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Yennurajalingam S, Azhar A, Lu Z, Rodriguez AJ, Arechiga AB, Guerra-Sanchez M, Stanton P, Andersen CR, Urbauer DL, Bruera E. Open-Label Placebo for the Treatment of Cancer-Related Fatigue in Patients with Advanced Cancer: A Randomized Controlled Trial. Oncologist 2022; 27:1081-1089. [PMID: 36106759 PMCID: PMC9732231 DOI: 10.1093/oncolo/oyac184] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine the effects of an open-labeled placebo (OLP) compared to a waitlist control (WL) in reducing cancer-related fatigue (CRF) in patients with advanced cancer using Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). MATERIALS AND METHODS In this randomized controlled trial, patients with fatigue ≥4/10 on Edmonton Symptom Assessment Scale (ESAS) were randomized to OLP one tablet twice a day or WL for 7 days. On day 8, patients of both arms received a placebo for 3 weeks. Changes in FACIT-F from baseline to day 8 (primary outcome) and at day 29, were assessed. Secondary outcomes included FACT-G, Multidimensional Fatigue Symptom Inventory-SF, Fatigue cluster (defined as a composite of ESAS fatigue, pain, and depression), Center for epidemiologic studies-depression, Godin leisure-time physical activity questionnaire, and global symptom evaluation. RESULTS A total of 84/90 (93%) patients were evaluable. The mean (SD) FACIT-F change at day 8 was 6.6 (7.6) after OLP, vs. 2.1 (9.4) after WL (P = .016). On days 15 and 29, when all patients received OLP, there was a significant improvement in CRF and no difference between arms. There was also a significant improvement in ESAS fatigue, and fatigue cluster score in the OLP arm on day 8 of the study (0.029, and 0.044, respectively). There were no significant differences in other secondary outcomes and adverse events between groups. CONCLUSIONS Open-labeled placebo was efficacious in reducing CRF and fatigue clusters in fatigued advanced cancer patients at the end of 1 week. The improvement in fatigue was maintained for 4 weeks. Further studies are needed.
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Affiliation(s)
- Sriram Yennurajalingam
- Corresponding author: Sriram Yennurajalingam, MD, MS, FAAHPM, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1414, Houston, TX 77030, USA. Tel: +1 713 792 3938; Fax: +1 713 792-6092;
| | - Ahsan Azhar
- The University of Texas MD Anderson Cancer Center, Department of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, Houston, TX, USA
| | - Zhanni Lu
- The University of Texas MD Anderson Cancer Center, Department of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, Houston, TX, USA
| | - Ashley J Rodriguez
- The University of Texas MD Anderson Cancer Center, Department of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, Houston, TX, USA
| | - Adrienne B Arechiga
- The University of Texas MD Anderson Cancer Center, Department of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, Houston, TX, USA
| | - Maria Guerra-Sanchez
- The University of Texas MD Anderson Cancer Center, Department of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, Houston, TX, USA
| | - Penny Stanton
- The University of Texas MD Anderson Cancer Center, Department of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, Houston, TX, USA
| | - Clark R Andersen
- The University of Texas MD Anderson Cancer Center, Biostatistics, Houston, TX, USA
| | - Diana L Urbauer
- The University of Texas MD Anderson Cancer Center, Biostatistics, Houston, TX, USA
| | - Eduardo Bruera
- The University of Texas MD Anderson Cancer Center, Department of Palliative Care, Rehabilitation Medicine, and Integrative Medicine, Houston, TX, USA
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Han K, Kim M, Kim E, Park Y, Kwon O, Kim A, Park H, Park Y, Cho JH, Kim J, Lee J. Moxibustion for treating cancer-related fatigue: A multicenter, assessor-blinded, randomized controlled clinical trial. Cancer Med 2021; 10:4721-4733. [PMID: 34189864 PMCID: PMC8290232 DOI: 10.1002/cam4.4020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/11/2021] [Accepted: 05/04/2021] [Indexed: 12/17/2022] Open
Abstract
Cancer-related fatigue (CRF) is one of the most common chronic symptoms experienced by cancer patients. As moxibustion is a popular traditional therapy for managing fatigue, it can be an alternative strategy to treat CRF as well. Therefore, we rigorously designed a full-scale, multicenter, assessor-blinded, randomized controlled trial to evaluate the efficacy and safety of moxibustion treatment for CRF. Ninety-six subjects suffering from CRF were recruited and randomly assigned to moxibustion group, sham moxibustion group, or usual care group. Both the moxibustion group and the sham group received moxibustion treatment for 8 weeks and the usual care group did not. Brief fatigue inventory (BFI) score and Functional Assessment of Cancer Therapy-Fatigue score were used to assess CRF at baseline and weeks 5, 9, and 13. Questionnaires for the assessment of cognitive impairment, quality of life, and Cold-Heat and Deficiency-Excess patterns were also evaluated. BFI scores significantly decreased in moxibustion group compared to the usual care group (mean difference of -1.92, p < 0.001 at week 9 and mean difference of -2.36, p < 0.001 at week 13). Although the sham group also showed significant improvement during the treatment period, only the moxibustion group showed improvement after 4 weeks of follow-up period (mean difference of -1.06, p < 0.001). There were no serious adverse events. Our findings confirmed the efficacy and safety of moxibustion for CRF compared to usual care. We also found that moxibustion has a prolonged treatment effect during 4 weeks of follow-up period.
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Affiliation(s)
- Kyungsun Han
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonRepublic of Korea
| | - Mikyung Kim
- Department of Internal Medicine, College of Korean MedicineSangji UniversityWonjuRepublic of Korea
| | - Eun‐Jung Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean MedicineDongguk UniversityGyeongjuRepublic of Korea
| | - Yeon‐Cheol Park
- Department of Acupuncture and Moxibustion MedicineKyung Hee University Hospital at GangdongSeoulRepublic of Korea
| | - Ojin Kwon
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonRepublic of Korea
| | - Ae‐Ran Kim
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonRepublic of Korea
| | - Hyo‐Ju Park
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonRepublic of Korea
| | - Yang‐Chun Park
- Department of Internal Medicine, College of Korean MedicineDaejeon UniversityDaejeonRepublic of Korea
| | - Jung Hyo Cho
- Department of Internal Medicine, College of Korean MedicineDaejeon UniversityDaejeonRepublic of Korea
| | - Joo‐Hee Kim
- Department of Acupuncture and Moxibustion Medicine, College of Korean MedicineSangji UniversityGangwon‐doRepublic of Korea
- Research Institute of Korean MedicineSangji UniversityGangwon‐doRepublic of Korea
| | - Jun‐Hwan Lee
- Clinical Medicine DivisionKorea Institute of Oriental MedicineDaejeonRepublic of Korea
- Korean Medicine Life ScienceUniversity of Science and Technology (UST), Campus of Korea Institute of Oriental MedicineDaejeonRepublic of Korea
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Han Q, Yang L, Huang SY, Yeung JWF, Chen XH, Xue H, Xu LP, Suen LKP. Effectiveness of auricular point therapy for cancer-related fatigue: A systematic review and meta-analysis. J Adv Nurs 2020. [PMID: 32428970 DOI: 10.1111/jan.14375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 11/30/2022]
Abstract
AIMS To systemically review the efficacy and safety of auricular point therapy in patients with cancer-related fatigue. DESIGN A systematic review and meta-analysis of randomized controlled trials. DATA SOURCES Eight electronic databases (PubMed, CENTRAL, Embase, CINAHL, Web of Science, China Biology Medicine, China National Knowledge Infrastructure and WanFang Data Knowledge Service Platform) were explored for randomized controlled trials from their inception to 1 December 2018. REVIEW METHODS The risk of bias assessment tool was adopted in accordance with Cochrane Handbook 5.3.0. All included studies reported the effects on cancer-related fatigue as the primary outcome. Effect size was estimated using relative risk, standardized mean difference or mean difference with a corresponding 95% confidence interval. Review Manager 5.3 was used for meta-analysis. RESULTS Six studies comprising 394 patients were included. The results of meta-analysis showed that auricular point therapy plus standard care produced more positive effects on cancer-related fatigue and quality of life than standard care alone. It could significantly improve the role, emotional, cognitive, and social functions of patients with cancer-related fatigue. CONCLUSIONS Auricular point therapy may be a safe therapy to relieve cancer-related fatigue and enhance the quality of life of patients with cancer. However, the evidence was inconclusive due to limitations on the quantity and quality of included studies. Rigorously designed randomized controlled trials should be conducted to verify the results. IMPACT Auricular point therapy is a simple and safe therapeutic approach that may alleviate cancer-related fatigue of common complications in patients with cancer and it is worth promoting in the community, family, and hospital. Moreover, the research findings can provide suggestions and inspiration for nurses and researchers to implement the proposal, which is conducive to design more rigorous and high-quality randomized controlled trials.
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Affiliation(s)
- Qiong Han
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Liu Yang
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shuang-Yan Huang
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jerry W F Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | | | - Hui Xue
- School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Li-Ping Xu
- The Third Affiliated People's Hospital, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Lorna K P Suen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Kim M, Kim JE, Lee HY, Kim AR, Park HJ, Kwon OJ, Kim EJ, Park YC, Seo BK, Cho JH, Kim JH. Moxibustion for cancer-related fatigue: study protocol for a randomized controlled trial. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:353. [PMID: 28679410 PMCID: PMC5499061 DOI: 10.1186/s12906-017-1856-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022]
Abstract
Background Cancer-related fatigue is one of the most common symptoms experienced by cancer patients, and it diminishes their quality of life. However, there is currently no confirmed standard treatment for cancer-related fatigue, and thus, many patients who suffer cancer-related fatigue seek complementary and alternative medicines such as moxibustion. Moxibustion is one of the most popular therapies in traditional Korean medicine used to manage fatigue. Recent studies have also demonstrated that moxibustion is effective for treating chronic fatigue. However, there is insufficient evidence supporting the effect of moxibustion against cancer-related fatigue. The aim of this study is to assess the efficacy and safety of moxibustion treatment for cancer-related fatigue. Methods/design A multi-center, three-armed parallel, randomized controlled trial will be conducted. Ninety-six patients with cancer-related fatigue will be recruited from three clinical research centers. They will be randomly allocated to one of three groups in a 1:1:1 ratio. The moxibustion group will receive moxibustion treatment at CV8, CV12, LI4 and ST36. The sham moxibustion group will receive sham moxibustion at non-acupoints. Both the moxibustion and sham moxibustion groups will receive 30-min treatments twice a week for 8 weeks. The usual care group will not receive moxibustion treatment. All participants will be educated via a brochure on how to manage cancer-related fatigue in daily life. The outcome measurements will be evaluated at baseline, week 5, week 9, and week 13 by assessors who are blinded to the group allocation. The primary outcome measure will be the mean change in the average scores of the Brief Fatigue Inventory before and after treatments between groups. The secondary outcome measures will be the mean difference in changes from baseline of the Brief Fatigue Inventory, functional assessments of cancer therapy-fatigue, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 scores, and Montreal Cognitive Assessment scores between groups. Safety will be assessed by monitoring adverse events at each visit. Discussion The results of this study will provide evidence to confirm whether moxibustion can be used as a therapeutic option for treating cancer-related fatigue. Trial registration Clinical Research Information Service KCT0002170. Registered 16 December 2016. Electronic supplementary material The online version of this article (doi:10.1186/s12906-017-1856-3) contains supplementary material, which is available to authorized users.
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