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Rau KM, Shun SC, Hung SH, Chou HL, Ho CL, Chao TC, Liu CY, Lien CT, Hong MY, Wu CJ, Tsai LY, Jane SW, Hsieh RK. Management of cancer-related fatigue in Taiwan: an evidence-based consensus for screening, assessment and treatment. Jpn J Clin Oncol 2022; 53:46-56. [PMID: 36354095 PMCID: PMC9825724 DOI: 10.1093/jjco/hyac164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/08/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Cancer-related fatigue is one of the most common and persistent issues experienced by cancer patients. Cancer-related fatigue is a distinct form of fatigue that is subjective, long-lasting and unalleviated by rest or sleep. Studies have shown that almost all cancer patients experience severe fatigue that disrupts the quality of life and physical function, but cancer-related fatigue remains under-addressed in clinical care, and only about half of all patients receive treatment. METHODS To increase the awareness of cancer-related fatigue and improve current management, the Taiwan Society of Cancer Palliative Medicine and the Taiwan Oncology Nursing Society convened a consensus committee to develop recommendations for the screening, assessment and treatment of cancer-related fatigue. RESULTS Thirteen consensus recommendations were subsequently developed based on the best available evidence and the clinical experience of committee members. CONCLUSIONS These recommendations are expected to facilitate the standardization of cancer-related fatigue management across Taiwan and may also serve as a reference for other clinicians.
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Affiliation(s)
| | | | - Shih-Hsin Hung
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiu-Ling Chou
- Department of Nursing, Asia Eastern University of Science and Technology, New Taipei City, Taiwan,Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan,School of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Liang Ho
- Division of Hematology and Oncology, Tri-Service General Hospital, Taipei, Taiwan,Division of Oncology, National Defense Medical Center, Taipei, Taiwan
| | - Ta-Chung Chao
- Department of Oncology and Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Yu Liu
- Division of Transfusion Medicine, Department of Medicine and Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan,Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Ting Lien
- Department of Nursing, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ming-Ying Hong
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Jung Wu
- Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan,Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan,Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Li-Yun Tsai
- College of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Sui-Whi Jane
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Ruey-Kuen Hsieh
- For reprints and all correspondence: Ruey-Kuen Hsieh, Department of Hematology and Oncology, MacKay Memorial Hospital, Taipei, Taiwan. No. 92, Sec. 2, Zhongshan N. Rd., Taipei City 10449, Taiwan. E-mail:
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2
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Pedersen L, Lund L, Petersen MA, Sjogren P, Groenvold M. Methylphenidate as Needed for Fatigue in Patients With Advanced Cancer. A Prospective, Double-Blind, and Placebo-Controlled Study. J Pain Symptom Manage 2020; 60:992-1002. [PMID: 32464260 DOI: 10.1016/j.jpainsymman.2020.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 11/12/2022]
Abstract
CONTEXT Cancer-related fatigue is a highly prevalent symptom with a strong negative impact on patients' daily life. OBJECTIVES To evaluate the efficacy of methylphenidate as needed for the management of fatigue in patients with advanced cancer. METHODS A prospective, controlled, double-blind, and paired design, where the patient was her and/or his own control. Patients with advanced cancer with a tiredness score of ≥50 on a 0-100 visual analogue scale (VAS) were included. Patients were given 10 placebo and 10 methylphenidate tablets numbered 1-20 packed in blocks of four with two active and two placebo tablets (randomly arranged). Patients taking minimum three tablets were regarded evaluable. Primary effect parameters were mean differences in VAS for tiredness after two and five hours. With 28 evaluable patients, the study had a power of 0.90 to detect a mean difference of 15 between active and placebo. RESULTS Thirty-eight patients were enrolled to get 28 evaluable patients. Mean tiredness score before taking the tablets was 75 for placebo and 72 for methylphenidate on VAS (0-100). Mean changes (decrease) for methylphenidate after two and five hours were 20 and 17, respectively, and eight and five for placebo. Comparing mean differences, a significant decrease for methylphenidate compared with placebo was observed after two hours (P = 0.004) and five hours (P = 0.001), respectively. CONCLUSION In this controlled and double-blind study in patients with advanced cancer, methylphenidate as needed was significantly more effective than placebo in relieving fatigue after two and five hours.
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Affiliation(s)
- Lise Pedersen
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Line Lund
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Morten A Petersen
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Per Sjogren
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Section of Palliative Medicine, Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Mogens Groenvold
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Cheng TC, Lee YH, Mar CL, Huang WT, Chang YP. The Health Promoting Mindfulness or Qigong Educational Programs for Beneficial Lifestyle Changes of Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:743-750. [PMID: 31001740 DOI: 10.1007/s13187-019-01522-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study used heart rate variability (HRV) to monitor levels of cancer-related fatigue (CRF) and quality of life (QOL) of cancer survivors subjected to program measures at different psychosomatic or functional levels. A longitudinal study was conducted at a cancer center in Taiwan. Fifty-two cancer survivals were randomly assigned to either the mindfulness group (n = 25) or the Qigong group (n = 27). Both groups received a 12-week mindfulness and Qigong programs, respectively. Improvements in CRF, QOL, and HRV after a 12-week program and at the 3-month follow-up point. For the long-term effects in both mindfulness and Qigong groups, CRF showed a significant downward trend (p < 0.05), but a significant upward trend was observed in HRV (p < 0.001). Mindfulness and Qigong exhibited different effectiveness in individuals, indicating that the mental and physical aspects of health are equally essential and should be addressed in a complementary combination. These findings are worthy of being shared with cancer survivors to benefit their physical and mental well-being. We suggest that healthcare professionals incorporate mindfulness and Qigong in cancer survivors' daily life as means to encourage lifestyle changes for improving their health.
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Affiliation(s)
- Tse-Chou Cheng
- Department of Urology, Chi Mei Medical Center, Liouying, 201, Taikang, Taikang Vil., Liouying Dist., Tainan City, 73657, Taiwan
| | - Yi-Hua Lee
- Department of Administration, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
- PhD Program in Management, Da-Yeh University, 168 University Road, Dacun, Changhua, 51591, Taiwan
| | - Chun-Lin Mar
- College of Educational Sciences, Yulin Normal University, 1303 Educational E. Road, Yulin City, Guangxi, 537000, China
| | - Wen-Tsung Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chi Mei Medical Center, Liouying, 201, Taikang, Taikang Vil., Liouying Dist., Tainan City, 73657, Taiwan
| | - Yuan-Ping Chang
- Nursing Department, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan.
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Henson LA, Maddocks M, Evans C, Davidson M, Hicks S, Higginson IJ. Palliative Care and the Management of Common Distressing Symptoms in Advanced Cancer: Pain, Breathlessness, Nausea and Vomiting, and Fatigue. J Clin Oncol 2020; 38:905-914. [PMID: 32023162 PMCID: PMC7082153 DOI: 10.1200/jco.19.00470] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Good symptom management in oncology is associated with improved patient and family quality of life, greater treatment compliance, and may even offer survival advantages. With population growth and aging, the proportion of patients with multiple symptoms—both related and unrelated to their cancer—is anticipated to increase, supporting calls for a more routine and integrated approach to symptom management. This article presents a summary of the literature for the use of symptom assessment tools and reviews the management of four common and distressing symptoms commonly experienced by people with advanced cancer: pain, breathlessness, nausea and vomiting, and fatigue. We also discuss the role of palliative care in supporting a holistic approach to symptom management throughout the cancer trajectory.
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Affiliation(s)
- Lesley A Henson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Catherine Evans
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
| | - Martin Davidson
- King's College Hospital National Health Service Foundation Trust, Denmark Hill, London, United Kingdom
| | - Stephanie Hicks
- King's College Hospital National Health Service Foundation Trust, Denmark Hill, London, United Kingdom
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, United Kingdom
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Lee YH, Lai GM, Lee DC, Tsai Lai LJ, Chang YP. Promoting Physical and Psychological Rehabilitation Activities and Evaluating Potential Links Among Cancer-Related Fatigue, Fear of Recurrence, Quality of Life, and Physiological Indicators in Cancer Survivors. Integr Cancer Ther 2018; 17:1183-1194. [PMID: 30354701 PMCID: PMC6247550 DOI: 10.1177/1534735418805149] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objectives: Cancer-related fatigue and fear of recurrence (FOR) are
the most common symptoms in cancer survivors and severely affect quality of life
(QOL). This study aims to promote and evaluate the effectiveness of physical and
psychological rehabilitation activities for cancer survivors.
Methods: A longitudinal study with an interventional research
design was conducted. A total of 80 participants were randomly assigned to
experimental groups E1 (Qigong exercise [QE]) or E2 (stress management [SM]) or
the control group. The E1 and E2 groups received QE and SM, respectively, as
interventions once a week for 12 weeks, and effects were assessed.
Cancer-related fatigue, FOR, QOL, and heart rate variability (HRV) were
evaluated at baseline (T0), after 12 weeks (T1), and at the 3-month follow-up
(T2). Results: QE and SM effectively strengthened the physical and
psychological functions of cancer survivors at the T1 phase. Although
differences in FOR and QOL were not statistically significant, the scores were
decreased and increased, respectively. Although the effects during the T2 phase
were not as significant as those during T1, the score progress was maintained.
The effects on HRV were significantly different among the E1, E2, and control
groups at T1, which shows that the performance of both experimental groups was
better than that of the control group. Conclusions: Physical and
psychological rehabilitation activities should be practiced periodically and
should be led by professional staff. Long-term educational resources and care
should also be provided. HRV can be used to efficiently monitor the status of
the mind-body balance and is a more suitable index than questionnaires for
physical and psychological function evaluation in cancer survivors.
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Affiliation(s)
- Yi-Hua Lee
- 1 National Health Research Institutes, Zhunan, Miaoli County, Taiwan.,2 Da-Yeh University, Dacun, Changhua, Taiwan
| | - Gi-Ming Lai
- 3 Taipei Municipal Wanfang Hospital, Wenshan District, Taipei City, Taiwan.,4 Taipei Medical University, Taipei, Taiwan
| | - De-Chih Lee
- 2 Da-Yeh University, Dacun, Changhua, Taiwan
| | | | - Yuan-Ping Chang
- 6 Fooyin University, Daliao District, Kaohsiung City, Taiwan
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Abstract
PURPOSE OF REVIEW To review recent evidence on the efficacy and safety of methylphenidate as a symptomatic treatment of patients with cancer-related fatigue (CRF). RECENT FINDINGS Five clinical trials published since 2011 were identified. Two of these concluded that methylphenidate is more efficacious than placebo in providing relief from CRF, but the remaining three showed no difference in favour of methylphenidate. The studies were heterogeneous as per the dosage, scales used for evaluating fatigue and the target group studied. None of the studies detected serious reactions, and only mild and infrequent side-effects of methylphenidate were reported. Three new metanalyses show the slightly superior effect of methylphenidate compared to placebo in CRF. SUMMARY Overall, literature supports the existence of moderate benefit of methylphenidate in CRF, backed up by weak evidence. Future studies should aim at better identifying the profile of patients who would benefit most from this pharmacological intervention.
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Kolak A, Kamińska M, Wysokińska E, Surdyka D, Kieszko D, Pakieła M, Burdan F. The problem of fatigue in patients suffering from neoplastic disease. Contemp Oncol (Pozn) 2017; 21:131-135. [PMID: 28947882 PMCID: PMC5611502 DOI: 10.5114/wo.2017.68621] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 12/20/2016] [Indexed: 12/12/2022] Open
Abstract
Modern therapeutic management of patients with cancer is associated with many adverse side effects, including fatigue defined as weariness, burnout, lassitude, malaise, apathy, impatience, and/or inability to perform daily activities. It occurs frequently before the diagnosis of cancer and may persist for a long time after the end of cancer therapy. It is a common problem that occurs regardless of the type of cancer and applied therapeutic procedure. The appearance of this symptom significantly affects the quality of life of patients and often reduces the effectiveness of implemented treatment. The symptom of fatigue occurs among approximately 80% of patients treated with chemotherapy and/or radiotherapy, as well as among more than 75% of patients with metastatic disease. Causes of fatigue include metabolic and immune system disorders as well as increased level of tumour necrosis factor α (TNF-α). Recent studies also indicate a significant contribution of other cytokines, especially pro-inflammatory ones, i.e. interleukin-1 (IL-1), interleukin-6 (IL-6), soluble tumour necrosis factor receptor type II (sTNF type II) and C-reactive protein (CRP). A patient reporting fatigue should be properly diagnosed and thoroughly interviewed by doctors. Patients are mostly treated non-pharmacologically (by means of physical exercise and psychotherapy) and pharmacologically (by applying methylphenidate and methylprednisolone). What is also extremely important is proper education of the patient and their closest family/friends on the symptoms, which significantly reduces anxiety and stress. On the other hand therapeutic management hinders the subjectivity of feeling and lack of standardised scales to rate symptoms.
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Affiliation(s)
- Agnieszka Kolak
- St. John of Dukla Lublin Region Cancer Centre, Lublin, Poland
| | | | | | - Dariusz Surdyka
- St. John of Dukla Lublin Region Cancer Centre, Lublin, Poland
| | - Dariusz Kieszko
- St. John of Dukla Lublin Region Cancer Centre, Lublin, Poland
| | - Magdalena Pakieła
- Department of Social Nursing, Warsaw Medical University, Warsaw, Poland
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Chang YD, Smith J, Portman D, Kim R, Oberoi-Jassal R, Rajasekhara S, Davis M. Single Institute Experience With Methylphenidate and American Ginseng in Cancer-Related Fatigue. Am J Hosp Palliat Care 2017; 35:144-150. [PMID: 28299946 DOI: 10.1177/1049909117695733] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Single therapy with methylphenidate or American ginseng contributes to the reduction in cancer-related fatigue (CRF) with different pharmacologic mechanisms and is relatively safe. However, the safety and efficacy of treating CRF with methylphenidate and AG combination therapy is unknown. AIM The primary objective was to assess the clinical safety and the change in fatigue with numerical rating scale (NRS) on the Edmonton Symptom Assessment Scale (ESAS) after intervention with methylphenidate and AG combination therapy. METHODS We reviewed the electronic medical records of 857 patients seen in our Palliative Medicine outpatient clinic between February 1, 2015, and December 31, 2015. Fatigue was assessed by NRS on ESAS. Toxicity was reviewed on clinician's documents. RESULTS We identified 28 patients who were prescribed a combination of methylphenidate (10-40 mg/d) and AG (2000 mg/d). Ten patients did not comply with the combination therapy. Three patients had stage 2 adverse effects. Fifteen patients completed prescribed combination therapy per instructions. The mean time interval between pre- and postintervention follow-up was 30.5 days (standard deviation [SD]: 7.78). There was a significant reduction in the fatigue score (mean score 6.93-4.13) from the pre- to postscore records (mean: -2.8; SD: 1.61; P < .0002* [*refers to statistically significant]). Sixty percent of patients reported significant reduction in fatigue (cutoff value: ≥3; reduction in fatigue score from baseline: 80% ≥2, 60% ≥3, and 46.7% ≥4). CONCLUSION In our retrospective medical record review, the combination treatment of methylphenidate and AG had no discernible associated toxicities and showed potential clinical benefit in CRF.
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Affiliation(s)
- Young D Chang
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Joshua Smith
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Diane Portman
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Richard Kim
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Ritika Oberoi-Jassal
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Sahana Rajasekhara
- 1 Supportive Care Medicine, Department of Oncology Science, Moffitt Cancer Center, University of South Florida, Tampa, FL, USA
| | - Mellar Davis
- 2 Palliative Medicine, Geisinger Medical Center, Danville, PA, USA
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Eklund A, du Bois RM. Approaches to the treatment of some of the troublesome manifestations of sarcoidosis. J Intern Med 2014; 275:335-49. [PMID: 24433397 DOI: 10.1111/joim.12198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sarcoidosis can be a major therapeutic challenge given its multiplicity of clinical presentations, variable combination of organ involvement and severity, and unpredictable longitudinal behaviour. Six manifestations of sarcoidosis are especially difficult to manage because of (i) an incomplete knowledge of causation - fatigue and small fibre neuropathy, (ii) the rare occurrence in sarcoidosis - intra-abdominal complications or (iii) the potentially life-threatening consequences in some patients - neurological disease, pulmonary hypertension and hypercalcaemia. In none of these situations have a prospective, double-blind, placebo-controlled trial of any therapy been conducted. Despite this absence of any firm evidence base to support therapeutic recommendations, these six entities can be extremely problematic for the practising clinician. It is for this reason that we have focused in this review on these six disease manifestations and provided a synopsis of each problem together with suggested treatment approaches, based on an analysis of the current literature.
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Affiliation(s)
- A Eklund
- Department of Medicine, Karolinska University Hospital, Karolinska Institutet and Centre for Molecular Medicine, Stockholm, Sweden
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Chan RJ. Do Nursing Interventions Targeting Concurrent Symptoms Hold Promise for Managing Fatigue in Patients With Advanced Cancer? J Clin Oncol 2014; 32:853-4. [DOI: 10.1200/jco.2013.52.4363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Raymond J. Chan
- Royal Brisbane and Women's Hospital, Herston; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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