Cancer-related fatigue: scientific progress has been made in 40 years

Effects of Cognitive Training and Social Support on Cancer-Related Fatigue and Quality of Life in Colorectal Cancer Survivors: A Systematic Review and Meta-Analysis

Background:

Few studies have evaluated the effects of cognitive training and social support on cancer-related fatigue and quality of life. We performed a meta-analysis of randomized controlled trials to examine the efficacy of cognitive training and social support in colorectal cancer patients and survivors.

Methods:

The PubMed, Ovid, EMBASE, Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure databases were searched from database establishment until August 2021 to identify suitable studies according to relevant key words, taking cancer-related fatigue and quality of life as the outcomes. The Jadad scale was used to evaluate the methodological quality of the studies. Stata 15.1 software was used for statistical analyses, and sensitivity analyses were performed.

Results:

Eleven studies (6 published in English and 5 published in Chinese) involving 980 patients and survivors were included in the meta-analysis. All studies had Jadad scores ≥3. Statistically significant effects of cognitive training and social support were detected for cancer-related fatigue within 14 weeks (SMD = −1.13, P < .001) and after 14 weeks (SMD = −0.56, P < .001), overall quality of life within 14 weeks (SMD = 0.73, P < .001) and after 14 weeks (SMD = 0.54, P = .003). However, no statistically significant effects of the combination intervention were detected on long-term QOL (SMD = 0.50, P = .435).

Conclusions:

Distinct cognitive interventions and a combination of cognitive and social support interventions can help to alleviate long-term and short-term CRF and short-term QOL. Further studies are needed to examine the mechanisms of cognitive training and social support for cancer-related fatigue and overall quality of life in patients and survivors with colorectal cancer.

Sleep problems and their interaction with physical activity and fatigue in hematological cancer patients during onset of high dose chemotherapy

PURPOSE

Sleep problems reported by hematological cancer patients are usually linked to higher levels of cancer-related fatigue. Although the awareness of sleep problems in solid cancer patients is rising, there has been less attention to the issue in hematological cancer patients. The present study assesses the differences in sleep by comparing physical activity and fatigue levels among hematological cancer patients during the onset of chemotherapy. Furthermore, it investigates the relationship between sleep, physical activity, and fatigue through mediation analysis.

METHODS

The recruited sample consists of 58 newly diagnosed hematological cancer patients (47.1 ± 15.4 yrs; 51.7% males). Subjects completed questionnaires assessing sleep (PSQI), physical activity (visual analogue scale), fatigue (MFI-20), anxiety, depression (HADS), and quality of life (EORTC QLQ-C30) within two weeks from starting treatment.

RESULTS

The sample reported more sleep problems in comparison to the German population norm. The classification as good (ca 25%) or bad sleepers (ca 75%) showed less frequent physical activity (p = .04), higher fatigue (p = .032), anxiety (p = .003), depression (p = .011) and pain (p = .011) in bad sleepers. The mediation analysis revealed significant indirect effects of sleep on fatigue through physical activity habits.

CONCLUSIONS

This study highlights the combined action of sleep problems and physical activity on fatigue during the onset of induction chemotherapy. These two parameters could represent meaningful intervention targets to improve a patient's status during chemotherapy.

TRIAL REGISTRATION

The study was registered on the WHO trial register (DRKS00007824).

Self-Reported Changes and Perceived Barriers to Healthy Eating and Physical Activity among Global Breast Cancer Survivors: Results from an Exploratory Online Novel Survey

BACKGROUND

Despite being motivated to improve nutrition and physical activity behaviors, cancer survivors are still burdened by suboptimal dietary intake and low levels of physical activity.

OBJECTIVE

The aim of this study was to assess changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, barriers to eating a healthy diet and staying physically active, and sources for seeking nutrition advice reported by breast cancer survivors.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTING

The study included 315 survivors of breast cancer who were recruited through social media and provided completed responses to an online exploratory survey.

MAIN OUTCOME MEASURES

Self-reported changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, perceived barriers to healthy eating and physical activity, and sources of nutrition advice were measured.

STATISTICAL ANALYSIS

Frequency distribution of nutrition and physical activity behaviors and changes, barriers to healthy eating and physical activity, and sources of nutrition advice were estimated.

RESULTS

About 84.4% of the breast cancer survivors reported at least 1 positive behavior for improving nutrition and physical activity after cancer diagnosis or treatment. Fatigue was the top barrier to both making healthy food choices (72.1%) and staying physically active (65.7%), followed by stress (69.5%) and treatment-related changes in eating habits (eg, change in tastes, loss of appetite, and craving unhealthy food) (31.4% to 48.6%) as barriers to healthy eating, and pain or discomfort (53.7%) as barriers to being physically active. Internet search (74.9%) was the primary source for seeking nutrition advice. Fewer than half reported seeking nutrition advice from health care providers.

CONCLUSIONS

Despite making positive changes in nutrition and physical activity behaviors after cancer diagnosis or treatment, breast cancer survivors experience treatment-related barriers to eating a healthy diet and staying physically active. Our results reinforce the need for developing tailored intervention programs and integrating nutrition into oncology care.

PI3K Inhibitors and Adverse Events: Optimizing Patient Care for the Treatment of Advanced Breast Cancer

BACKGROUND

Excessive activation of the PI3K pathway has been associated with malignant transformation and resistance to treatment in various cancer types. Various PI3K inhibitors have been evaluated in phase 3 clinical trials; however, most have been associated with modest clinical improvement and poor tolerability. The safety profile of PI3K inhibitors poses new challenges in treatment monitoring and management of common adverse events (AEs).

OBJECTIVES

The purpose of this article is to provide an overview of AEs associated with PI3K inhibitors, with a focus on alpelisib, as well as guidance on the prevention and management of AEs.

METHODS

The literature and results from phase 3 trials evaluating the efficacy and safety of endocrine therapy plus PI3K inhibitors in patients with advanced breast cancer were reviewed.

FINDINGS

AEs associated with PI3K inhibitors include hyperglycemia, diarrhea, nausea, rash, and decreased appetite. Prevention strategies are recommended to avoid the development or decrease the severity of these AEs. Patient education and multidisciplinary care are necessary for the optimal care of these patients.

The role of neuro-immune interactions in cancer-related fatigue: Biobehavioral risk factors and mechanisms

Fatigue is a common and distressing symptom in both patients with cancer and cancer survivors. There is substantial variation in the severity and persistence of cancer-related fatigue that may be driven by individual differences in host factors, including characteristics that predate the cancer experience as well as responses to cancer and its treatment. This review examines biobehavioral risk factors linked to fatigue and the mechanisms through which they influence fatigue across the cancer continuum, with a focus on neuro-immune processes. Among psychosocial risk factors, childhood adversity is a strong and consistent predictor of cancer-related fatigue; other risk factors include history of depression, catastrophizing, lack of physical activity, and sleep disturbance, with compelling preliminary evidence for loneliness and trait anxiety. Among biologic systems, initial work suggests that alterations in immune, neuroendocrine, and neural processes are associated with fatigue. The identification of key risk factors and underlying mechanisms is critical for the development and deployment of targeted interventions to reduce the burden of fatigue in the growing population of cancer survivors. Given the multidimensional nature of fatigue, interventions that influence multiple systems may be most effective.

Symptoms, Mobility and Function, and Quality of Life in Adults With Acute Leukemia During Initial Hospitalization

OBJECTIVES

To examine longitudinal symptoms, mobility and function, and quality of life (QOL) in adults newly diagnosed with acute leukemia.

SAMPLE & SETTING

55 adults undergoing induction chemotherapy at the University of North Carolina Lineberger Comprehensive Cancer Center and the Duke Cancer Institute.

METHODS & VARIABLES

A prospective, longitudinal study with measures of mobility and function, global physical and mental health, cancer-related fatigue, anxiety, depression, sleep disturbance, pain intensity, and leukemia-specific QOL was conducted. Data were analyzed using descriptive statistics, linear mixed modeling, and one-way analysis of variance.

RESULTS

49 adults with acute leukemia completed assessments during hospitalizations. Global mental health and pain intensity did not change significantly. Global physical health significantly improved. Fatigue, anxiety, depression, and sleep disturbance decreased significantly. QOL increased significantly.

IMPLICATIONS FOR NURSING

The significant decrease in anxiety and fatigue during hospitalization may be attributable to understanding of the disease process, familiarity with the staff, and ability to communicate concerns.

Symptom Distress in Patients With Hepatocellular Carcinoma Toward the End of Life

PURPOSE/OBJECTIVES

To describe the presence, frequency, severity, and distress of symptoms in outpatients with advanced hepatocellular carcinoma toward the end of life, and the variability in psychological and physical symptom distress between and within patients over time. 
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DESIGN

A prospective, longitudinal, descriptive design. 
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SETTING

Outpatient clinics at two healthcare institutions. 
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SAMPLE

18 patients (15 men and 3 women) with hepatocellular carcinoma and a mean age of 63.3 years (range = 54-81 years).
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METHODS

Data were collected monthly for six months. Patients completed the Memorial Symptom Assessment Scale, which reports a total score, and three subscales that provide global distress, psychological distress, and physical distress scores.
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MAIN RESEARCH VARIABLES

Global, psychological, and physical distress.
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FINDINGS

Patients reported lack of energy and pain as the most frequent and distressing symptoms. Problems with sexual interest or activity was the fourth most present symptom after drowsiness. Global Distress Index mean scores had notable variability between and within patients over time. During data collection, six patients died. None were referred to palliative care.
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CONCLUSIONS

Gaining knowledge about symptom distress and prevalent symptoms experienced by patients with advanced hepatocellular carcinoma is critical for designing symptom management strategies that are comprehensive and tailored to patients to optimize their quality of life as they approach death.
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IMPLICATIONS FOR NURSING

Nurses play a vital role in advocating for, initiating, and providing comprehensive holistic care based on individual patient needs by facilitating discussions about apparent and less apparent distressing symptoms, including those related to sexuality.

Self-Management Intervention for Adult Cancer Survivors After Treatment: A Systematic Review and Meta-Analysis

PROBLEM IDENTIFICATION

This study aims to evaluate the effects of self-management interventions (SMIs) for cancer survivors who completed primary treatment. 
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LITERATURE SEARCH

Using PubMed, EMBASE, CINAHL®, PsycINFO®, and Cochrane Central Register of Controlled Trails (CENTRAL), the authors conducted a systematic search of randomized, controlled trials published in English from database conception through June 2016. 
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DATA EVALUATION

The meta-analysis was conducted with Cochrane Review Manager, version 5.3, and R program, version 3.3.1.
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SYNTHESIS

12 studies were systematically reviewed for self-management content, mode of delivery, session composition, and type of self-management skills used. Then, a meta-analysis of nine randomized, controlled trials involving 2,804 participants was conducted comparing SMIs with usual care, attention control, and a waitlist group. Qualitative synthesis showed that (a) the major study population was comprised of breast cancer survivors; (b) SMIs focused on medical/behavioral and emotional management; (c) the most common mode of delivery was web-based; and (d) the most frequently evaluated outcomes were depression, self-efficacy, and health-related quality of life (HRQOL). Quantitative results demonstrated a significant medium effect on HRQOL and a large effect on fatigue of borderline significance. The effects on anxiety, depression, and self-efficacy were not statistically significant. 
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CONCLUSIONS

SMIs had a significant medium effect on HRQOL for cancer survivors post-treatment, but the findings should be interpreted with caution because of substantial heterogeneity. In addition, the small number of studies limits conclusions. 
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IMPLICATIONS FOR NURSING

SMI as a nursing intervention for improving HRQOL of cancer survivors can be recommended, but more research should be undertaken to determine the most effective SMI format in terms of type, mode of delivery, and session composition.

Early Nutrition and Physical Activity Interventions in Childhood Cancer Survivors

PURPOSE OF REVIEW

Childhood cancer survivors experience excessive weight gain early in treatment. Lifestyle interventions need to be initiated early in cancer care to prevent the early onset of obesity and cardiovascular disease (CVD). We reviewed the existing literature on early lifestyle interventions in childhood cancer survivors and consider implications for clinical care.

RECENT FINDINGS

Few lifestyle interventions focus on improving nutrition in childhood cancer survivors. A consistent effect on reducing obesity and CVD risk factors is not evident from the limited number of studies with heterogeneous intervention characteristics, although interventions with a longer duration and follow-up show more promising trends. Future lifestyle interventions should be of a longer duration and include a nutrition component. Interventions with a longer duration and follow-up are needed to assess the timing and sustainability of the intervention effect. Lifestyle interventions introduced early in cancer care are both safe and feasible.

A Systematic Review of Psychometric Properties of Health-Related Quality-of-Life and Symptom Instruments in Adult Acute Leukemia Survivors

BACKGROUND

Acute leukemia represents 4% of cancer cases in the United States annually. There are more than 302 000 people living with acute and chronic leukemia in the United States. Treatment has been shown to have both positive and negative effects on health-related quality of life (HRQOL).

OBJECTIVE

The aims of this study were to examine psychometric properties of symptom and HRQOL instruments and to provide implications for the assessment in adults with acute leukemia relevant to clinical practice and future research.

METHODS

Systematic literature search was conducted from 1990 to 2014 using electronic databases and manual searches. Psychometric studies were considered eligible for inclusion if (1) the psychometric paper was published using at least 1 HRQOL or symptom instrument, and (2) adults with acute leukemia were included in the sample. Studies were excluded if the age groups were not adults, or if the instrument was in a language other than English.

RESULTS

Review identified a total of 7 instruments (1 cancer generic HRQOL, 2 symptom related, 3 HRQOL combined with symptom questions, and 1 disease specific). The most commonly used instrument was the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, followed by the Functional Assessment of Cancer Therapy-Fatigue.

CONCLUSIONS

An acute leukemia diagnosis can have a significant impact on HRQOL. Our recommendations include using both an HRQOL and symptom instrument to capture patient experiences during and after treatment.

IMPLICATIONS FOR PRACTICE

The availability of comprehensive, valid, and reliable HRQOL and symptom instruments to capture the experiences of adults with acute leukemia during and after treatment is limited.

The Effects of Exercise on Patient-Reported Outcomes and Performance-Based Physical Function in Adults With Acute Leukemia Undergoing Induction Therapy: Exercise and Quality of Life in Acute Leukemia (EQUAL)

Introduction. Fatigue is a distressing symptom for adults with acute leukemia, often impeding their ability to exercise. Objectives. 1) Examine effects of a 4-week mixed-modality supervised exercise program (4 times a week, twice a day) on fatigue in adults with acute leukemia undergoing induction chemotherapy. 2) Evaluate effects of exercise program on cognition, anxiety, depression, and sleep disturbance. 3) Evaluate effect of intervention on adherence to exercise. Methods. 17 adults (8 intervention, 9 control), aged 28-69 years, newly diagnosed with acute leukemia were recruited within 4 days of admission for induction treatment. Patient-reported outcomes (PROs) (fatigue, cognition, anxiety, depression, sleep disturbance, mental health, and physical health) and fitness performance-based measures (Timed Up and Go [TUG], Karnofsky Performance Status, and composite strength scoring) were assessed at baseline and at discharge. Changes in PRO and performance-based physical function measures from baseline to time of discharge were compared between groups using Wilcoxon Rank Sum tests. Results. With PROMIS (Patient-Reported Outcomes Measurement Information System) Fatigue, we found a median change in fatigue (−5.95) for the intervention group, which achieved a minimally important difference that is considered clinically relevant. Intervention group reduced their TUG performance by 1.73 seconds, whereas the control group remained fairly stable. A concerning finding was that cognition decreased for both groups during their hospitalization. 80% adherence of visits completed with a mean of 6 sessions attended per week. Conclusions. Our study provides information on the impact of exercise on symptomatology, with focus on fatigue and other psychosocial variables in acute leukemia.

Exercise Promotion in Geriatric Oncology

Evidence of the benefits of exercise for people with cancer from diagnosis through survivorship is growing. However, most cancers occur in older adults and little exercise advice is available for making specific recommendations for older adults with cancer. Individualized exercise prescriptions are safe, feasible, and beneficial for the geriatric oncology population. Oncology providers must be equipped to discuss the short- and long-term benefits of exercise and assist older patients in obtaining appropriate exercise prescriptions. This review provides detailed information about professionals and their roles as it relates to functional assessment, intervention, and evaluation of the geriatric oncology population. This review addresses the importance of functional status assessment and appropriate referrals to other oncology professionals.

Comparison of Methods for Determining Aerobic Exercise Intensity Using Heart Rate in Acute Leukemia Patients Prior to Induction Chemotherapy

INTRODUCTION

Cardiopulmonary exercise testing (CPET), the gold standard of cardiopulmonary evaluation, is used to determine VO2 levels at different aerobic exercise training intensities; however, it may not be feasible to conduct CPET in all clinical settings.

AIMS

To compare the heart rate reserve (HRR) and percent of 220-age methods for prescribing cycle ergometry exercise intensity using heart rate (HR) against the HRs obtained during a CPET in adults undergoing treatment for acute leukemia (AL).

METHODS

In this exploratory study, part of a larger randomized controlled trial, 14 adults with AL completed CPET on a cycle ergometer with indirect calorimetry within 96 hr of admission to a cancer hospital to determine VO2peak and HR corresponding to low (40% VO2peak), moderate (60% VO2peak), and high (75% VO2peak) exercise intensities. Analyses of variance were used to compare estimated HR for each intensity level using the HRR and percent of 220-age methods with HR determined via VO2peak.

RESULTS

HR corresponding to low-intensity exercise differed significantly across all three methods (p ≤ .05). No significant differences were observed between HR estimated via the percent of 220-age method and determined via VO2peak at moderate (100 ± 8 and 113 ± 24 bpm, p = .122) or high intensities (125 ± 10 and 123 ± 25 bpm, p = .994).

CONCLUSION

In adults with AL, HR-based methods for defining aerobic exercise intensities should be used with caution. At low intensity, neither should be used, while at moderate and high intensities, the percent of 220-age equation might serve as an adequate substitute for CPET.

Patient education programs for cancer-related fatigue: A systematic review

OBJECTIVE

To evaluate the effect of patient education programs on cancer-related fatigue (CRF).

METHODS

A search of randomized controlled trials (RCTs) was performed in Pubmed, Cochrane Library, Web of Science, Elsevier, and CINAHL through April 2014. Two reviewers selected trials, conducted critical appraisals, and extracted data. No meta-analysis was performed. Effect sizes (ESs) of CRF reduction and related outcomes were calculated.

RESULTS

Ten trials involving 1534 adults with cancer were identified and the methodological quality was generally fair. The results showed that the included RCTs showed inconsistent effects of patient education programs on CRF reduction. Different effects on CRF-related outcomes were found. No adverse events were reported.

CONCLUSION

Our study has provided limited support for the clinical use of patient education programs to reduce CRF. Yet patient education programs appear to play some positive role in managing CRF. Some elements, such as exercise, sleep hygiene, nutrition and relaxation, are possible beneficial approaches. More rigorous experimental studies are warranted and should be more explicitly characterized, in order to be reproducible and assessed.

PRACTICE IMPLICATIONS

As a safe modality, patient education program can be considered as a potentially useful approach for reducing CRF.