Biobehavioral effects of Tai Chi Qigong in men with prostate cancer: Study design of a three-arm randomized clinical trial.

Fatigue is often one of the most commonly reported symptoms in prostate cancer survivors, but it is also one of the least understood cancer-related symptoms. Fatigue is associated with psychological distress, disruptions in sleep quality, and impairments in health-related quality of life. Moreover, inflammatory processes and changes related to the hypothalamic-pituitary-adrenal (HPA) axis and/or autonomic nervous system may also play a role in cancer-related fatigue. Thus, effective treatments for fatigue in prostate cancer survivors represent a current unmet need. Prior research has shown that Tai Chi Qigong, a mind-body exercise intervention, can improve physical and emotional health. Herein, we describe the protocol of the ongoing 3-arm randomized controlled Health Empowerment & Recovery Outcomes (HERO) clincal trial. One hundred sixty-six prostate cancer survivors with fatigue are randomized to a modified Tai Chi Qigong intervention (TCQ), intensity-matched body training intervention (BT), or usual care (UC) condition. Guided by biopsychosocial and psychoneuroimmunology models, we propose that TCQ, as compared to BT or UC will: i) reduce fatigue (primary outcome) in prostate cancer survivors; ii) reduce inflammation; and iii) regulate the expression of genes from two major functional clusters: a) inflammation, vasodilation and metabolite sensing and b) energy and adrenergic activation. Assessments are conducted at baseline, the 6-week midpoint of the intervention, and 1 week, 3 months, and 12 months post-intervention. If our findings show that TCQ promotes recovery from prostate cancer and its treatment, this type of intervention can be integrated into survivorship care plans as the standard of care. The study's findings will also provide novel information about underlying biobehavioral mechanisms of cancer-related fatigue. Trial registration number:NCT03326713; clinicaltrials.gov

A comparison of cognitive function, sleep and activity levels in disease-free breast cancer patients with or without cancer-related fatigue syndrome.

Chronic fatigue is a feature in a subset of women successfully treated for breast cancer but is not well characterised. This study examines differences in objective cognitive function, activity levels and sleep in disease-free women who do and do not meet criteria for cancer-related fatigue syndrome (CRFS)

A methodological framework for capturing relative eyetracking coordinate data to determine gaze patterns and fixations from two or more observers

While physical activity during cancer treatment is found beneficial for breast cancer patients, evidence indicates ambiguous findings concerning effects of scheduled exercise programs on treatment-related symptoms. This study investigated effects of a scheduled home-based exercise intervention in breast cancer patients during adjuvant chemotherapy, on cancer-related fatigue, physical fitness, and activity level. Sixty-seven women were randomized to an exercise intervention group (n=33, performed strength training 3x/week and 30 minutes brisk walking/day) and a control group (n=34, performed their regular physical activity level). Data collection was performed at baseline, at completion of chemotherapy (Post1), and 6-month postchemotherapy (Post2). Exercise levels were slightly higher in the scheduled exercise group than in the control group. In both groups, cancer-related fatigue increased at Post1 but returned to baseline at Post2. Physical fitness and activity levels decreased at Post1 but were significantly improved at Post2. Significant differences between intervention and control groups were not found. The findings suggest that generally recommended physical activity levels are enough to relief cancer-related fatigue and restore physical capacity in breast cancer patients during adjuvant chemotherapy, although one cannot rule out that results reflect diminishing treatment side effects over time

Perceived Cognitive Changes with Chemotherapy for Breast Cancer: A Pilot Study

Purpose The purpose of this study was to determine perceived cognitive functioning, fatigue, depression and general well-being among women before and after the initiation of chemotherapy for breast cancer compared to a sample of healthy women. Method This descriptive, repeated measures study compared women receiving chemotherapy and healthy women. Women completed measures of quality of life, fatigue, cognitive changes and depression. Results Before chemotherapy, women with cancer reported more fatigue and depression than healthy women. After chemotherapy, women with cancer reported decreased cognitive functioning accompanied by more fatigue and depressive symptoms than healthy women. Conclusion This study is one of the first to use multiple symptom measures before and after starting chemotherapy. Understanding cognitive changes and related symptoms that occur before and during chemotherapy for breast cancer is the first step toward helping women cope with changes that occur with breast cancer treatment

Cancer-Related Fatigue: The Referral to Physical Therapy as a Collaborative Treatment Approach

Abstract Purpose The purpose of this project was to determine if referral of patients with cancer-related fatigue to physical therapy as an intervention would improve patient fatigue levels and quality of life, and to develop and implement a change in policy and procedure within a select healthcare system for health care providers to adequately address cancer-related fatigue. Background Cancer-related fatigue is one of the most commonly reported symptoms among individuals diagnosed with cancer and is often exacerbated by cancer treatment; however, cancer-related fatigue remains undertreated despite the negative impact it has on quality of life (Thong et al., 2020; Gerber, 2016). With the number of individuals being diagnosed with cancer and death rates from cancer declining, it is imperative cancer-related fatigue is adequately assessed and treated. Methods To gather additional supporting evidence and using a pre- and post-intervention survey design, adults diagnosed with cancer and cancer-related fatigue were recruited from outpatient oncology clinics affiliated with a large healthcare system in Atlanta, Georgia. Self-reported fatigue and quality of life were assessed pre and post participant completion of 4-6 weeks of physical therapy prescribed for the treatment of fatigue. Strategies to improve health care provider assessment and treatment of cancer-related fatigue were outlined including the implementation of a computer-based work rule engine to be integrated into the EHR system to increase compliance of providers in addressing cancer-related fatigue. Steps to achieve a system-wide change in policy and procedure related to the assessment and treatment of cancer-related fatigue also were outlined. Significance Three participants completed the initial study for the project. Due to a small sample size, analysis of data was limited. Trends in results suggest a decrease in fatigue levels and increase in quality of life of participants who complete 4-6 weeks of physical therapy for cancer-related fatigue. Conclusion Referring patients to physical therapy as a treatment plan for cancer-related fatigue may be an effective and efficient way to improve this symptom and positively impact patient quality of life. Implementing a system-wide change in current policy and procedure could simplify the process of assessment and treatment of cancer-related fatigue and increase health care provider compliance in addressing this debilitating symptom

Educational interventions for the management of cancer-related fatigue in adults

Background: Cancer-related fatigue is reported as the most common and distressing symptom experienced by patients with cancer. It can exacerbate the experience of other symptoms, negatively affect mood, interfere with the ability to carry out everyday activities, and negatively impact on quality of life. Educational interventions may help people to manage this fatigue or to cope with this symptom, and reduce its overall burden. Despite the importance of education for managing cancer-related fatigue there are currently no systematic reviews examining this approach. Objectives: To determine the effectiveness of educational interventions for managing cancer-related fatigue in adults. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, OTseeker and PEDro up to 1st November 2016. We also searched trials registries. Selection criteria: We included randomised controlled trials (RCTs) of educational interventions focused on cancer-related fatigue where fatigue was a primary outcome. Studies must have aimed to evaluate the effect of educational interventions designed specifically to manage cancer-related fatigue, or to evaluate educational interventions targeting a constellation of physical symptoms or quality of life where fatigue was the primary focus. The studies could have compared educational interventions with no intervention or wait list controls, usual care or attention controls, or an alternative intervention for cancer-related fatigue in adults with any type of cancer. Data collection and analysis: Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. Trial authors were contacted for additional information. A third independent person checked the data extraction. The main outcome considered in this review was cancer-related fatigue. We assessed the evidence using GRADE and created a 'Summary of Findings' table. Main results: We included 14 RCTs with 2213 participants across different cancer diagnoses. Four studies used only 'information-giving' educational strategies, whereas the remainder used mainly information-giving strategies coupled with some problem-solving, reinforcement, or support techniques. Interventions differed in delivery including: mode of delivery (face to face, web-based, audiotape, telephone); group or individual interventions; number of sessions provided (ranging from 2 to 12 sessions); and timing of intervention in relation to completion of cancer treatment (during or after completion). Most trials compared educational interventions to usual care and meta-analyses compared educational interventions to usual care or attention controls. Methodological issues that increased the risk of bias were evident including lack of blinding of outcome assessors, unclear allocation concealment in over half of the studies, and generally small sample sizes. Using the GRADE approach, we rated the quality of evidence as very low to moderate, downgraded mainly due to high risk of bias, unexplained heterogeneity, and imprecision. There was moderate quality evidence of a small reduction in fatigue intensity from a meta-analyses of eight studies (1524 participants; standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.52 to -0.04) comparing educational interventions with usual care or attention control. We found low quality evidence from twelve studies (1711 participants) that educational interventions had a small effect on general/overall fatigue (SMD -0.27, 95% CI -0.51 to -0.04) compared to usual care or attention control. There was low quality evidence from three studies (622 participants) of a moderate size effect of educational interventions for reducing fatigue distress (SMD -0.57, 95% CI -1.09 to -0.05) compared to usual care, and this could be considered clinically significant. Pooled data from four studies (439 participants) found a small reduction in fatigue interference with daily life (SMD -0.35, 95% CI -0.54 to -0.16; moderate quality evidence). No clear effects on fatigue were found related to type of cancer treatment or timing of intervention in relation to completion of cancer treatment, and there were insufficient data available to determine the effect of educational interventions on fatigue by stage of disease, tumour type or group versus individual intervention. Three studies (571 participants) provided low quality evidence for a reduction in anxiety in favour of the intervention group (mean difference (MD) -1.47, 95% CI -2.76 to -0.18) which, for some, would be considered clinically significant. Two additional studies not included in the meta-analysis also reported statistically significant improvements in anxiety in favour of the educational intervention, whereas a third study did not. Compared with usual care or attention control, educational interventions showed no significant reduction in depressive symptoms (four studies, 881 participants, SMD -0.12, 95% CI -0.47 to 0.23; very low quality evidence). Three additional trials not included in the meta-analysis found no between-group differences in the symptoms of depression. No between-group difference was evident in the capacity for activities of daily living or physical function when comparing educational interventions with usual care (4 studies, 773 participants, SMD 0.33, 95% CI -0.10 to 0.75) and the quality of evidence was low. Pooled evidence of low quality from two of three studies examining the effect of educational interventions compared to usual care found an improvement in global quality of life on a 0-100 scale (MD 11.47, 95% CI 1.29 to 21.65), which would be considered clinically significant for some. No adverse events were reported in any of the studies. Authors' conclusions: Educational interventions may have a small effect on reducing fatigue intensity, fatigue's interference with daily life, and general fatigue, and could have a moderate effect on reducing fatigue distress. Educational interventions focused on fatigue may also help reduce anxiety and improve global quality of life, but it is unclear what effect they might have on capacity for activities of daily living or depressive symptoms. Additional studies undertaken in the future are likely to impact on our confidence in the conclusions. The incorporation of education for the management of fatigue as part of routine care appears reasonable. However, given the complex nature of this symptom, educational interventions on their own are unlikely to optimally reduce fatigue or help people manage its impact, and should be considered in conjunction with other interventions. Just how educational interventions are best delivered, and their content and timing to maximise outcomes, are issues that require further research

The course of cancer related fatigue up to ten years in early breast cancer patients. What impact in clinical practice?

Little is known about the cancer related fatigue (CRF) along cancer course and risk factors that could predict CRF development and persistence in breast cancer (BC) survivors. This prospective study detected incidence, timing of onset, duration of CRF, impact on QoL and psychological distress. Seventy-eight early BC patients, undergoing chemotherapy (CT) followed or not by hormonal therapy were assessed for QoL and psychological distress by EORTC QLQC30 and HADs questionnaires. Fatigue was investigated with mix methods, structured interview and psychometric measures. A qualitative analysis was added to assess the behavioral pattern of CRF. Low fatigue levels were identified after surgery (9%), increasing during (49%) and at the end of CT (47%), maintaining after 1 year (31%) and declining up to ten years of follow-up. Prevalence of CRF was higher at the end of CT and lower at follow-up. At the end and after 1 and 2 years from CT, persistence of CRF was associated to anxiety in 20%, 11% and 5% and to depression in 15%, 10% and 5% respectively. A relationship between CRF and psychological distress was observed; patients presenting depression and anxiety before CT were at higher risk for fatigue onset at a later period. A relationship between fatigue and QoL was noted at the end of CT. Our study shows the fatigue timely trend in early BC patients from surgery, CT and follow-up. Identification of biological, psychological, social predictor factors related to fatigue could be helpful for early interventions in patients at higher risk of developing fatigue

Inflammation And Cancer-Related Fatigue In Breast Cancer Survivors

Purpose: Cancer-related fatigue negatively impacts quality of life and possible recurrence and overall mortality in breast cancer survivors. This study aimed to investigate the associations between inflammation and cancer-related fatigue in breast cancer survivors using methods of systematic review and quantitative assessment of the Hormones and Physical Exercise (HOPE) Study in a high-risk population. Methods: A PubMed search was conducted to identify peer-reviewed studies that assessed the associations among inflammatory markers, CRP, IL-6, and TNF-α, and cancer-related fatigue in breast cancer survivors. The HOPE Study was a randomized control trial in 121 postmenopausal Stage I-IIIC breast cancer survivors, who were taking Aromatase Inhibitors (AIs) and experiencing arthralgia. This study investigated the associations of baseline (N = 69) pro-inflammatory markers CRP, IL-6, and TNF-α and self-reported fatigue. Results: Fifteen studies with more than 1,900 participants were included in the systematic review. The literature inconclusively supports a positive association between CRP and cancer-related fatigue. TNF-α and IL-6 were not associated with cancer-related fatigue. In the HOPE Study, CRP, IL-6, and TNF-α, fatigue, and sleep duration were not significantly associated. There was the suggestion of a positive trending association between CRP and cancer-related fatigue among women with higher stage of disease. BMI status and joint pain intensity were significant risk factors of cancer-related fatigue. Conclusion: A growing body of literature inconclusively supports the link between downstream inflammatory activity and cancer-related fatigue. There may be subgroups of women, e.g. those with higher stage of disease, for whom this may be particularly important. A further understanding of cancer-related fatigue mechanisms and the development of effective interventions are necessary to improve the quality and duration of life in the increasing population of cancer survivors

Cancer-Related Fatigue

Variables related to cancer-related fatigue were studied. Adults over the age of 18 who were actively undergoing cancer treatment in a rural, outpatient clinic were included in the study. The purpose of this project was to assess fatigue levels of patients who are undergoing cancer treatment. The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire was administered to participants and their scores were used to compare variables significance to cancer-related fatigue. The significant variables included cancer-related pain, dementia, congestive heart failure, and anxiety. This study increased provider and patient awareness of variables that influence how cancer-related fatigue is experienced and the need for evaluation during treatment

Synthesizing the best approach for the management of cancer related fatigue in children

Fatigue has been recognised as a symptom that affects 39%-90% of patients undergoing anti-cancer therapyy. Fatigue is considered as the most frequently reported physical problem in children with cancer yet the most distressing symptoms of cancer therapy for children undergoing anti-cancer treatment. The effective diagnosis and treatment of fatigue will improve patient’s quality of life. A thorough review of current literature is needed to understand the best approach for managing this problem. A review of several literature regarding cancer-related fatigue management from the last decade was conducted in 2012. As many as eight studies were identified as the qualified paper to summarise the best approach towards fatigue in pediatric cancer patient. Excercise, massage therapy, drug therapy and psychosocial therapy were synthesised as four different approaches that effectively applyed to manage fatigue in children patients as a single modality. Fatigue-nursing intervention and the National Comprehensive Cancer Network (NCCN) Fatigue Practice Guidelines were multi-modality approaches that offer better option for the mangement of cancer-related fatigue in pediatric patients. The NCCN Fatigue Practice Guidelines seem to be the most effective approach for cancer-related fatigue management