer. This study determined the feasibility of collecting blood and saliva samples across time, described the range and distribution of biomarkers, and explored the association of biomarkers with symptom adverse events (AEs). Method: This longitudinal, prospective repeated-measures single-site feasibility study recruited N = 10 children (M = 12.5 years) receiving treatment for advanced cancer. Symptom AE data and inflammation (cytokines and C-reactive protein) and physiologic response to stress (salivary cortisol and salivary alpha-amylase) biomarker levels were collected at three time points. Descriptive statistics were used to examine feasibility and acceptability and to summarize symptom AE, stress, and inflammatory biomarker data. A linear regression model was used to determine cortisol diurnal slopes. The relationship between symptom and inflammatory biomarker data was explored and Hedges's g statistic was used to determine its effect size. Results: Participants provided 83% of saliva samples (n = 199/240) and 185 samples were sufficient to be analyzed. Nurses collected 97% (n = 29/30) of blood samples. Participants reported the saliva collection instructions, kits, and reminders were clear and helpful. Insomnia, pain, fatigue, and anxiety demonstrated the most medium and large negative effects with inflammatory markers. Symptom AEs demonstrated the highest number of medium and large negative effects with interleukin-8 and tumor necrosis factor-alpha (-0.53 to -2.00). Discussion: The results indicate longitudinal concurrent collection of symptom and biomarker data is feasible and inflammatory and stress biomarkers merit consideration for inclusion in future studies.
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Affiliation(s)
| | - Mays Basha
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Leah Nyholm
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Corey Smith
- Department of Medicine - Pulmonary/Critical Care, UW Health, Madison, WI, USA
| | - Gene Ananiev
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alexander Fedorov
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Amita Kapoor
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Roger Brown
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Christian Capitini
- Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Wu JR, Chen VCH, Fang YH, Hsieh CC, Wu SI. The associates of anxiety among lung cancer patients: Dehydroepiandrosterone (DHEA) as a potential biomarker. BMC Cancer 2024; 24:476. [PMID: 38622547 PMCID: PMC11021003 DOI: 10.1186/s12885-024-12195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/27/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE Anxiety is a prevalent comorbidity in lung cancer (LC) patients associated with a decline in quality of life. Dehydroepiandrosterone (DHEA), a neuroactive steroid, levels rise in response to stress. Prior research on the association between DHEA and anxiety has yielded contradictory results and no study has investigated this association in LC patients. METHODS A total of 213 patients with LC were recruited from a general hospital. Data on demographic and cancer-related variables were collected. Using the Chinese version of the Hospital Anxiety and Depression Scale (HADS), the degree of anxiety was determined. Cortisol, DHEA, and Dehydroepiandrosterone sulfate (DHEA-S) levels in saliva were measured. Adjusting for confounding variables, a multivariate regression analysis was conducted. RESULTS 147 men and 66 women comprised our group with an average age of 63.75 years. After accounting for demographic and treatment-related factors, anxiety levels were significantly correlated with, post-traumatic stress symptoms (PTSSs) (β = 0.332, p < 0.001) and fatigue (β = 0.247, p = 0.02). Association between anxiety and three factors, including DHEA, PTSSs, and fatigue, was observed in patients with advanced cancer stages (III and IV) (DHEA β = 0.319, p = 0.004; PTSS β = 0.396, p = 0.001; fatigue β = 0.289, p = 0.027) and those undergoing chemotherapy (DHEA β = 0.346, p = 0.001; PTSS β = 0.407, p = 0.001; fatigue β = 0.326, p = 0.011). CONCLUSIONS The association between anxiety and DHEA remained positive in advanced cancer stages and chemotherapy patients. Further study is necessary to determine whether DHEA is a potential biomarker of anxiety in LC patients.
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Affiliation(s)
- Jia-Rong Wu
- Department of Psychiatry, Chang Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
| | - Vincent Chin-Hung Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
- School of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, Taiwan
| | - Yu-Hung Fang
- Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
| | - Ching-Chuan Hsieh
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan Tao-Yuan, Taiwan
- Department of Surgery, Chang-Gung Memorial Hospital, 6, Sec. West Chia-Pu Road, 613, Pu-Zi City, Chiayi County, Taiwan
| | - Shu-I Wu
- Department of Medicine, Mackay Medical College, No.46, Sec.3, Zhongzheng Rd., Sanzhi Dist, 25245, New Taipei City, Taiwan.
- Department of Psychiatry, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Zhongshan Dist., 104, Taipei City, Taiwan.
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8
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Zhang X, Perry RJ. Metabolic underpinnings of cancer-related fatigue. Am J Physiol Endocrinol Metab 2024; 326:E290-E307. [PMID: 38294698 DOI: 10.1152/ajpendo.00378.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Abstract
Cancer-related fatigue (CRF) is one of the most prevalent and detrimental complications of cancer. Emerging evidence suggests that obesity and insulin resistance are associated with CRF occurrence and severity in cancer patients and survivors. In this narrative review, we analyzed recent studies including both preclinical and clinical research on the relationship between obesity and/or insulin resistance and CRF. We also describe potential mechanisms for these relationships, though with the caveat that because the mechanisms underlying CRF are incompletely understood, the mechanisms mediating the association between obesity/insulin resistance and CRF are similarly incompletely delineated. The data suggest that, in addition to their effects to worsen CRF by directly promoting tumor growth and metastasis, obesity and insulin resistance may also contribute to CRF by inducing chronic inflammation, neuroendocrinological disturbance, and metabolic alterations. Furthermore, studies suggest that patients with obesity and insulin resistance experience more cancer-induced pain and are at more risk of emotional and behavioral disruptions correlated with CRF. However, other studies implied a potentially paradoxical impact of obesity and insulin resistance to reduce CRF symptoms. Despite the need for further investigation utilizing interventions to directly elucidate the mechanisms of cancer-related fatigue, current evidence demonstrates a correlation between obesity and/or insulin resistance and CRF, and suggests potential therapeutics for CRF by targeting obesity and/or obesity-related mediators.
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Affiliation(s)
- Xinyi Zhang
- Departments of Cellular & Molecular Physiology and Medicine (Endocrinology), Yale University School of Medicine, New Haven, Connecticut, United States
| | - Rachel J Perry
- Departments of Cellular & Molecular Physiology and Medicine (Endocrinology), Yale University School of Medicine, New Haven, Connecticut, United States
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Matsunaga M, He Y, Khine MT, Shi X, Okegawa R, Li Y, Yatsuya H, Ota A. Prevalence, severity, and risk factors of cancer-related fatigue among working cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 2024:10.1007/s11764-024-01557-8. [PMID: 38418754 DOI: 10.1007/s11764-024-01557-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE The aim of this study is to evaluate the prevalence, severity, and risk factors of cancer-related fatigue among currently working cancer survivors. METHODS We searched the PubMed, Embase, Scopus, CINAHL, Cochrane Library, and ICHUSHI databases. The risk of bias was evaluated independently using the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS). A meta-analysis was conducted to determine the prevalence, severity, and related factors associated with cancer-related fatigue among currently working cancer survivors. RESULTS Our meta-analysis included 18 studies and revealed that 42.2% of currently working cancer survivors experience cancer-related fatigue. The fatigue severity in this group was significantly higher than that in workers without cancer (absolute standardized mean difference (SMD) = 0.67), but lower than that in cancer survivors who had previously worked and were not currently working (absolute SMD = 0.72). Distress was identified as a potential risk factor for cancer-related fatigue in working cancer survivors (partial correlation coefficient = 0.38). CONCLUSIONS The high prevalence of cancer-related fatigue among employed cancer survivors underscores the need for targeted workplace interventions and fatigue management strategies. While the severity of fatigue is less than that seen in non-working survivors, the comparison with the general working population highlights a significant health disparity. The association between distress and fatigue suggests the necessity for a holistic approach to fatigue management that considers both physical and mental factors in working cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Our findings highlight the critical need for healthcare professionals and employers to monitor fatigue levels among working cancer survivors and offer appropriate support.
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Affiliation(s)
- Masaaki Matsunaga
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan.
| | - Yupeng He
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan
| | - May Thet Khine
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan
| | - Xuliang Shi
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan
| | - Ryusei Okegawa
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan
| | - Yuanying Li
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Nagoya, 466-8550, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Nagoya, 466-8550, Japan
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, 470-1192, Japan
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Ballesteros O, Mark S, Block A, Mackin L, Paul S, Cooper B, Abbott M, Chang S, Hammer MJ, Levine J, Pozzar R, Snowberg K, Tsai K, Van Blarigan E, Van Loon K, Miaskowski CA. COVID-19 pandemic stress and cancer symptom burden. BMJ Support Palliat Care 2024; 13:e1351-e1362. [PMID: 37541779 DOI: 10.1136/spcare-2023-004319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVES In a sample of patients with cancer (n=1145) who were assessed during the height of the COVID-19 pandemic, latent profile analysis was used to identify subgroups of patients with distinct stress profiles and to evaluate for differences in demographic and clinical characteristics and symptom severity scores among these subgroups. METHODS Patients completed measures of cancer-specific and COVID-19 stress, global stress, social isolation, loneliness, depression, state and trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain. Latent profile analysis was used to identify subgroups of patients with distinct stress profiles. Differences among the subgroups in study measures were evaluated using parametric and non-parametric tests. RESULTS Using clinically meaningful cut-off scores for the stress measures, four distinct stress profiles were identified (ie, none class (51.3%); low stress and moderate loneliness class (24.4%), high stress and moderate loneliness class (14.0%), and very high stress and moderately high loneliness class (high, 10.3%)). Risk factors associated with membership in the high class included: younger age, lower annual household income, lower functional status and higher comorbidity burden. The two worst stress profiles reported clinically meaningful levels of all of the common symptoms associated with cancer and its treatments. CONCLUSION Findings from this study, obtained prior to the availability of COVID-19 vaccines and anti-viral medications, provide important 'benchmark data' to evaluate for changes in stress and symptom burden in patients with cancer in the postvaccine era and in patients with long COVID-19.
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Affiliation(s)
- Olivia Ballesteros
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Sueann Mark
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Astrid Block
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Lynda Mackin
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Steven Paul
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Bruce Cooper
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Maura Abbott
- Department of Nursing, Columbia University Medical Center, New York, New York, USA
| | - Susan Chang
- Department of Medicine, School of Medicine, UCSF, San Francisco, CA, USA
| | - Marilyn J Hammer
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jon Levine
- Department of Medicine, School of Medicine, UCSF, San Francisco, CA, USA
| | - Rachel Pozzar
- Phyllis F. Cantor Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Karin Snowberg
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
| | - Katy Tsai
- Department of Medicine, School of Medicine, UCSF, San Francisco, CA, USA
| | - Erin Van Blarigan
- Department of Epidemiology and Biostatistics, School of Medicine, UCSF, San Francisco, California, USA
| | - Katherine Van Loon
- Department of Medicine, School of Medicine, UCSF, San Francisco, CA, USA
| | - Christine A Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California San Francisco (UCSF), San Francisco, California, USA
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11
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Lin Y, Bailey DE, Xiao C, Hammer M, Paul SM, Cooper BA, Conley YP, Levine JD, Kober KM, Miaskowski C. Distinct Co-occurring Morning and Evening Fatigue Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy. Cancer Nurs 2024; 47:E28-E37. [PMID: 36076314 PMCID: PMC10232668 DOI: 10.1097/ncc.0000000000001148] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with gastrointestinal cancers experience diurnal variations in fatigue severity during chemotherapy that decrease their functional status and quality of life. OBJECTIVES Study purposes were to identify subgroups of patients with distinct co-occurring morning and evening fatigue profiles and evaluate for differences among these subgroups in demographic, clinical, stress, and symptom characteristics. METHODS Patients with gastrointestinal cancers (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. The Lee Fatigue Scale was used to evaluate diurnal variations in fatigue severity. Latent profile analysis was used to identify subgroups of patients with distinct co-occurring morning AND evening fatigue profiles. Differences among the subgroups in demographic, clinical, stress, and symptom characteristics at enrollment were evaluated using parametric and nonparametric analyses. RESULTS Two classes were identified, namely: low morning and moderate evening fatigue (ie, Low-Moderate, 60.0%) and high morning and high evening fatigue (ie, Both High, 40.0%). Compared with the Low-Moderate class, the Both High class was significantly younger, female, unmarried, and unemployed and lacked regular exercise. In addition, they had childcare responsibilities, lower annual income, lower functional status, higher comorbidity burden, and self-reported anemia and depression. Patients in the Both High class reported higher levels of anxiety, depressive symptoms, sleep disturbance, pain, and stress, and lower levels of energy and cognitive function. CONCLUSIONS Findings provide new insights into the risk factors for higher levels of co-occurring morning and evening fatigue in patients with gastrointestinal cancers. IMPLICATIONS FOR PRACTICE Clinicians can use this information to identify high-risk patients and develop personalized symptom management interventions.
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Affiliation(s)
- Yufen Lin
- Author Affiliations: Nell Hodgson Woodruff School of Nursing, Emory University (Drs Lin and Xiao), Atlanta, Georgia; School of Nursing, Duke University (Dr Bailey), Durham, North Carolina; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; School of Nursing, University of California San Francisco (Drs Paul, Cooper, Kober, and Miaskowski); School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania; and School of Medicine, University of California San Francisco (Drs Levine and Miaskowski)
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12
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Alhowail AH, Eggert M, Bloemer J, Pinky PD, Woodie L, Bhattacharya S, Bhattacharya D, Buabeid MA, Smith B, Dhanasekaran M, Piazza G, Reed MN, Escobar M, Arnold RD, Suppiramaniam V. Phenyl-2-aminoethyl selenide ameliorates hippocampal long-term potentiation and cognitive deficits following doxorubicin treatment. PLoS One 2023; 18:e0294280. [PMID: 37948406 PMCID: PMC10637675 DOI: 10.1371/journal.pone.0294280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
Chemotherapy-induced memory loss ("chemobrain") can occur following treatment with the widely used chemotherapeutic agent doxorubicin (DOX). However, the mechanisms through which DOX induces cognitive dysfunction are not clear, and there are no commercially available therapies for its treatment or prevention. Therefore, the aim of this study was to determine the therapeutic potential of phenyl-2-aminoethyl selenide (PAESe), an antioxidant drug previously demonstrated to reduce cardiotoxicity associated with DOX treatment, against DOX-induced chemobrain. Four groups of male athymic NCr nude (nu/nu) mice received five weekly tail-vein injections of saline (Control group), 5 mg/kg of DOX (DOX group), 10 mg/kg PAESe (PAESe group), or 5 mg/kg DOX and 10 mg/kg PAESe (DOX+PAESe group). Spatial memory was evaluated using Y-maze and novel object location tasks, while synaptic plasticity was assessed through the measurement of field excitatory postsynaptic potentials from the Schaffer collateral circuit. Western blot analyses were performed to assess hippocampal protein and phosphorylation levels. In this model, DOX impaired synaptic plasticity and memory, and increased phosphorylation of protein kinase B (Akt) and extracellular-regulated kinase (ERK). Co-administration of PAESe reduced Akt and ERK phosphorylation and ameliorated the synaptic and memory deficits associated with DOX treatment.
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Affiliation(s)
- Ahmad H. Alhowail
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Kingdom of Saudi Arabia
| | - Matthew Eggert
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
| | - Jenna Bloemer
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
| | - Priyanka D. Pinky
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
| | - Lauren Woodie
- Department of Nutrition, Dietetics and Hospitality Management, College of Human Sciences, Auburn University, Auburn, AL, United States of America
| | - Subhrajit Bhattacharya
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
| | - Dwipayan Bhattacharya
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
| | - Manal A. Buabeid
- College of Pharmacy and Health Sciences, Ajman University, Ajman, UAE
| | - Bruce Smith
- Department of Anatomy, Physiology and Pharmacology, College of Veterinary Medicine, Auburn University, Auburn, AL, United States of America
| | - Muralikrishnan Dhanasekaran
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
- Center for Neuroscience Initiative, Auburn University, Auburn, AL, United States of America
| | - Gary Piazza
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
| | - Miranda N. Reed
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
- Center for Neuroscience Initiative, Auburn University, Auburn, AL, United States of America
| | - Martha Escobar
- Department of Psychology, Oakland University, Rochester, MI, United States of America
| | - Robert D. Arnold
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
- Center for Neuroscience Initiative, Auburn University, Auburn, AL, United States of America
| | - Vishnu Suppiramaniam
- Department of Drug Discovery and Development, Auburn University, Auburn, AL, United States of America
- Center for Neuroscience Initiative, Auburn University, Auburn, AL, United States of America
- Department of Molecular and Cellular Biology, College of Science and Mathematics, Kennesaw State University, Kennesaw, Georgia
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13
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Zhang X, Lee WD, Leitner BP, Zhu W, Fosam A, Li Z, Gaspar RC, Halberstam AA, Robles B, Rabinowitz JD, Perry RJ. Dichloroacetate as a novel pharmaceutical treatment for cancer-related fatigue in melanoma. Am J Physiol Endocrinol Metab 2023; 325:E363-E375. [PMID: 37646579 PMCID: PMC10642987 DOI: 10.1152/ajpendo.00105.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/01/2023]
Abstract
Cancer-related fatigue (CRF) is one of the most common complications in patients with multiple cancer types and severely affects patients' quality of life. However, there have only been single symptom-relieving adjuvant therapies but no effective pharmaceutical treatment for the CRF syndrome. Dichloroacetate (DCA), a small molecule inhibitor of pyruvate dehydrogenase kinase, has been tested as a potential therapy to slow tumor growth, based largely on its effects in vitro to halt cell division. We found that although DCA did not affect rates of tumor growth or the efficacy of standard cancer treatment (immunotherapy and chemotherapy) in two murine cancer models, DCA preserved physical function in mice with late-stage tumors by reducing circulating lactate concentrations. In vivo liquid chromatography-mass spectrometry/mass spectrometry studies suggest that DCA treatment may preserve membrane potential, postpone proteolysis, and relieve oxidative stress in muscles of tumor-bearing mice. In all, this study provides evidence for DCA as a novel pharmaceutical treatment to maintain physical function and motivation in murine models of CRF.NEW & NOTEWORTHY We identify a new metabolic target for cancer-related fatigue, dichloroacetate (DCA). They demonstrate that in mice, DCA preserves physical function and protects against the detrimental effects of cancer treatment by reducing cancer-induced increases in circulating lactate. As DCA is already FDA approved for another indication, these results could be rapidly translated to clinical trials for this condition for which no pharmaceutical therapies exist beyond symptom management.
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Affiliation(s)
- Xinyi Zhang
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Won D Lee
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, United States
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, New Jersey, United States
| | - Brooks P Leitner
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Wanling Zhu
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Andin Fosam
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Zongyu Li
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Rafael C Gaspar
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Alexandra A Halberstam
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Briana Robles
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, United States
- University of Florida, Gainesville, Florida, United States
| | - Joshua D Rabinowitz
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, United States
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, New Jersey, United States
- Department of Chemistry, Princeton University, Princeton, New Jersey, United States
- Ludwig Institute for Cancer Research, Princeton, New Jersey, United States
| | - Rachel J Perry
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States
- Department of Cellular & Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, United States
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14
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Chiu JWY, Lee SC, Ho JCM, Park YH, Chao TC, Kim SB, Lim E, Lin CH, Loi S, Low SY, Teo LLS, Yeo W, Dent R. Clinical Guidance on the Monitoring and Management of Trastuzumab Deruxtecan (T-DXd)-Related Adverse Events: Insights from an Asia-Pacific Multidisciplinary Panel. Drug Saf 2023; 46:927-949. [PMID: 37552439 PMCID: PMC10584766 DOI: 10.1007/s40264-023-01328-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 08/09/2023]
Abstract
Trastuzumab deruxtecan (T-DXd)-an antibody-drug conjugate targeting the human epidermal growth factor receptor 2 (HER2)-improved outcomes of patients with HER2-positive and HER2-low metastatic breast cancer. Guidance on monitoring and managing T-DXd-related adverse events (AEs) is an emerging unmet need as translating clinical trial experience into real-world practice may be difficult due to practical and cultural considerations and differences in health care infrastructure. Thus, 13 experts including oncologists, pulmonologists and a radiologist from the Asia-Pacific region gathered to provide recommendations for T-DXd-related AE monitoring and management by using the latest evidence from the DESTINY-Breast trials, our own clinical trial experience and loco-regional health care considerations. While subgroup analysis of Asian (excluding Japanese) versus overall population in the DESTINY-Breast03 uncovered no major differences in the AE profile, we concluded that proactive monitoring and management are essential in maximising the benefits with T-DXd. As interstitial lung disease (ILD)/pneumonitis is a serious AE, patients should undergo regular computed tomography scans, but the frequency may have to account for the median time of ILD/pneumonitis onset and access. Trastuzumab deruxtecan appears to be a highly emetic regimen, and prophylaxis with serotonin receptor antagonists and dexamethasone (with or without neurokinin-1 receptor antagonist) should be considered. Health care professionals should be vigilant for treatable causes of fatigue, and patients should be encouraged to use support groups and practice low-intensity exercises. To increase treatment acceptance, patients should be made aware of alopecia risk prior to starting T-DXd. Detailed monitoring and management recommendations for T-DXd-related AEs are discussed further.
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Affiliation(s)
- Joanne Wing Yan Chiu
- The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region Hong Kong
| | - Soo Chin Lee
- National University Cancer Institute Singapore, National University Health System, Singapore, Singapore
| | - James Chung-man Ho
- The University of Hong Kong, Hong Kong, Hong Kong Special Administrative Region Hong Kong
| | - Yeon Hee Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ta-Chung Chao
- Division of Medical Oncology, Department of Oncology, Faculty of Medicine, Taipei Veterans General Hospital, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Elgene Lim
- Faculty of Medicine and Health, Garvan Institute of Medical Research and St Vincent’s Clinical School, University of New South Wales, Sydney, NSW Australia
| | - Ching-Hung Lin
- Cancer Center Branch, National Taiwan University Hospital, Taipei, Taiwan
| | - Sherene Loi
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, Melbourne, Australia
| | - Su Ying Low
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Winnie Yeo
- The Chinese University of Hong Kong, Sha Tin, Hong Kong Special Administrative Region Hong Kong
| | - Rebecca Dent
- National Cancer Centre Singapore, Singapore, Singapore
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15
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Zhang Y, Cui G, Xiu Y, Zhao M. The Effect of Nutritional Support Based on the Dietary Anti-Inflammatory Index on Cancer-Related Fatigue in Lung Cancer Patients Undergoing Chemotherapy. Cancer Nurs 2023; 46:394-404. [PMID: 37607375 DOI: 10.1097/ncc.0000000000001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer-related fatigue is one of the most common symptoms reported by cancer patients and is considered to be related to inflammation. OBJECTIVE This study aimed to explore the effects of nutritional support based on the dietary anti-inflammatory index on cancer-related fatigue in lung cancer patients undergoing chemotherapy. METHODS This was a randomized controlled trial with 106 lung cancer patients who were divided into either the anti-inflammatory diet group (n = 53) or the usual diet group (n = 53) for 3 months. The primary outcome was cancer-related fatigue. Secondary outcomes included high sensitivity C-reactive protein (hs-CRP) concentrations, nutritional status, and quality of life. Repeated-measures analysis of variance was used to examine the effectiveness of this intervention. RESULTS The anti-inflammatory diet improved fatigue (-1.99 ± 1.78, P < .001), hs-CRP levels (-4.15 [-11.87, -0.58], P < .001), Patient-Generated Subjective Global Assessment (-2.53 ± 3.11, P = .030), and albumin concentrations (2.83 ± 0.59, P < .001) compared with the usual diet after 3 months. Simultaneously, in the repeated-measures analysis of variance, the differences in fatigue ( F = 5.536, P < .001), hs-CRP levels ( F = 6.918, P < .001), and albumin concentrations ( F = 2.727, P = .048) were statistically significant for the group-by-time interaction. CONCLUSION The study provided evidence for the positive effect of nutritional support based on the dietary anti-inflammatory index on cancer-related fatigue, hs-CRP levels, nutritional status, and quality of life in lung cancer patients undergoing chemotherapy. IMPLICATION FOR PRACTICE With an anti-inflammatory diet, nurses can help these patients improve their overall quality of life.
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16
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Chen X, Li J, Chen C, Zhang Y, Zhang S, Zhang Y, Zhou L, Hu X. Effects of exercise interventions on cancer-related fatigue and quality of life among cancer patients: a meta-analysis. BMC Nurs 2023; 22:200. [PMID: 37312185 DOI: 10.1186/s12912-023-01363-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
PURPOSE In this study, exercise interventions were evaluated for their effects on cancer-related fatigue (CRF) and quality of life (QoL) among cancer patients. DESIGN A meta-analysis was performed. METHODS We systematically searched the PubMed/Medline, Web of Science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, and CINAHL databases, and gray literature sources including the Virginia Henderson International Nursing Library and Google Scholar. This study only included randomized controlled trials (RCTs) examining how exercise interventions affect CRF and QoL among cancer patients. Based on the Cochrane Risk-of-Bias Assessment Tool, version 2 (RoB 2) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, the methodological quality of the included studies was evaluated. In addition, standardized mean differences (SMDs) and 95% confidence intervals (CIs) were applied to assess the intervention effect with respect to CRF and QoL. Data analysis was performed using Review Manager (version 5.4). RESULTS There were a total of 1573 participants in the 28 included articles. According to the meta-analysis, CRF (SMD = -0.35, 95% CI: -0.63 to -0.07, p = 0.01) and QoL (SMD = 0.36, 95% CI: 0.20 to 0.53, p < 0.01) were positively affected by exercise interventions. Subgroup analyses revealed considerable improvements in CRF (SMD = -0.54, 95% CI: -1.00 to -0.09, p = 0.02) and QoL (SMD = 0.38, 95% CI: 0.16 to 0.59, p < 0.01) from aerobic exercise. An intervention duration less than 12 weeks had a better effect on CRF (SMD = -0.80, 95% CI: -1.43 to -0.17, p = 0.01) and QoL (SMD = 0.53, 95% CI: 0.21 to 0.85, p < 0.01), and three times per week was the most effective frequency in improving QoL (SMD = 0.69, 95% CI: 0.28 to 1.11, p < 0.01). Exercise intervention was more successful in improving CRF (SMD = -0.66, 95% CI: -1.10 to -0.21, p < 0.01) and QoL (SMD=-0.50, 95% CI: 0.23 to 0.78, p < 0.01) in female cancer patients. Sensitivity analyses showed that the pooled outcomes were reliable and stable. CONCLUSION Exercise interventions are a workable approach to improve CRF and QoL among cancer patients. An aerobic exercise intervention of less than 12 weeks might be most effective in improving CRF and QoL, and three times per week might be the most appropriate frequency. Exercise might have a more positive effect on improving CRF and QoL in female cancer patients. Additionally, a larger number of high-quality RCTs should be conducted to further confirm the efficacy of exercise interventions on CRF and QoL among cancer patients. REGISTRATION NUMBER CRD42022351137.
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Affiliation(s)
- Xiaoli Chen
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, PR China
| | - Juejin Li
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, PR China
| | - Chongcheng Chen
- Department of Nephrology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, PR China
| | - Yalin Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, PR China
| | - Shu Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, PR China
| | - Yun Zhang
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, PR China
| | - Lin Zhou
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, PR China
| | - Xiaolin Hu
- Department of Nursing, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, PR China.
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17
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Burrai F, Sguanci M, Petrucci G, De Marinis MG, Piredda M. Effectiveness of immersive virtual reality on anxiety, fatigue and pain in patients with cancer undergoing chemotherapy: A systematic review and meta-analysis. Eur J Oncol Nurs 2023; 64:102340. [PMID: 37290160 DOI: 10.1016/j.ejon.2023.102340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/11/2023] [Accepted: 04/29/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE This Systematic review and meta-analysis aimed to assess the effectiveness of Virtual Reality on anxiety, fatigue and pain in patients with cancer during chemotherapy and provide evidence for decision-making in clinical practice. METHODS A systematic literature search was performed in the databases PubMed, Web of Science, Scopus, Cumulative Index of Nursing and Allied Health Literature and the Cochrane Library. Risk of Bias was used to assess the quality of individual studies, and Grading of Recommendations Assessment, Development and Evaluation was used to assess confidence for each individual outcome. A random-effects model was used to examine the overall effect. RESULTS Four randomized controlled trials and four crossover studies were included, with an overall sample of 459 patients. Results showed that Virtual Reality compared with standard care had a significant reduction of anxiety only (MD = -6.57, 95% CI: -11.59 to -1.54, p = 0.01) but with considerable heterogeneity (I2 = 92%), while Virtual Reality was not significantly different from integrative interventions. The trials included showed small sample sizes, lack of statistical power, low methodological quality, high heterogeneity, and different Virtual Reality technology types, lengths and frequencies. CONCLUSION The quality of evidence is very low and the strength of recommendation is weak. Further research has large potential for reducing uncertainty about the effects of Virtual Reality in patients with cancer receiving chemotherapy. This study was registered with PROSPERO as CRD42020223375.
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Affiliation(s)
- Francesco Burrai
- Department of Biomedicine and Prevention, PhD School in Nursing Science and Public Health, University of Rome "Tor Vergata", Viale Montpellier, 1, 00133, Rome, Italy.
| | - Marco Sguanci
- Department of Medicine and Surgery, Research Unit Nursing Science, Campus Bio-Medico of Rome University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Giorgia Petrucci
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico of Rome University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Maria Grazia De Marinis
- Department of Medicine and Surgery, Research Unit Nursing Science, Campus Bio-Medico of Rome University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Michela Piredda
- Department of Medicine and Surgery, Research Unit Nursing Science, Campus Bio-Medico of Rome University, Via Alvaro del Portillo, 21, 00128, Rome, Italy
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18
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Akingbesote ND, Owusu D, Liu R, Cartmel B, Ferrucci LM, Zupa M, Lustberg MB, Sanft T, Blenman KRM, Irwin ML, Perry RJ. A review of the impact of energy balance on triple-negative breast cancer. J Natl Cancer Inst Monogr 2023; 2023:104-124. [PMID: 37139977 DOI: 10.1093/jncimonographs/lgad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 05/05/2023] Open
Abstract
Cancer cells cannot proliferate without sufficient energy to generate biomass for rapid cell division, as well as to fuel their functions at baseline. For this reason, many recent observational and interventional studies have focused on increasing energy expenditure and/or reducing energy intake during and after cancer treatment. The impact of variance in diet composition and in exercise on cancer outcomes has been detailed extensively elsewhere and is not the primary focus of this review. Instead, in this translational, narrative review we examine studies of how energy balance impacts anticancer immune activation and outcomes in triple-negative breast cancer (TNBC). We discuss preclinical, clinical observational, and the few clinical interventional studies on energy balance in TNBC. We advocate for the implementation of clinical studies to examine how optimizing energy balance-through changes in diet and/or exercise-may optimize the response to immunotherapy in people with TNBC. It is our conviction that by taking a holistic approach that includes energy balance as a key factor to be considered during and after treatment, cancer care may be optimized, and the detrimental effects of cancer treatment and recovery on overall health may be minimized.
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Affiliation(s)
- Ngozi D Akingbesote
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
| | - Dennis Owusu
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
- Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti Region, Ghana
| | - Ryan Liu
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
- Cedar Park High School, Cedar Park, TX, USA
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Leah M Ferrucci
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | | | - Maryam B Lustberg
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Tara Sanft
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Kim R M Blenman
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
- Department of Computer Science, Yale University, New Haven, CT, USA
| | - Melinda L Irwin
- Yale School of Public Health, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
| | - Rachel J Perry
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Cellular & Molecular Physiology, Yale University, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
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Almeida SS, Oliveira MA, Medeiros R, Guerra MP, Pariante CM, Fernandes L. Emotional, inflammatory, and genetic factors of resilience and vulnerability to depression in patients with premenopausal breast cancer: A longitudinal study protocol. PLoS One 2023; 18:e0279344. [PMID: 36787313 PMCID: PMC9928105 DOI: 10.1371/journal.pone.0279344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 12/06/2022] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Psychosocial stress and depressive disorder have been associated with cancer as putative contributors to worse prognosis. On the other hand, cancer diagnosis is a recognised life event that can contribute to distress and depressive states. Humoral and cellular inflammation can promote depressive disorder by means of decreased monoamine synthesis, glutamate neurotoxicity, neurogenesis and neuroplasticity, dysregulated hypothalamic-pituitary-adrenal axis, and glucocorticoid resistance. This protocol objectives are to observe the interactions between psychosocial variables and biochemical and immunological biomarkers in a longitudinal, prospective design; to identify inflammation-related depression endophenotypes in breast cancer patients and to understand if early diagnosed and treated depression in this population will translate in better inflammation status and better global prognosis. METHODS Prospective observational cohort, composed by 100 consecutive premenopausal patients, diagnosed with non-distant metastatic breast carcinoma and with no history of major psychopathology or other organic illness. The participants will have an in-person assessment in three different moments, along illness treatment and follow-up, with respect to cytometric, immunologic, and psychosocial parameters and will be tested for depression vulnerability and resilience inflammation-related functional genetic polymorphisms. Additionally, at years 5 and 10 post enrollment, patients`medical records will be assessed. As a control cohort, all patients excluded due to psychiatric history or past psychiatric treatments will have their clinical records assessed at years 5 and 10 after admission. All the data will be managed with the SPSS® software. DISCUSSION AND CONCLUSION This study is an original longitudinal cohort of breast cancer premenopausal patients, with a comprehensive approach to psychosocial, clinical, inflammatory, and genetic variables. It expects to provide evidence regarding the links between genetic, cytometric, immunologic, and psychosocial factors, their potential contribution to the pathophysiology of depressive disorder, breast cancer course, progression, and prognosis. It may further contribute with data to better efficacy of the psycho-oncological interventions. TRIAL REGISTRATION National Commission of Data Protection (CNPD) 13413/2017; Ethics Committee of IPOP project code CI-IPOP81/2017.
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Affiliation(s)
- Susana S. Almeida
- Psychiatry Service, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- Psychiatry and Psychology Service, CUF Porto Hospital, Porto, Portugal
| | - Magda A. Oliveira
- Psychiatry and Psychology Service, CUF Porto Hospital, Porto, Portugal
- Psychology Service, Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Rui Medeiros
- Molecular Oncology and Viral Pathology Group, Research Center of IPO Porto (CI-IPOP)/RISE@CI-IPOP (Health Research Network), Portuguese Oncology Institute of Porto (IPO Porto) /Porto Comprehensive Cancer Center (Porto.CCC), Research Center-LAB2, Porto, Portugal
- ICBAS, Abel Salazar Institute for the Biomedical Sciences, University of Porto, Porto, Portugal
- Biomedical Research Center (CEBIMED), Faculty of Health Sciences, Fernando Pessoa University (UFP), Porto, Portugal
- Research Department, LPCC- Portuguese League Against Cancer (NRNorte), Porto, Portugal
| | - Marina P. Guerra
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology at University of Porto (CPUP), Porto, Portugal
| | - Carmine M. Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College of London, London, United Kingdom
| | - Lia Fernandes
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- Psychiatry Service, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
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The antioxidant potential, phenolic compounds, cytotoxic activity and mineral element analysis of Gentiana septemfida Pallas and its antiproliferative effect on HT-29 cell line. Eur J Integr Med 2023. [DOI: 10.1016/j.eujim.2023.102240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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21
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Animaw L, Woldegiorgis Abate T, Endeshaw D, Tsegaye D. Fatigue and associated factors among adult cancer patients receiving cancer treatment at oncology unit in Amhara region, Ethiopia. PLoS One 2023; 18:e0279628. [PMID: 36607977 PMCID: PMC9821493 DOI: 10.1371/journal.pone.0279628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Fatigue is one of the most commonly and frequently reported symptoms by cancer patients. The cause of fatigue is multifactorial in origin, and its impact varies in range from affecting patients' daily social life, and physical, mental, economic, and social well-being to becoming a threat to their quality of life. Therefore every cancer patient needs to be screened for fatigue and considered as one of the vital signs. OBJECTIVE To assess the prevalence of fatigue and associated factors among adult cancer patients, receiving cancer treatment at the oncology unit in Amhara region, Ethiopia, 2022. METHOD Institutional-based, cross-sectional study was conducted among adult cancer patients receiving cancer treatment from May 9th-June 8th, 2022. A stratified random sampling technique was used to select study participants. Data were entered into Epi data version 4.6 and then exported to the SPSS statistical package version 23 for further analysis. Both bivariable and multivariable logistic regression analyses were carried out. P-values <0.05 in multivariable logistic regression were considered statistically significant. RESULTS The prevalence of cancer-related fatigue was 77.3% at 95% CI (73.1-81.1) with nonresponse rate of 1.97% (9). Poor social support (AOR = 3.62; 95% CI: 1.53-8.60), anxiety (AOR = 3.13; 95% CI: 1.54-6.36), physical inactivity (AOR = 3.67; 95% CI: 1.74-7.54), underweight (AOR = 2.03; 95% CI: 1.05-3.90), anemia (AOR = 2.01; 95% CI: 1.04-3.90), surgery as a treatment modality (AOR = 0.21; 95% CI: 0.06-0.78), combination therapy (AOR = 3.56; 95% CI: 1.68-7.54), treatment less than 3 cycle (AOR = 4.43; 95% CI: 1.53-12.80), and treatment 3-5 cycle (AOR = 3.55; 95% CI: 1.38-9.09) were significantly associated factors with cancer related fatigue. CONCLUSION Psychosocial assessment and intervention, nutritional support, early intervention of anemia, and promoting exercise are the key elements to minimizing fatigue among cancer patients.
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Affiliation(s)
- Lingerew Animaw
- Adult Health Nursing at Feres Bet primary hospital, Amhara, Ethiopia
| | - Teshager Woldegiorgis Abate
- Department of Adult Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Destaw Endeshaw
- Department of Adult Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dejen Tsegaye
- Department of Nursing, Debre Markos University, College of Health Sciences, Debre Markos, Ethiopia
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Stacker T, Kober KM, Dunn L, Viele C, Paul SM, Hammer M, Conley YP, Levine JD, Miaskowski C. Associations Between Demographic, Clinical, and Symptom Characteristics and Stress in Oncology Patients Receiving Chemotherapy. Cancer Nurs 2023; 46:E62-E69. [PMID: 35671412 PMCID: PMC9437148 DOI: 10.1097/ncc.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients undergoing cancer treatment experience global stress and cancer-specific stress. Both types of stress are associated with a higher symptom burden. OBJECTIVE In this cross-sectional study, we used a comprehensive set of demographic, clinical, and symptom characteristics to evaluate their relative contribution to the severity of global and cancer-specific stress. METHODS Patients (N = 941) completed study questionnaires before their second or third cycle of chemotherapy. RESULTS Consistent with our a priori hypothesis, we found both common and distinct characteristics associated with higher levels of global stress and cancer-specific stress. A significant proportion of our patients had scores on the Impact of Event Scale-Revised suggestive of subsyndromal (29.4%) or probable (13.9%) posttraumatic stress disorder. Four of the 5 stepwise linear regression analyses for the various stress scales explained between 41.6% and 54.5% of the total variance. Compared with various demographic and clinical characteristics, many of the common symptoms associated with cancer and its treatments uniquely explained a higher percentage of the variance in the various stress scales. Symptoms of depression made the largest unique contribution to the percentage of total explained variance across all 5 scales. CONCLUSION Clinicians need to assess for global stress, cancer-specific stress, and depression in patients receiving chemotherapy. IMPLICATIONS FOR PRACTICE Patients may benefit from integrative interventions (eg, mindfulness-based stress reduction, cognitive behavioral therapy, acupuncture) that simultaneously address stress and symptoms commonly associated with cancer and its treatments.
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Affiliation(s)
- Tara Stacker
- Author Affiliations: School of Nursing, University of California (Ms Stacker and Viele, and Drs Kober, Paul, and Miaskowski), San Francisco; School of Medicine, Stanford University (Dr Dunn), California; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania; and School of Medicine, University of California (Drs Levine and Miaskowski), San Francisco
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Yennurajalingam S, Lu Z, Rozman De Moraes A, Tull NN, Kubiak MJ, Geng Y, Andersen CR, Bruera E. Meta-Analysis of Pharmacological, Nutraceutical and Phytopharmaceutical Interventions for the Treatment of Cancer Related Fatigue. Cancers (Basel) 2022; 15:cancers15010091. [PMID: 36612088 PMCID: PMC9817820 DOI: 10.3390/cancers15010091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Purpose: In this study we aimed to estimate the effectiveness of pharmacological, nutraceutical, and phytopharmaceutical treatments on CRF. Methods: Ovid MEDLINE, Ovid Embase, Ovid Psych info, CINHAHL and Cochrane Library databases were searched up to 30 September 2021. Randomized controlled trials of pharmacological, nutraceutical and phytopharmaceutical interventions for treatment of CRF for at least one week duration and have used valid tool to assess severity of CRF as a primary or secondary outcome were considered. Results: 32 eligible studies (4896 patients) were reviewed. For the overall meta-analysis, the random effect models yielded the treatment effect (95% CI) of −0.29 (−0.48,−0.09), p < 0.001. The meta-analysis did not show significant reduction of CRF with treatment with ginseng (n = 6), guarana (n = 3), megestrol (n = 2), mistletoe (n = 3), psychostimulants (n = 14), SSRI/antidepressants (n = 2). Corticosteroids (n = 2) showed significant reduction in CRF with treatment effects of 0.94 (−1.21, −0.67), p <0.0001, respectively. Conclusions: In this study, overall meta-analysis of all studies demonstrates significant reduction of CRF using Pharmacological, Nutraceutical and Phytopharmaceutical interventions with a pooled standardized treatment effect of −0.29. Metanalysis of Corticosteroids studies showed significant reduction in CRF. Further studies are needed.
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Affiliation(s)
- Sriram Yennurajalingam
- Department of Palliative Care Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence: ; Tel.: +1-(713)-792-3930; Fax: +1-(713)-792-6092
| | - Zhanni Lu
- Department of Palliative Care Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Aline Rozman De Moraes
- Department of Palliative Care Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nhu Nhu Tull
- Department of Palliative Care Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Michal J. Kubiak
- Department of Palliative Care Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Yimin Geng
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Clark R. Andersen
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eduardo Bruera
- Department of Palliative Care Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Álvarez-Salvago F, Jiménez-García JD, Martínez-Amat A, Hita-Contreras F, Aibar-Almazán A. Time course and predictors of persistent cancer-related fatigue in long-term breast cancer survivors: a prospective observational study. Support Care Cancer 2022; 31:35. [PMID: 36517728 DOI: 10.1007/s00520-022-07516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The present study investigated whether the level of cancer-related fatigue (CRF) after finishing oncology treatment was related to higher levels of persistent CRF and its relationship with both functional and psychological disturbances. Second, to identify potential predictors of persistent CRF. METHODS Eighty BC survivors were classified into non-fatigued (≤ 3.9) or fatigued (≥ 4), according to their Piper Fatigue Scale total score after finishing oncology treatment. The time course of fatigue and the impact on its domains, pain, mood state, perceived physical fitness, the level of physical activity, and quality of life were assessed at ≥ 5 years. RESULTS Women classified as fatigued after finishing oncology treatment had not only a higher prevalence of persistent CRF (41.2%) at the reassessment, but also greater levels of pain (P = .006 to .048) and mood disturbances (P = .007 to .015), and lower levels of physical fitness condition (P = .002 to .039) and quality of life (P < .001 to < .05) over time. Regression analyses revealed that "sadness/depression," "global health status," "physical activity level," and "type of treatment" were significant predictors of persistent CRF (r2 = .692). CONCLUSION Higher levels of CRF implied greater levels of persistent CRF and a lower functional and psychological profile over time. 69.2% of of persistent CRF was explained.
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Affiliation(s)
- Francisco Álvarez-Salvago
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain.,Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | | | - Antonio Martínez-Amat
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Fidel Hita-Contreras
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
| | - Agustín Aibar-Almazán
- Department of Health Sciences, Faculty of Health Sciences, University of Jaén, Jaén, Spain
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Integrative Approaches to the Treatment of Cancer. Cancers (Basel) 2022; 14:cancers14235933. [PMID: 36497414 PMCID: PMC9740147 DOI: 10.3390/cancers14235933] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
A significant proportion of cancer patients use forms of complementary medicine or therapies. An integrative approach to cancer management combines conventional medicine with evidence-based complementary medicines/therapies and lifestyle interventions, for the treatment and prevention of disease and the optimisation of health. Its basis is a holistic one; to treat the whole person, not just the disease. It makes use of adjunct technologies which may assist the clinician in diagnosis of early carcinogenesis and monitoring of treatment effectiveness. Many factors contribute to the development of cancer including some which are largely modifiable by the patient and which oncologists may be in a position to advise on, such as stress, poor nutrition, lack of physical activity, poor sleep, and Vitamin D deficiency. An integrative approach to addressing these factors may contribute to better overall health of the patient and better outcomes. Evidence-based complementary medicine approaches include the use of supplements, herbal medicine, various practices that reduce stress, and physical therapies. Individualised to the patient, these can also help address the symptoms and signs associated with cancer and its orthodox treatment.
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[Investigation on mindfulness level of patients with oral and maxillofacial malignant tumor after operation and analysis of its influencing factors]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2022; 54. [PMID: 35950399 PMCID: PMC9385532 DOI: 10.19723/j.issn.1671-167x.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the status quo of postoperative mindfulness level in patients with oral and maxillofacial malignant tumors, to analyze its influencing factors, and to provide targeted support for the patients, in order to provide evidence for clinical support. METHODS A total of 452 patients with oral and maxillofacial malignant tumor who were admitted to the Peking University School of Stomatology from January 2021 to June 2021 were followed up by convenience sampling method, the general information questionnaire, the Five Facet Mindfulness Questionnaire, the 10-item perceived stress scale, and the self-esteem scale were used. The t test and analysis of variance were used to compare the scores of mindfulness of the patients with different demographic characteristics after oral and maxillofacial malignant tumors, and the differences of mindfulness levels between the patients with oral and maxillofacial malignant tumors and the normal population were compared by the Z test, Spearman correlation analysis was used to analyze the correlation between the scores of mindfulness and perceived stress and self-esteem. Multiple linear regression was used to analyze the influencing factors of mindfulness levels. RESULTS A total of 439 valid questionnaires were collected. The average score of postoperative mindfulness of the patients with oral and maxillofacial malignant tumor was 120.28±13.86. The scores of each dimension from high to low were as follows: act with awareness, non-judging, describing, observing, and non-reacting. Compared with the normal population, the patients with oral and maxillofacial malignant tumor showed significant differences in the total scores and scores of various dimensions after surgery. The t test and ANOVA showed that different duration of disease, age, residence, education, marital status, per capita monthly income, occupation, and medical payment methods had influences on postoperative mindfulness level of the patients with oral and maxillofacial malignant tumor (P < 0.10). Spearman correlation analysis showed that the level of mindfulness was negatively correlated with the level of perceived stress, and positively correlated with the level of self-esteem. The duration of illness, marital status, stress perception and self-esteem were included in the regression equation, suggesting that postoperative mindfulness levels of the patients with oral and maxillofacial malignant tumor had an important effect. CONCLUSION Patients with oral and maxillofacial malignant tumors have low postoperative mindfulness, which is related to duration of disease, marital status, and the level of perceived stress. Medical staff should identify this group as soon as possible, provide effective psychological intervention, help to improve the level of mindfulness, and strive to improve the patients'mental health.
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Fatigue among post-hematopoietic stem cell transplant patients in Jordan: prevalence and associated factors. Support Care Cancer 2022; 30:7679-7687. [PMID: 35689677 DOI: 10.1007/s00520-022-07186-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND During hematopoietic stem cell transplant (HSCT), patients underwent various serious prolonged treatments, including conditioning and immunosuppressive drugs, resulting in several symptoms and alterations in the patient's functioning. One of the most commonly reported symptoms is fatigue. AIM To assess fatigue levels and associated factors during the first 100 days post-HSCT among Jordanian patients. METHODS A descriptive cross-sectional design assessed fatigue and associated factors during the first 100 days post-HSCT among Jordanian patients. A convenient sample was used to recruit post-HSCT patients. Data were collected using the demographic survey and the Brief Fatigue Inventory (BFI) scale. RESULTS The findings of this study demonstrated that 40.5% of the participants had severe total fatigue scores, while the mean BFI intensity average score was 5.01 and the mean interference of fatigue with patients' daily life was 5.06. In terms of fatigue interference with daily activities, the highest interference was with the patient's mood and normal work, while the lowest interference was with the walking ability. The analysis revealed a strong positive correlation between the fatigue intensity and its interference with the daily activities (r = .98, p ˂.001). Besides, a significantly strong negative correlation was found between the number of days post-HSCT and fatigue scores (r = - .92, p ˂.001). CONCLUSION Post-transplant, patients experienced increased fatigue intensity, reduced physical activity, interference with the patient's mood, and diminished functional capacity. Patients who have HSCT require a significant nursing care immediately post-transplant.
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Oppegaard K, Shin J, Harris CS, Schimmel A, Paul SM, Cooper BA, Levine JD, Conley YP, Hammer M, Dunn L, Kober KM, Miaskowski C. Higher stress and symptom severity are associated with worse depressive symptom profiles in patients receiving chemotherapy. Eur J Oncol Nurs 2022; 58:102031. [PMID: 35397404 PMCID: PMC10788966 DOI: 10.1016/j.ejon.2021.102031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE In a sample of oncology patients, identify subgroups of patients with distinct depressive symptom profiles and evaluate for differences in demographic and clinical characteristics, levels of stress and resilience, and the severity of common co-occurring symptoms. METHODS Patients (n = 1327) had a diagnosis of breast, gastrointestinal, gynecological, or lung cancer; had received chemotherapy within the preceding four weeks; and were scheduled to receive at least two additional cycles of chemotherapy. Demographic and clinical characteristics, stress, resilience, and co-occurring symptoms were evaluated at enrollment. Depressive symptoms were evaluated using the Center for Epidemiological Studies-Depression (CES-D) scale a total of six times over two cycles of chemotherapy. Latent profile analysis (LPA) was used to identify subgroups of patients (i.e., latent classes) with distinct depressive symptom profiles using the six CES-D scores. RESULTS Based on the findings from the LPA, 47.3% of the patients were classified as "None"; 33.6% as "Subsyndromal"; 13.8% as "Moderate"; and 5.3% as "High". Compared to None class, patients in the Subsyndromal, Moderate, and High classes had a lower functional status, a higher comorbidity burden, and a self-reported diagnosis of depression or back pain. Those patients with higher levels of depressive symptoms reported higher levels of stress, lower levels of resilience, and increased severity of co-occurring symptoms. CONCLUSIONS Inter-individual variability in depressive symptoms was associated with demographic and clinical characteristics, multiple types of stress and levels of resilience, as well as with the increased severity of multiple co-occurring symptoms. The risk factors associated with worse depressive symptom profiles can assist clinicians to identify high risk patients and initiate more timely supportive care interventions.
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Affiliation(s)
- Kate Oppegaard
- School of Nursing, University of California, San Francisco, CA, USA
| | - Joosun Shin
- School of Nursing, University of California, San Francisco, CA, USA
| | - Carolyn S Harris
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Laura Dunn
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA.
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Study Protocol to Evaluate Influences of Stress and Inflammation on Mucositis in Adolescents and Young Adults With Cancer. Nurs Res 2022; 71:404-410. [PMID: 35446269 PMCID: PMC9420760 DOI: 10.1097/nnr.0000000000000599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) cancer diagnoses are rising, and gains in survivorship are falling behind for this age group. Dose-limiting toxicities of therapy, including mucositis, are more frequent in this age group and may be contributing to poorer survivorship. Animal models and observational studies suggest that stress and inflammation may be contributing to the high prevalence of dose-limiting mucositis in this age demographic. The AYA oncology population has been an overlooked and under-researched oncology demographic, leading to poor understanding of why this age group has high side-effect burdens and poorer cancer survival. OBJECTIVES This paper describes a novel, prospective clinical study in AYAs receiving chemotherapy designed to evaluate if stress at the time of chemotherapy administration predicts the development of dose-limiting mucositis and determines if stress-induced inflammatory profiles mediate this relationship. This is the first study to translate these stress and inflammation findings from animal models to a nurse-centered research design in humans. METHODS Persons aged 15-39 years who are receiving chemotherapy with a significant (> 20%) risk of developing mucositis will be recruited for a prospective study. Baseline stress is measured through participant questionnaires, and blood is collected to analyze for inflammatory markers. Participants receive chemotherapy as clinically planned and complete a daily survey of mucositis symptoms for 14 days after chemotherapy. Regression and mediation analysis will determine if stress and inflammatory profiles predict the development of dose-limiting mucositis. RESULTS This model of inquiry through a nursing framework uses a biobehavioral model that considers physiologic and psychologic risk factors for chemotherapy toxicities. This study is also an important translational science study essential in bringing data from laboratory studies to the clinical arena. The study may also be important to implementation science since assessing the ability of critically ill individuals to participate in low-burden clinical studies that may yield essential findings to improve care delivery. DISCUSSION Findings from this work will identify potentially modifiable factors that may be manipulated to minimize chemotherapy toxicities and lead to improved survival. Data from this study will inform larger research endeavors to better understand symptom development in this high-risk oncologic population.
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Yang MS, Quach L, Lee LO, Spiro A, Burr JA. Subjective well-being among male veterans in later life: the enduring effects of early life adversity. Aging Ment Health 2022; 26:107-115. [PMID: 33170037 PMCID: PMC9239431 DOI: 10.1080/13607863.2020.1842999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study investigated the association between childhood and young adult adversities and later-life subjective well-being among older male veterans. We also explored whether early-life parent-child relationships and later-life social engagement served as moderators and mediators, respectively. METHODS Data were from the 2008 to 2012 waves of the Health and Retirement Study for male veterans (N = 2026). Subjective well-being measures included depressive symptoms, self-rated health, and life satisfaction. Linear regression with the Process macro was employed to estimate the relationships. RESULTS Adverse childhood experiences (ACEs) were positively associated with number of depressive symptoms and negatively related to life satisfaction. Combat exposure, a young adulthood adversity experience, was positively associated with depressive symptoms, but not with self-rated health or life satisfaction. Later-life social engagement mediated the relationship between ACEs and subjective well-being indices. Parent-child relationship quality did not moderate the association between the measures of adversity and any measure of subjective well-being. DISCUSSION Childhood adversity and combat exposure were related to worse later life subjective well-being. Also, later-life social engagement mediated the association of two early life adversity measures and subjective well-being. Future research should examine subjective well-being and early life adversity for female veterans and should employ more detailed information about combat exposure.
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Affiliation(s)
- Mai See Yang
- Center on Demography and Economics of Aging, University of Chicago
| | - Lien Quach
- Department of Veterans Affairs, Boston Healthcare System and University of Massachusetts Boston
| | - Lewina O. Lee
- Boston University and Department of Veterans Affairs, Boston Healthcare System
| | - Avron Spiro
- Department of Veterans Affairs, Boston Healthcare System and Boston University
| | - Jeffrey A. Burr
- Department of Gerontology, University of Massachusetts Boston
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Momayyezi M, Fallahzadeh H, Farzaneh F, Momayyezi M. Sleep Quality and Cancer-Related Fatigue in Patients with Cancer. J Caring Sci 2021; 10:145-152. [PMID: 34849358 PMCID: PMC8609120 DOI: 10.34172/jcs.2021.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
Introduction: Sleep problems and fatigue are common symptoms reported by cancer patients. In this study, the researchers used a specialized tool to measure fatigue in cancer patients and its relationship with sleep quality in Yazd, Iran.
Methods: This descriptive correlational study included 149 cancer patients (age range: over 18 years) referred to Shahid Sadoughi Hospital in Yazd, Iran. Data were collected by the Pittsburgh Sleep Quality Index (PSQI) and Cancer-Related Fatigue Questionnaire. A PSQI score of ≥5 indicated a poor sleep. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, IL, USA), Pearson’s correlation, t test, analysis of variance (ANOVA), and linear regression.
Results: The mean (SD) PSQI score of patients was 13 (4.85) out of 21. About 69.3% of patients had a poor sleep quality. While the mean (SD) of sleep duration was 5.57 (0.54) hours, it was 69.44 (46.58) minutes for sleep latency. Also, with increasing the mean of sleep quality, the mean of fatigue significantly increased (P < 0.001, R=0.63).
Conclusion: According to the results, there was a relationship between the sleep quality and fatigue in cancer patients, so that patients with better sleep quality had less fatigue.
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Affiliation(s)
- Mahdieh Momayyezi
- Department of Biostatistics and Epidemiology, Center for Healthcare Data Modeling, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- Department of Biostatistics and Epidemiology, Center for Healthcare Data Modeling, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Farzaneh
- Departement of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Momayyezi
- Shahid Sadoughi Teaching Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Fasting and Exercise in Oncology: Potential Synergism of Combined Interventions. Nutrients 2021; 13:nu13103421. [PMID: 34684421 PMCID: PMC8537603 DOI: 10.3390/nu13103421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/28/2022] Open
Abstract
Nutrition and exercise interventions are strongly recommended for most cancer patients; however, much debate exists about the best prescription. Combining fasting with exercise is relatively untouched within the oncology setting. Separately, fasting has demonstrated reductions in chemotherapy-related side effects and improved treatment tolerability and effectiveness. Emerging evidence suggests fasting may have a protective effect on healthy cells allowing chemotherapy to exclusively target cancer cells. Exercise is commonly recommended and attenuates treatment- and cancer-related adverse changes to body composition, quality of life, and physical function. Given their independent benefits, in combination, fasting and exercise may induce synergistic effects and further improve cancer-related outcomes. In this narrative review, we provide a critical appraisal of the current evidence of fasting and exercise as independent interventions in the cancer population and discuss the potential benefits and mechanisms of combined fasting and exercise on cardiometabolic, body composition, patient-reported outcomes, and cancer-related outcomes. Our findings suggest that within the non-cancer population combined fasting and exercise is a viable strategy to improve health-related outcomes, however, its safety and efficacy in the oncology setting remain unknown. Therefore, we also provide a discussion on potential safety issues and considerations for future research in the growing cancer population.
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The Effect of Acupressure on Relieving Cancer-Related Fatigue: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cancer Nurs 2021; 44:E578-E588. [PMID: 34380961 DOI: 10.1097/ncc.0000000000000997] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fatigue, a common complaint reported by patients with cancer or in survivorship, has been negatively associated with quality of life, emotional health, and cognitive functions. Acupressure, a traditional Chinese medicine, has been increasingly practiced in clinical and community settings. However, little evidence supports the beneficial effects of acupressure on the reduction of general, physical, and mental fatigue in cancer survivors. OBJECTIVE The aim of this study was to examine the effect of acupressure on fatigue in cancer survivors and the moderators of the effect of acupressure on cancer-related fatigue relief. METHODS Databases, namely, PubMed, Embase, CINAHL, and ProQuest, were searched from their inception to July 17, 2020. No language and publication period restrictions were applied. Only randomized controlled trials that examined the effects of acupressure on cancer-related fatigue were included. A random-effects model was used for data analyses. RESULTS Fourteen articles involving 776 participants with cancers were included. Acupressure considerably alleviated cancer-related general, physical, and mental fatigue (g = -0.87, -0.87, and -0.37) compared with controls. Increasing female percentage of participants significantly reduced the effects of acupressure on fatigue (B = -0.01, P < .001). The executor and operation approach as well as treatment period during chemotherapy did not moderate the effects of acupressure on fatigue relief. CONCLUSION Acupressure is effective at alleviating cancer-related fatigue. IMPLICATIONS FOR PRACTICE Health professionals and patients can use acupressure to alleviate fatigue during and after chemotherapy. Nursing personnel could incorporate acupressure into clinical practice as part of a multimodal approach to alleviating fatigue in cancer survivors.
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Madel MB, Elefteriou F. Mechanisms Supporting the Use of Beta-Blockers for the Management of Breast Cancer Bone Metastasis. Cancers (Basel) 2021; 13:cancers13122887. [PMID: 34207620 PMCID: PMC8228198 DOI: 10.3390/cancers13122887] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Bone represents the most common site of metastasis for breast cancer and the establishment and growth of metastatic cancer cells within the skeleton significantly reduces the quality of life of patients and their survival. The interplay between sympathetic nerves and bone cells, and its influence on the process of breast cancer bone metastasis is increasingly being recognized. Several mechanisms, all dependent on β-adrenergic receptor signaling in stromal bone cells, were shown to promote the establishment of disseminated cancer cells into the skeleton. This review provides a summary of these mechanisms in support of the therapeutic potential of β-blockers for the early management of breast cancer metastasis. Abstract The skeleton is heavily innervated by sympathetic nerves and represents a common site for breast cancer metastases, the latter being the main cause of morbidity and mortality in breast cancer patients. Progression and recurrence of breast cancer, as well as decreased overall survival in breast cancer patients, are associated with chronic stress, a condition known to stimulate sympathetic nerve outflow. Preclinical studies have demonstrated that sympathetic stimulation of β-adrenergic receptors in osteoblasts increases bone vascular density, adhesion of metastatic cancer cells to blood vessels, and their colonization of the bone microenvironment, whereas β-blockade prevented these events in mice with high endogenous sympathetic activity. These findings in preclinical models, along with clinical data from breast cancer patients receiving β-blockers, support the pathophysiological role of excess sympathetic nervous system activity in the formation of bone metastases, and the potential of commonly used, safe, and low-cost β-blockers as adjuvant therapy to improve the prognosis of bone metastases.
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Affiliation(s)
| | - Florent Elefteriou
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX 77030, USA;
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence:
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Tamura S. Factors Related to Resilience, Anxiety/Depression, and Quality of Life in Patients with Colorectal Cancer Undergoing Chemotherapy in Japan. Asia Pac J Oncol Nurs 2021; 8:393-402. [PMID: 34159232 PMCID: PMC8186384 DOI: 10.4103/apjon.apjon-2099] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/06/2021] [Indexed: 12/22/2022] Open
Abstract
Objective: This study clarifies the relationship between resilience and anxiety and depression, quality of life (QOL), and other related factors that influence colorectal cancer patients undergoing chemotherapy. Methods: This cross-sectional study focused on outpatients with colorectal cancer undergoing chemotherapy. A questionnaire including the Connor-Davidson Resilience Scale, Hospital Anxiety and Depression Scale, the MOS 12-item Short-Form Health Survey, and items based on a literature review was administered between August 2019 and August 2020. SPSS version 26 was used for data analysis. Correlation analysis and t-test were applied. In addition, Amos version 26 was used and structural equation modeling was applied to create a causal model. Results: A total of 121 participants (94.5%) were included in the study. The goodness of fit (GFI) of the causal model was GFI = 0.94, adjusted GFI = 0.906, comparative fit index = 0.997, and root mean square error of approximation = 0.011. Resilience had a negative effect on anxiety and depression and a positive effect on QOL. Depression had a negative effect on QOL. Conclusions: The results of this study indicate that resilience is a predictor of anxiety, depression, and QOL in colorectal cancer patients undergoing chemotherapy. Therefore, I believe that it is important to enhance resilience in order to maintain and improve patients’ mental health and QOL. In addition, since resilience was affected by cancer metastasis and the presence of metastasis was a predictor of resilience, it is a challenge to explore interventions to enhance resilience, especially in patients with metastasis.
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Affiliation(s)
- Saori Tamura
- Graduate School of Nursing, Osaka Medical College, Takatsuki, Osaka, Japan
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Muthanna FMS, Karuppannan M, Hassan BAR, Mohammed AH. Impact of fatigue on quality of life among breast cancer patients receiving chemotherapy. Osong Public Health Res Perspect 2021; 12:115-125. [PMID: 33980002 PMCID: PMC8102880 DOI: 10.24171/j.phrp.2021.12.2.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/27/2021] [Indexed: 02/07/2023] Open
Abstract
Objectives Fatigue is the most frequently reported symptom experienced by cancer patients and has a profound effect on their quality of life (QOL). The study aimed to determine the impact of fatigue on QOL among breast cancer patients receiving chemotherapy and to identify the risk factors associated with severe fatigue incidence. Methods This was an observational prospective study carried out at multiple centers. In total, 172 breast cancer patients were included. The Functional Assessment of Chronic Illness Therapy-Fatigue Questionnaire was used to measure QOL, while the Brief Fatigue Inventory (BFI) was used to assess the severity of fatigue. Results The total average mean and standard deviation of QOL were 84.58±18.07 and 4.65±1.14 for BFI scores, respectively. A significant association between fatigue and QOL was found in linear and multiple regression analyses. The relationships between fatigue severity and cancer stage, chemotherapy dose delay, dose reduction, chemotherapy regimen, and ethnicity were determined using binary logistic regression analysis. Conclusion The findings of this study are believed to be useful for helping oncologists effectively evaluate, monitor, and treat fatigue related to QOL changes.
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Affiliation(s)
- Fares Mohammed Saeed Muthanna
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, Cawangan Selangor, Kampus Puncak Alam, Selangor, Malaysia
| | - Mahmathi Karuppannan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, Cawangan Selangor, Kampus Puncak Alam, Selangor, Malaysia
| | | | - Ali Haider Mohammed
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Selangor, Malaysia
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McFarland DC, Saracino RM, Miller AH, Breitbart W, Rosenfeld B, Nelson C. Prognostic implications of depression and inflammation in patients with metastatic lung cancer. Future Oncol 2021; 17:183-196. [PMID: 33305608 PMCID: PMC7857340 DOI: 10.2217/fon-2020-0632] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/29/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Lung cancer-related inflammation is associated with depression. Both elevated inflammation and depression are associated with worse survival. However, outcomes of patients with concomitant depression and elevated inflammation are not known. Materials & methods: Patients with metastatic lung cancer (n = 123) were evaluated for depression and inflammation. Kaplan-Meier plots and Cox proportional hazard models provided survival estimations. Results: Estimated survival was 515 days for the cohort and 323 days for patients with depression (hazard ratio: 1.12; 95% CI: 1.05-1.179), 356 days for patients with elevated inflammation (hazard ratio: 2.85, 95% CI: 1.856-4.388), and 307 days with both (χ2 = 12.546; p < 0.001]). Conclusion: Depression and inflammation are independently associated with inferior survival. Survival worsened by inflammation is mediated by depression-a treatable risk factor.
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Affiliation(s)
- Daniel C McFarland
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Rebecca M. Saracino
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Andrew H. Miller
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - William Breitbart
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Barry Rosenfeld
- Department of Psychology, Fordham University, Bronx, NY 10458, USA
| | - Christian Nelson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Jakovljevic K, Kober KM, Block A, Cooper BA, Paul SM, Hammer MJ, Cartwright F, Conley YP, Wright F, Dunn LB, Levine JD, Miaskowski C. Higher Levels of Stress Are Associated With a Significant Symptom Burden in Oncology Outpatients Receiving Chemotherapy. J Pain Symptom Manage 2021; 61:24-31.e4. [PMID: 32721501 PMCID: PMC7770050 DOI: 10.1016/j.jpainsymman.2020.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/27/2022]
Abstract
CONTEXT A cancer diagnosis and associated treatments, as well as the uncertainty of the disease course, are stressful experiences for most patients. However, little information is available on the relationship between stress and symptom burden. OBJECTIVES The study purpose was to evaluate for differences in the severity of fatigue, lack of energy, sleep disturbance, and cognitive function, among three groups of patients with distinct stress profiles. METHODS Patients receiving chemotherapy (n = 957) completed measures of general, cancer-specific, and cumulative life stress and symptom inventories. Latent profile analysis was used to identify subgroups of patients with distinct stress profiles. RESULTS Three distinct subgroups of patients were identified (i.e., stressed [39.3%], normative [54.3%], resilient [5.7%]). For cognitive function, significant differences were found among the latent classes (stressed < normative < resilient). For both sleep disturbance and morning and evening fatigue, compared to the normative and resilient classes, the stressed class reported higher severity scores. Compared to the normative and resilient classes, the stressed class reported low levels of morning energy. Compared to the normative class, the stressed class reported lower levels of evening energy. CONCLUSIONS Consistent with our a priori hypothesis, patients in the stressed class had the highest symptom severity scores for all four symptoms and all these scores were above the clinically meaningful cutoffs for the various instruments.
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Affiliation(s)
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Astrid Block
- School of Nursing, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | | | | | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Stanford, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
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Jang MK, Park C, Lee KS, Lee K, Hwang EK, Joh HJ, Lim KH, Ko YH, Kim DM, Han J, Kim S. Does the Association Between Fatigue and Fatigue Self-management Preference Vary by Breast Cancer Stage? Cancer Nurs 2020; 45:43-51. [PMID: 33259375 DOI: 10.1097/ncc.0000000000000910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is a major issue facing breast cancer survivors (BCS) that can negatively impact their symptoms and quality of life. OBJECTIVES The aims of this study were to examine levels of fatigue, identify preferred types of fatigue self-management, and explore the relationship between fatigue levels and management choices by cancer stage. METHODS This cross-sectional descriptive study included 229 BCS recruited from 5 hospitals in Korea. The study inclusion criteria were limited to BCS between 20 and 69 years old in stages 1, 2, or 3 who were undergoing or had completed active therapy. The Revised Piper Fatigue Scale and a questionnaire developed for fatigue management were used for data collection. RESULTS The stage 2 group experienced more fatigue (mean, 5.31) than the other cancer stage groups, and significant differences in fatigue were found between stages 1 and 2 (P < .001). Fatigue self-management choices showed different correlations with fatigue levels in each stage. Physical activity control was most frequently used in stage 1, whereas exercise was most frequently used in stages 2 and 3. Multivariate regression analysis showed that exercise consistently and effectively decreased all fatigue dimensions. CONCLUSION Stage 2 BCS experienced the greatest level of CRF, and fatigue levels and management choices differed in BCS by cancer stage. IMPLICATIONS FOR PRACTICE Recognizing how CRF and patients' preferences for fatigue self-management may differ by cancer stage can alert clinicians in assessing CRF and tailoring effective fatigue management for BCS.
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Affiliation(s)
- Min Kyeong Jang
- Author Affiliations: Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois at Chicago (Drs Jang and Park); University of Illinois Cancer Center (Dr Jang), Chicago; National Cancer Center (Mss K.S. Lee and D.M. Kim), Ilsan, Korea; Severance Hospital (Ms K. Lee), Seoul, Korea; Seoul National University Hospital (Ms Hwang), Korea; Catholic University Seoul St. Mary's Hospital (Ms Joh), Korea; College of Nursing, Keimyung University (Dr Lim), Daegu, Korea; and College of Nursing, Yonsei University (Ms Ko, and Drs Han and S. Kim), Seoul, Korea
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Miaskowski C, Paul SM, Snowberg K, Abbott M, Borno H, Chang S, Chen LM, Cohen B, Hammer MJ, Kenfield SA, Kober KM, Levine JD, Pozzar R, Rhoads KF, Van Blarigan EL, Van Loon K. Stress and Symptom Burden in Oncology Patients During the COVID-19 Pandemic. J Pain Symptom Manage 2020; 60:e25-e34. [PMID: 32889039 PMCID: PMC7462969 DOI: 10.1016/j.jpainsymman.2020.08.037] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT No information is available on oncology patients' level of stress and symptom burden during the coronavirus disease 2019 (COVID-19) pandemic. OBJECTIVES To evaluate for differences in demographic and clinical characteristics, levels of social isolation and loneliness, and the occurrence and severity of common symptoms between oncology patients with low vs. high levels of COVID-19 and cancer-related stress. In addition, to determine which of these characteristics were associated with membership in the high-stressed group. METHODS Patients were 18 years and older; had a diagnosis of cancer; and were able to complete an online survey. RESULTS Of the 187 patients in this study, 31.6% were categorized in the stressed group (Impact of Event Scale-Revised [score of ≥24]). Stressed group's Impact of Event Scale-Revised score exceeds previous benchmarks in oncology patients and equates with probable post-traumatic stress disorder. In this stressed group, patients reported occurrence rates for depression (71.2%), anxiety (78.0%), sleep disturbance (78.0%), evening fatigue (55.9%), cognitive impairment (91.5%), and pain (75.9%). Symptom severity scores equate with clinically meaningful levels for each symptom. CONCLUSION We identified alarmingly high rates of stress and an extraordinarily high symptom burden among patients with cancer, exceeding those previously benchmarked in this population and on par with noncancer patients with post-traumatic stress disorder. Given that the COVID-19 pandemic will likely impact cancer care for an indefinite period, clinicians must exhibit increased vigilance in their assessments of patients' level of stress and symptom burden. Moreover, an increase in referrals to appropriate supportive care resources must be prioritized for high-risk patients.
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Affiliation(s)
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Karin Snowberg
- School of Nursing, University of California, San Francisco, California, USA
| | - Maura Abbott
- Columbia University Medical Center, New York, New York, USA
| | - Hala Borno
- School of Medicine, University of California, San Francisco, California, USA
| | - Susan Chang
- School of Medicine, University of California, San Francisco, California, USA
| | - Lee M Chen
- School of Medicine, University of California, San Francisco, California, USA
| | - Bevin Cohen
- Mount Sinai Medical Center, New York, New York, USA
| | | | - Stacey A Kenfield
- School of Medicine, University of California, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, California, USA
| | - Rachel Pozzar
- Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kim F Rhoads
- School of Medicine, University of California, San Francisco, California, USA
| | - Erin L Van Blarigan
- School of Medicine, University of California, San Francisco, California, USA
| | - Katherine Van Loon
- School of Medicine, University of California, San Francisco, California, USA
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Chan R, Cooper B, Paul S, Conley Y, Kober K, Koczwara B, Chan A, Tan CJ, Gordon L, Thomy L, Levine J, Miaskowski C. Distinct financial distress profiles in patients with breast cancer prior to and for 12 months following surgery. BMJ Support Palliat Care 2020; 12:347-354. [PMID: 32913003 DOI: 10.1136/bmjspcare-2020-002461] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Study purposes were to identify subgroups of patients with breast cancer with distinct self-reported financial distress (FD) profiles and determine which demographic, clinical and symptom characteristics, as well as quality of life (QOL) outcomes were associated with subgroup membership. METHODS Patients (n=391) who were assessed for changes in FD a total of 10 times from prior to through 12 months after breast cancer surgery. Latent profile analysis was used to identify subgroups of patients with distinct FD profiles. RESULTS Three distinct FD profiles (ie, None (14.6%), Low (52.7%), High (32.7%)) were identified. Compared with None and/or Low subgroups, patients in the High subgroup were more likely to report a lower annual household income and performance status; had a higher body mass index, axillary lymph node dissection and more advanced stage disease; had a longer time from cancer diagnosis to surgery; and had received neoadjuvant or adjuvant chemotherapy. In addition, patients in the High subgroup reported higher fatigue, sleep disturbance, state/trait anxiety, depressive symptom scores, and lower attentional function and QOL scores. CONCLUSION This study provides new insights on risk factors for and evidence of a higher symptom burden associated with FD. Findings from this study provide clinicians with information on how to identify high-risk patients and to recommend appropriate interventions for both symptom management and FD. Additional research on the mechanisms that underlie the relationships among FD and common physical and psychological symptoms may inform future interventions.
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Affiliation(s)
- Raymond Chan
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bruce Cooper
- School of Nursing, UCSF, San Francisco, California, USA
| | - Steven Paul
- School of Nursing, UCSF, San Francisco, California, USA
| | - Yvette Conley
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kord Kober
- School of Nursing, UCSF, San Francisco, California, USA
| | - Bogda Koczwara
- Flinders University, Adelaide, South Australia, Australia
| | - Alexandre Chan
- University of California Irvine, Irvine, California, USA.,Department of Pharmacy, University of California Irvine, Irvine, CA, United States
| | | | - Louisa Gordon
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Lebogang Thomy
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jon Levine
- School of Medicine, UCSF, San Francisco, California, USA
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Zhou YT, Li SS, Ai M, Chen H, Liu YX, Li BY, Zhao Y, Cai WW, Hou B, Ni LL, Xu F, Qiu LY. 1,25(OH)2D3 mitigate cancer-related fatigue in tumor-bearing mice: Integrating network pharmacological analysis. Biomed Pharmacother 2020; 128:110256. [DOI: 10.1016/j.biopha.2020.110256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 12/19/2022] Open
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Prakash A, Sardar M, Shaikh N, Inkollu S, Danish M, Sharon DJ, Goldberg S. The Perspective of a Breast Cancer Patient: A Survey Study Assessing Needs and Expectations. Cureus 2020; 12:e9171. [PMID: 32766015 PMCID: PMC7398723 DOI: 10.7759/cureus.9171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Patient satisfaction is one of the key indicators of health care quality. We aim to identify patient's needs and expectations in a breast cancer clinic to provide patient-centered care and better overall satisfaction. Methods A 17-item survey was administered to 110 patients at a breast cancer clinic. The survey was designed after a thorough literature review and approved by an oncologist and a palliative care physician. Results Self-reported knowledge about the disease was reported adequate by 90.9% of our patients yet only 55.45% of our patients could identify the stage of their cancer. More education was desired by 32.7% of patients including various treatment options (29%), common complications (24.5%), prognosis (26.3%) and risk factors (11.8%). The majority of our patients were having some form of cancer-related emotional stress and physical symptoms. The majority of our patients (57.27%) wanted their oncologist to address social/emotional issues and 25.45% felt the need for more focus on physical symptoms in their subsequent visits. End-of-life (EoL) care discussions were considered an integral component of overall care by 29% of our patients. Components of EoL care discussions that patients stated they could benefit from included prognosis (27.27%), life expectancy (29%), the treatment effect on the quality of life (22.7%), palliative care (9%), hospice (10.9%), advance directives (11.8%), and family involvement in medical decision-making (13.6%). There was a difference noted regarding their EoL care discussion based on the stage of cancer. Patients with early-stage disease wanted their oncologists to decide on the frequency of this discussion (72.7%). Patients with advanced disease wanted EoL care discussion to be done more frequently as initiated by them or their oncologist or if there’s a change in the treatment plan. Conclusions A discrepancy between self-reported and actual knowledge in breast cancer patients emphasizes the need for patient education. Most patients rely on their oncologists for their diagnosis-related emotional and social issues. Surprisingly, more than a quarter of our patients consider EoL care discussions important even though the majority of our patients were healthy and having stage I and II disease.
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Affiliation(s)
- Amulya Prakash
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Muhammad Sardar
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | - Nasreen Shaikh
- Internal Medicine, Monmouth Medical Center, Long Branch, USA
| | | | - Mary Danish
- Oncology, Monmouth Medical Center, Long Branch, USA
| | - David J Sharon
- Oncology, Monmouth Medical Center, Leon Hess Cancer Center, Long Branch, USA
| | - Shira Goldberg
- Hospice and Palliative Care, Monmouth Medical Center, Long Branch, USA
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Al Maqbali M, Gracey J, Dunwoody L, Rankin J, Hacker E, Hughes C. Healthcare professionals knowledge on cancer-related fatigue: A cross-sectional survey in Oman. Nurs Health Sci 2020; 22:732-740. [PMID: 32270899 DOI: 10.1111/nhs.12720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/27/2022]
Abstract
Cancer-related fatigue is a common and distressing cancer symptom that negatively affects quality of life. The main objective of this study was to determine health professionals' knowledge relating to cancer patients' fatigue in Oman and identify current management practices of cancer-related fatigue. A cross-sectional survey design using Qualtrics® software was performed. The survey had five sections and comprised 32 items. A total of 138 healthcare professionals working in Oman participated in the study (response rate 63.9%). Nearly three quarters of the participants were nurses (74.6%, n = 103). The mean level of knowledge of cancer-related fatigue was 16.6/23, with 50% of participants having the expected level of knowledge above 12. The result indicated that professional discipline and work experience each were significantly associated with overall level of knowledge. Participants identified the need for guidelines, assessment tools, and training for the oncology staff to help improve the quality of life of patients with cancer-related fatigue.
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Affiliation(s)
- Mohammed Al Maqbali
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Jackie Gracey
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Lynn Dunwoody
- Psychology Research Institute, Ulster University, Coleraine, UK
| | - Jane Rankin
- Physiotherapy Department, Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
| | | | - Ciara Hughes
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
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Holder TRN, Gruen ME, Roberts DL, Somers T, Bozkurt A. A Systematic Literature Review of Animal-Assisted Interventions in Oncology (Part II): Theoretical Mechanisms and Frameworks. Integr Cancer Ther 2020; 19:1534735420943269. [PMID: 32698731 PMCID: PMC7378713 DOI: 10.1177/1534735420943269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/29/2020] [Accepted: 05/20/2020] [Indexed: 11/16/2022] Open
Abstract
Animal-assisted interventions (AAIs) can improve patients' quality of life as complementary medical treatments. Part I of this 2-paper systematic review focused on the methods and results of cancer-related AAIs; Part II discusses the theories of the field's investigators. Researchers cite animal personality, physical touch, physical movement, distraction, and increased human interaction as sources of observed positive outcomes. These mechanisms then group under theoretical frameworks such as the social support hypothesis or the human-animal bond concept to fully explain AAI in oncology. The cognitive activation theory of stress, the science of unitary human beings, and the self-object hypothesis are additional frameworks mentioned by some researchers. We also discuss concepts of neurobiological transduction connecting mechanisms to AAI benefits. Future researchers should base study design on theories with testable hypotheses and use consistent terminology to report results. This review aids progress toward a unified theoretical framework and toward more holistic cancer treatments.
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Affiliation(s)
- Timothy R. N. Holder
- University of North Carolina, Chapel
Hill, NC, USA
- North Carolina State University,
Raleigh, NC, USA
| | | | | | | | - Alper Bozkurt
- University of North Carolina, Chapel
Hill, NC, USA
- North Carolina State University,
Raleigh, NC, USA
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Arizona IKLT, Sukartini T, Efendi F, Estiadewi PS, Anggraeni NPDA. The Experiences of Cancer-Related Fatigue among Adult Cancer Patients: A Systematic Review. JURNAL NERS 2019. [DOI: 10.20473/jn.v14i3.16973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Cancer-related fatigue (CRF) is one of the symptoms commonly experienced and it is a subjective feeling felt by cancer patients. The aim of this systematic review was to summarize how fatigue has been described from the perspective of adult cancer patients, the impact of fatigue on their quality of life, what the patient reported as contributing factors and potential coping strategies to reduce fatigue.Methods: A systematic review is in line with PRISMA guidelines. Five databases were systematically searched (Scopus, PubMed, Springerlink, ProQuest and Science Direct) from January 2009 to February 2019 for qualitative studies describing the experience of adult cancer patients using a predefined search strategy and any relevant keywords.Results: In total, 13 out of 4692 studies were included. The ages of the included patient cancer ranged from 26 to 84 years. The majority of studies used in-depth interviews and semi-structured interviews to elicit the participant’s experiences of fatigue. Four themes were identified: the perception of cancer-related fatigue, the etiology of cancer fatigue, impact and coping strategies.Conclusion: Fatigue is impactful on quality of life from the perspective of cancer patients. Future research should focus on the prospective exploration of the impact of fatigue on woman's and men's health and identifying approaches to reduce fatigue.
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Longitudinal assessment of the impact of higher body mass index on cancer-related fatigue in patients with breast cancer receiving chemotherapy. Support Care Cancer 2019; 28:1411-1418. [PMID: 31267279 DOI: 10.1007/s00520-019-04953-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/18/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the impact of obesity on cancer-related fatigue (CRF) in patients with breast cancer, through a secondary analysis of a large, longitudinal, nationwide study of breast cancer patients beginning chemotherapy. METHODS All patients (N = 565; aged 53 ± 10.6) with breast cancer completed the multidimensional fatigue symptom inventory and the symptom inventory to measure CRF symptoms at baseline, post-chemotherapy, and 6 months post-chemotherapy. Height and weight at baseline were used to categorize subjects based on body mass index (BMI): obese (≥ 30.0 kg/m2; n = 294), overweight (25.0-29.9 kg/m2; n = 146), and normal weight (18.5-24.9 kg/m2; n = 125). Multivariate regression models evaluated the relationship of obesity level to CRF over time, controlling for age, menopausal status, race, Karnofsky Performance Status, cancer stage, radiation, and exercise status. RESULTS At baseline, the obese had significantly higher CRF symptoms than the normal weight subjects for both the Multidimensional fatigue symptom inventory (MFSI) total (obese = 11.2 vs normal weight = 6.3; p = 0.03) and Symptom Inventory (SI) (obese = 3.5 vs normal weight = 2.9; p = 0.03). Significantly higher SI fatigue scores persisted at post-chemotherapy for the obese (obese = 5.0 vs normal weight = 4.4; p = 0.02). At 6 months post-chemotherapy, the obese patients still had significantly higher SI fatigue scores (obese = 3.5 vs normal weight = 3.0; p = 0.05). CONCLUSION Obese patients suffered greater CRF from pre-chemotherapy through 6 months post-chemotherapy. Recommendations for weight loss or weight maintenance may impact CRF levels in obese breast cancer patients before and after chemotherapy.
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Toh YL, Tan CJ, Yeo AHL, Shwe M, Ho HK, Gan YX, Foo KM, Chu P, Olson K, Chan A. Association of plasma leptin, pro-inflammatory adipokines and cancer-related fatigue in early-stage breast cancer patients: A prospective cohort study. J Cell Mol Med 2019; 23:4281-4289. [PMID: 31016867 PMCID: PMC6533466 DOI: 10.1111/jcmm.14319] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/25/2019] [Indexed: 12/17/2022] Open
Abstract
Cancer‐related fatigue (CRF) is subjective and has wide inter‐individual variability. Given that leptin is commonly associated with fatigue syndrome, its use as a potential biomarker for CRF is being investigated. The primary objective of this study was to evaluate the association between leptin and CRF in early‐stage breast cancer patients receiving chemotherapy. In a prospective cohort study, patients completed assessments at baseline (T1), during chemotherapy (T2) and after chemotherapy (T3). Levels of plasma leptin and adipokines were measured using a Luminex bead‐immunoassay and CRF was measured using the Multi‐Dimensional Fatigue Symptom Inventory‐Short Form (MFSI‐SF). Data were analysed longitudinally using a generalised estimating equation incorporating clinically relevant parameters and pro‐inflammatory adipokines. The analysis included 136 patients (mean age ± SD = 51.5 ± 8.8 years; 69.1% receiving anthracycline‐based chemotherapy). More patients experienced CRF at T3 (23.8%) than at T2 (13.8%) compared to baseline. An increase was observed in the median plasma leptin level at T2, followed by a decrease at T3 (T1: 4.07 ng/mL, T2: 4.95 ng/mL and T3: 3.96 ng/mL). In the multivariate model, the change in leptin levels over time was significantly associated with the total MFSI‐SF score (β = −0.15, P = 0.003) after adjusting for the tumour necrosis factor‐α (TNF‐α) level, anxiety, depression, insomnia, age, menopausal status and type of chemotherapy. This is the first study to report leptin as a biomarker that predicts the onset of CRF over time. Future studies are required to validate the findings.
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Affiliation(s)
- Yi Long Toh
- Department of Pharmacy, National University of Singapore, Singapore
| | - Chia Jie Tan
- Department of Pharmacy, National University of Singapore, Singapore
| | | | - Maung Shwe
- Department of Pharmacy, National University of Singapore, Singapore
| | - Han Kiat Ho
- Department of Pharmacy, National University of Singapore, Singapore
| | - Yan Xiang Gan
- Department of Pharmacy, National Cancer Centre Singapore, Singapore
| | - Koon Mian Foo
- Department of Pharmacy, KK's Women and Children Hospital, Singapore
| | - Pat Chu
- Singapore Cord Blood Bank, Singapore
| | - Karin Olson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Alexandre Chan
- Department of Pharmacy, National University of Singapore, Singapore.,Department of Pharmacy, National Cancer Centre Singapore, Singapore
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Rodrigues C, Karmali A, Machado J. The extracts of Gentiana lutea with potential cytotoxic effects on human carcinoma cell lines: A preliminary study. Eur J Integr Med 2019. [DOI: 10.1016/j.eujim.2019.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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