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Campbell R, Shaw JM, Banks H, Carlick T, Faris MM, Jeon MS, Legge D, Foster C, Leonard R, Chan RJ, Agar MR, Miller A, Dhillon HM. Co-designing a web-based intervention (RESTORE) to support self-management of cancer-related fatigue in people living with a brain tumour. Support Care Cancer 2025; 33:426. [PMID: 40293503 PMCID: PMC12037432 DOI: 10.1007/s00520-025-09471-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 04/15/2025] [Indexed: 04/30/2025]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a debilitating symptom commonly reported by people with a brain tumour (BT). Many interventions have been developed to reduce CRF; however, few have been evaluated in people with BT despite the unique functional deficits experienced by this population. We aimed to explore the appropriateness of a web-based intervention (RESTORE) to support self-management of fatigue for people with a BT and identify recommended modifications. METHODS Semi-structured interviews were conducted with people with BT, their caregivers and healthcare professionals (HCPs) who treat them. Interviews explored the appropriateness of RESTORE for this population, and suggested modifications to improve relevance and suitability. Interviews were transcribed and analysed thematically using interpretive description to devise recommendations. RESULTS Forty participants were interviewed (24 people with BT, 5 caregivers, 11 HCPs). Four themes were identified: feedback on content; feedback on format; feedback on use; and, barriers to engagement. These themes were linked by an overarching need for flexible and responsive tailoring to the unique needs of people with BT. Thirty-two recommended modifications were derived from feedback to optimise RESTORE for this population. CONCLUSION Results suggest a BT-specific version of RESTORE would be acceptable to address fatigue in this population. Recommended adaptations include greater flexibility and tailoring of content and format for effective use among people with BT. Barriers to engagement including digital access and literacy and awareness of the resource should be addressed in the implementation of a BT-specific version of RESTORE.
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Affiliation(s)
- R Campbell
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - J M Shaw
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - H Banks
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - T Carlick
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - M M Faris
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - M S Jeon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - D Legge
- Oliva Newton-John Cancer and Wellness Centre, Austin Hospital, Heidelberg, Australia
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Bentley, Australia
| | - C Foster
- Centre for Psychosocial Research in Cancer (CentRIC), School of Health Sciences, University of Southampton, Southampton, UK
| | - R Leonard
- Brain Cancer Collective, NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - R J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
| | - M R Agar
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - A Miller
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - H M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.
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Wagner AS, Milzer M, Schmidt ME, Kiermeier S, Maatouk I, Steindorf K. Nurses' Knowledge of Cancer-Related Fatigue and the Coverage of This Subject in Nursing Training: A Cross-Sectional Study. J Nurs Res 2025; 33:e379. [PMID: 40162696 DOI: 10.1097/jnr.0000000000000666] [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: 04/02/2025] Open
Abstract
BACKGROUND Although cancer-related fatigue has a major impact on daily functioning and quality of life of patients, it remains underestimated in cancer care. Nurses play a significant role in multidisciplinary approaches to fatigue care. PURPOSE This study was designed to investigate knowledge and attitudes among nurses regarding cancer-related fatigue and its management in daily clinical practice and training to suggest future actions for improvement. METHODS A cross-sectional design and an online questionnaire were used to assess nurses' perceived knowledge and self-efficacy, knowledge of guidelines and treatment options, and related coverage in education and training and to suggest how to improve training. The link to the study survey was distributed to cancer nurses working in Germany via mailing lists of randomly selected hospitals and rehabilitation centers, professional nursing associations, and social media. Data were analyzed descriptively as well as using the Mann-Whitney U test. Logistic regression analyses were conducted to identify variables linked to fatigue-related knowledge. RESULTS Nurses participating in the study were mainly working in certified cancer care institutions (70.1%). More than one-third of the 184 participants felt rather poorly or very poorly informed and reported low self-efficacy in counseling. Although working in certified institutions was found to increase the likelihood of accurately recalling the fatigue-related guidelines (OR = 6.24, 95% CI = [1.71, 22.74], p < .01), few of the participants in this study knew any. Despite this, the majority was aware of the empirical evidence supporting physical activity (92.4%), yoga (79.9%), psychotherapeutic interventions (76.7%), mindfulness-based interventions (69%), and exercise (60.3%). Recommendation rates were heterogeneous. Those participants working in certified institutions were more likely to know about the empirical evidence related to exercise (OR = 3.03, 95% CI = [1.49, 6.18], p < .01), which was positively associated with both recommending exercise and self-assessing one's subjective knowledge as high. Cancer-related fatigue is addressed minimally in basic nursing training and moderately (30.4%) to comprehensively (29.9%) in advanced nursing training. The participants suggested various strategies to improve related training. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Most of the participants work in certified institutions but lack guidelines-related knowledge. Nevertheless, the participants had a fairly good awareness of interventions effective in reducing fatigue. However, awareness of the empirical evidence for exercise as one of the most promising treatment options was relatively low. Based on these findings, guidelines-oriented training is needed to strengthen related knowledge, particularly regarding self-efficacy in counseling in nurses. Awareness of this frequent sequelae should be raised early during basic nursing training and be covered comprehensively in advanced oncology nursing training. In general, the role of nurses within multidisciplinary teams in fatigue care needs to be determined to enable effective collaboration.
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Affiliation(s)
- Anna S Wagner
- Department of Internal Medicine II, Section of Psychosomatics, Psychotherapy and Psychooncology, University Hospital Würzburg, Würzburg, Germany
| | | | | | - Senta Kiermeier
- Department of Internal Medicine II, Section of Psychosomatics, Psychotherapy and Psychooncology, University Hospital Würzburg, Würzburg, Germany
| | - Imad Maatouk
- Department of Internal Medicine II, Section of Psychosomatics, Psychotherapy and Psychooncology, University Hospital Würzburg, Würzburg, Germany
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Wagner AS, Wehlen L, Milzer M, Schmidt ME, Kiermeier S, Maatouk I, Steindorf K. Physicians' perspectives on cancer-related fatigue management and their suggestions for improvements in medical training: a cross-sectional survey study in Germany. Support Care Cancer 2024; 32:788. [PMID: 39537876 PMCID: PMC11560979 DOI: 10.1007/s00520-024-08978-2] [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: 07/15/2024] [Accepted: 10/30/2024] [Indexed: 11/16/2024]
Abstract
PURPOSE Contrary to guidelines, many cancer patients are not screened for cancer-related fatigue (CRF) and do not receive information or adequate treatment. As physicians play a key role in cancer therapy, their knowledge of this common sequela and perspectives on its management are of major interest. METHODS For an online survey, physicians working in oncology in Germany were systematically drawn from registers and invited by using institutional newsletters or colleagues. Descriptive analyses, logistic regression analysis of physicians' knowledge, and Mann‒Whitney U tests were performed. RESULTS Two-thirds of the 148 surveyed physicians felt (rather) well informed about CRF and capable of counseling patients. Only 32% of the sample were aware of CRF-specific guidelines. Despite of this, participants rated the scientific evidence for recommending physical activity, exercise programs, and psychotherapeutic interventions in accordance with guidelines as being mostly (very) strong. However, despite 82.4% of the physicians being (rather) aware of its evidence, only 56.1% often to almost always recommended psychotherapeutic interventions. CRF was rarely covered in medical studies and medical specialist training. The completion of advanced training for palliative care increased the likelihood of knowing guidelines (OR = 2.6, 95% CI [1.1-6.0], p < 0.05). Suggestions for improving training included the mandatory coverage of CRF in medical training or its consideration in interprofessional supportive care workshops. CONCLUSION Although awareness and recommendation rates were adequate for some interventions in CRF treatment (such as physical activity), there were lower recommendation rates for others, including psychotherapy. Studies are required assessing for the reasons of this knowledge-to-practice gap. Moreover, training is needed among physicians in order to enhance knowledge of CRF guidelines. TRIAL REGISTRATION Clinicaltrials.gov , identifier: NCT04921644. Registered in June 2021.
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Affiliation(s)
- Anna S Wagner
- Department of Internal Medicine II, Section of Psychosomatics, Psychotherapy and Psychooncology, University Hospital Würzburg, Würzburg, Germany
| | - L Wehlen
- Department of Internal Medicine II, Section of Psychosomatics, Psychotherapy and Psychooncology, University Hospital Würzburg, Würzburg, Germany
| | - Marlena Milzer
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
- University Hospital Mannheim, Mannheim Cancer Center, Heidelberg University, Mannheim, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer (C110), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
| | - Senta Kiermeier
- Department of Internal Medicine II, Section of Psychosomatics, Psychotherapy and Psychooncology, University Hospital Würzburg, Würzburg, Germany
| | - Imad Maatouk
- Department of Internal Medicine II, Section of Psychosomatics, Psychotherapy and Psychooncology, University Hospital Würzburg, Würzburg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer (C110), German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Division of Physical Activity, Prevention and Cancer, National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany.
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Rutkowski NA, Jones G, Brunet J, Lebel S. An Ideal Intervention for Cancer-Related Fatigue: Qualitative Findings from Patients, Community Partners, and Healthcare Providers. Curr Oncol 2024; 31:4357-4368. [PMID: 39195308 PMCID: PMC11353202 DOI: 10.3390/curroncol31080325] [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: 07/03/2024] [Revised: 07/17/2024] [Accepted: 07/26/2024] [Indexed: 08/29/2024] Open
Abstract
Patients consistently rate cancer-related fatigue (CrF) as the most prevalent and debilitating symptom. CrF is an important but often neglected patient concern, partly due to barriers to implementing evidence-based interventions. This study explored what an ideal intervention for CrF would look like from the perspectives of different stakeholders and the barriers to its implementation. Three participant populations were recruited: healthcare providers (HCPs; n = 32), community support providers (CSPs; n = 14), and cancer patients (n = 16). Data were collected via nine focus groups and four semi-structured interviews. Data were coded into themes using content analysis. Two main themes emerged around addressing CrF: "It takes a village" and "This will not be easy". Participants discussed an intervention for CrF could be anywhere, offered by anyone and everyone, and provided early and frequently throughout the cancer experience and could include peer support, psychoeducation, physical activity, mind-body interventions, and interdisciplinary care. Patients, HCPs, and CSPs described several potential barriers to implementation, including patient barriers (i.e., patient variability, accessibility, online literacy, and overload of information) and systems barriers (i.e., costs, lack of HCP knowledge, system insufficiency, and time). As CrF is a common post-treatment symptom, it is imperative to offer patients adequate support to manage CrF. This study lays the groundwork for the implementation of a patient-centered intervention for CrF in Canada and possibly elsewhere.
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Affiliation(s)
- Nicole Anna Rutkowski
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (J.B.); (S.L.)
| | - Georden Jones
- Mary A. Rackham Institute, University of Michigan, Ann Arbor, MI 48104, USA;
| | - Jennifer Brunet
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (J.B.); (S.L.)
- School of Human Kinetics, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Sophie Lebel
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada; (J.B.); (S.L.)
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Agbejule OA, Hart NH, Ekberg S, Chan RJ. Development of a self-management support practice framework for addressing cancer-related fatigue: a modified Delphi study. J Cancer Surviv 2024; 18:972-982. [PMID: 36826459 PMCID: PMC11082027 DOI: 10.1007/s11764-023-01348-7] [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: 08/03/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023]
Abstract
PURPOSE Managing cancer-related fatigue requires individuals to adopt a range of self-management behaviours. However, clinicians report the lack of clear guidance on self-management support practices hinders their provision of supportive care. To develop consensus on a framework of core practices required by health professionals to deliver effective self-management support to cancer patients and survivors experiencing cancer-related fatigue. METHODS A preliminary framework of 47 practice items (14 Key Practices, 33 Practice Components) was derived from a systematic review, and a self-management support capability outline for primary care professionals. This preliminary framework was presented for consensus rating and comment in a two-round modified Delphi study conducted with a panel of health professionals, research academics, and cancer consumers. RESULTS Fifty-two panel participants comprising consumers (n = 25), health professionals (n = 19), and researchers (n = 16) were included in Round 1 of the modified Delphi study. Feedback from the panel produced consensus on retaining 27 of 47 original practice items without change. Seventeen items (including 12 modified, and 5 newly created practice items) were sent to the panel for rating in Round 2. Thirty-six experts produced consensus on retaining all 17 practice items in Round 2. The final framework comprised 44 items (13 Key Practices, 31 Practice Components). CONCLUSIONS The practice framework offers an evidence- and consensus-based model of best practice for health professionals providing self-management support for cancer-related fatigue. IMPLICATIONS FOR CANCER SURVIVORS This framework is the first to focus on quality provision of self-management support in managing cancer-related fatigue, one of the most prevalent symptoms experienced by cancer patients and survivors.
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Affiliation(s)
- Oluwaseyifunmi Andi Agbejule
- Caring Futures Institute, College of Nursing and Allied Health, Flinders University, Bedford Park, South Australia, 5042, Australia.
| | - Nicolas H Hart
- Caring Futures Institute, College of Nursing and Allied Health, Flinders University, Bedford Park, South Australia, 5042, Australia
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
- Centre for IMPACCT, Faculty of Health, University of Technology, NSW, Sydney, 2007, Australia
| | - Stuart Ekberg
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
- School of Psychology & Counselling, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
| | - Raymond Javan Chan
- Caring Futures Institute, College of Nursing and Allied Health, Flinders University, Bedford Park, South Australia, 5042, Australia
- Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
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Larsen EH, Wahl AK, Ruud E, Mellblom AV, Ålykkja A, Lie HC. Adolescent Cancer Survivors and Their Parents' Experiences With the Transition Off Treatment to Survivorship: A Qualitative Interview Study. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2024; 41:172-187. [PMID: 38656765 DOI: 10.1177/27527530231214528] [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: 04/26/2024]
Abstract
Background: Transitioning from active cancer treatment to survivorship represents a vulnerable yet underresearched phase for adolescents and their families. Knowledge of their support needs, the challenges they experience, and how they manage them are useful to inform tailored follow-up care. Thus, we aimed to explore their transition experiences. Method: We interviewed 15 adolescents (12-19 years) who had transitioned off of treatment 1 to 47 months prior at Oslo University Hospital's Department of Paediatric Haematology and Oncology and their biological parents (n = 16). The interviews were analyzed using inductive, reflexive thematic analysis inspired by Braun and Clarke. NVivo-12 was used for data management. Results: Four main themes were identified: (a) consequences of cancer beyond transition, (b) transition back to normalcy, (c) survivorship competence, and (d) changes in roles and relationships. The families described happiness and relief but also said that the lingering effects of cancer treatment had a profound impact on day-to-day living. The adolescents expressed closeness with and dependency on their parents, and they perceived family and friends as essential for social readjustment. Discussion: Although adolescent survivors and their parents described a wide variety of strategies for returning to "normalcy," their perspectives also illustrate ongoing psychosocial and educational support needs that changed over time. Our findings indicate a need for improved preparation for and support through the transition. Nurses are well positioned to provide continuous and structured transition support tailored to the needs of the individual survivors and their families.
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Affiliation(s)
- Elna Hamilton Larsen
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Astrid Klopstad Wahl
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Ellen Ruud
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
| | - Anneli Viktoria Mellblom
- Regional Centre for Child and Adolescent Mental Health Eastern and Southern Norway (RBUP), Nydalen, Oslo, Norway
| | - Anette Ålykkja
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
- Department of Paediatric Haematology and Oncology, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Nydalen, Oslo, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Blindern, Oslo, Norway
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Milzer M, Wagner AS, Schmidt ME, Maatouk I, Hermann S, Kiermeier S, Steindorf K. Patient-physician communication about cancer-related fatigue: a survey of patient-perceived barriers. J Cancer Res Clin Oncol 2024; 150:29. [PMID: 38270814 PMCID: PMC10810981 DOI: 10.1007/s00432-023-05555-8] [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: 07/31/2023] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE Cancer-related fatigue is a subjective, distressing, and common sequela of cancer which is often disregarded and underdiagnosed. Fatigue is assessed by self-report requiring communication between patient and physician. In this study, we investigated the patients' perspective on the patient-physician communication about fatigue. METHODS On average five months after diagnosis 1179 cancer patients, recruited in Germany, completed a survey as part of the LIFT project. The survey included questions on sociodemographic data, fatigue, depression, fatigue management, patient-physician communication, and communication barriers. Data were analyzed descriptively and using logistic regression analyses. RESULTS Half of the participants reported that their physician had never asked them whether they felt exhausted. Patients undergoing chemo-, radio-, or immunotherapy were more likely to be asked about fatigue, while older age and major depression decreased the likelihood. Sixty-four percent of the patients felt impeded by communication barriers. Common barriers were not knowing who to turn to for fatigue (39%), time constraints (31%), and the fear of being perceived as weak (22%). Almost half of the participants indicated that their physicians were not appreciative and did not deal adequately with fatigue-related questions. CONCLUSION This study revealed gaps in the patient-physician communication regarding cancer-related fatigue. Contrary to guideline recommendations a minority of physicians addressed fatigue. On the other hand, cancer patients felt reluctant to bring up this topic due to structural barriers and fears. Physicians should routinely address fatigue and adopt a communication style which encourages patients to likewise state their symptoms and raise their questions. TRIAL REGISTRATION Clinicaltrials.gov, identifier: NCT04921644. Registered in June 2021.
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Grants
- Grants No. MA 7865/3-1, SCHM 3423/3-1, STE 1493/6-1, Project No. 438839893 Deutsche Forschungsgemeinschaft
- Grants No. MA 7865/3-1, SCHM 3423/3-1, STE 1493/6-1, Project No. 438839893 Deutsche Forschungsgemeinschaft
- Grants No. MA 7865/3-1, SCHM 3423/3-1, STE 1493/6-1, Project No. 438839893 Deutsche Forschungsgemeinschaft
- Grants No. MA 7865/3-1, SCHM 3423/3-1, STE 1493/6-1, Project No. 438839893 Deutsche Forschungsgemeinschaft
- Grants No. MA 7865/3-1, SCHM 3423/3-1, STE 1493/6-1, Project No. 438839893 Deutsche Forschungsgemeinschaft
- Deutsches Krebsforschungszentrum (DKFZ) (1052)
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Affiliation(s)
- Marlena Milzer
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
| | - Anna S Wagner
- Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian-University, Würzburg, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian-University, Würzburg, Germany
| | - Silke Hermann
- Epidemiological Cancer Registry of Baden-Württemberg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Senta Kiermeier
- Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian-University, Würzburg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- National Center for Tumor Diseases (NCT), NCT Heidelberg, a partnership between DKFZ and University Medical Center Heidelberg, Heidelberg, Germany.
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Jones MD, Casson SM, Barry BK, Li SH, Valenzuela T, Cassar J, Lamanna C, Lloyd AR, Sandler CX. eLearning improves allied health professionals' knowledge and confidence to manage medically unexplained chronic fatigue states: A randomized controlled trial. J Psychosom Res 2023; 173:111462. [PMID: 37619433 DOI: 10.1016/j.jpsychores.2023.111462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES To evaluate the impact of eLearning by allied health professionals on improving the knowledge and confidence to manage people with medically unexplained chronic fatigue states (FS). METHODS Using a parallel randomized controlled trial design, participants were randomized 1:1 to a 4-week eLearning or wait-list control group. Knowledge and self-reported confidence in clinical skills to implement a therapeutic intervention for patients with FS were assessed at baseline, post-intervention and follow-up. Secondary outcomes (adherence and satisfaction with online education, knowledge retention) were also assessed. Data was analyzed using intention-to-treat. RESULTS There were 239 participants were randomized (eLearning n = 119, control n = 120), of whom 101 (85%) eLearning and 107 (89%) control participants completed baseline assessments and were included in the analysis. Knowledge (out of 100) improved significantly more in the eLearning group compared to the control group [mean difference (95% CI) 8.6 (5.9 to 11.4), p < 0.001]. Knowledge was reduced in the eLearning group at follow-up but was still significantly higher than baseline [6.0 (3.7 to 8.3), p < 0.001]. Median change (out of 5) in confidence in clinical skills to implement the FS intervention was also significantly greater in the eLearning group compared to the control group [knowledge: eLearning (1.2), control (0); clinical skills: eLearning (1), control (0.1); both p < 0.001)]. Average time spent on the eLearning program was 8.8 h. Most participants (80%) rated the lesson difficulty as at the "right level", and 91% would recommend it to others. CONCLUSIONS eLearning increased knowledge and confidence to manage FS amongst allied health professionals and was well-accepted. REGISTRATION ACTRN12616000296437 https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370222&isReview=true.
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Affiliation(s)
- Matthew D Jones
- The Kirby Institute, The University of New South Wales, Sydney, Australia; School of Health Sciences, The University of New South Wales, Sydney, Australia; Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Sally M Casson
- The Kirby Institute, The University of New South Wales, Sydney, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Benjamin K Barry
- School of Health Sciences, The University of New South Wales, Sydney, Australia; Medical School, The University of Queensland, Brisbane, Australia; Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia
| | - Sophie H Li
- Black Dog Institute and School of Psychology, The University of New South Wales Australia, Sydney, Australia
| | - Trinidad Valenzuela
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Joanne Cassar
- The Kirby Institute, The University of New South Wales, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Camillo Lamanna
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Andrew R Lloyd
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Carolina X Sandler
- The Kirby Institute, The University of New South Wales, Sydney, Australia; School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
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Milzer M, Wagner AS, Steindorf K, Kiermeier S, Schmidt ME, Maatouk I. Psycho-oncologists' knowledge of cancer-related fatigue and the targets for improving education and training: results from a cross-sectional survey study. Support Care Cancer 2023; 31:412. [PMID: 37351639 DOI: 10.1007/s00520-023-07882-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
PURPOSE To explore psycho-oncologists' knowledge of cancer-related fatigue and their self-efficacy to intervene for fatigue. We further aimed to examine the role of fatigue in psycho-oncological training and derive specific suggestions for improvements. METHODS For this cross-sectional survey study, psycho-oncologists working in Germany were systematically recruited via an address directory or invited by training institutes or colleagues. The online survey encompassed questions on knowledge of fatigue guidelines and interventions, self-efficacy, counseling, and fatigue in professional training. Data were analyzed descriptively and using Mann-Whitney U tests. A logistic regression analysis was performed to identify variables linked to fatigue guideline knowledge. RESULTS Seventy two percent of the 144 surveyed psycho-oncologists stated not knowing any fatigue-specific guidelines. Those unaware of guidelines reported a lower self-efficacy to intervene for fatigue. However, despite low knowledge of the guidelines, more than 80% of the participants felt well informed about fatigue and reported high self-efficacy. Most participants were aware of the empirical evidence for psychotherapeutic interventions (95%); everyday physical activity, e.g., taking a walk (98%); yoga (82%); and mindfulness-based interventions (82%). Knowledge gaps existed concerning the evidence of resistance/endurance training for treating fatigue. Knowing that resistance/endurance training is an effective treatment was related to an increased frequency to recommend it to patients. Suggestions to improve training for psycho-oncologists included raising awareness earlier in the career path and offering multidisciplinary trainings for fatigue. CONCLUSION To improve fatigue-related guideline knowledge among psycho-oncologists and enhance implementation into clinical practice multidisciplinary trainings are needed. Psycho-oncologists should play an important role in fatigue management. TRIAL REGISTRATION Clinicaltrials.gov , identifier: NCT04921644. Registered in June 2021.
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Affiliation(s)
- Marlena Milzer
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Medical Faculty, University of Heidelberg, Heidelberg, Germany
| | - Anna S Wagner
- Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian-University, Wuerzburg, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
| | - Senta Kiermeier
- Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian-University, Wuerzburg, Germany
| | - Martina E Schmidt
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Imad Maatouk
- Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian-University, Wuerzburg, Germany
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10
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Pearson EJ, Denehy L, Edbrooke L. Identifying strategies for implementing a clinical guideline for cancer-related fatigue: a qualitative study. BMC Health Serv Res 2023; 23:395. [PMID: 37095506 PMCID: PMC10127293 DOI: 10.1186/s12913-023-09377-9] [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: 11/18/2022] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Clinical practice guidelines assist health professionals' (HPs) decisions. Costly to develop, many guidelines are not implemented in clinical settings. This paper describes an evaluation of contextual factors to inform clinical guideline implementation strategies for the common and distressing problem of cancer-related fatigue (CRF) at an Australian cancer hospital. METHODS A qualitative inquiry involving interviews and focus groups with consumers and multidisciplinary HPs explored key Canadian CRF guideline recommendations. Four HP focus groups examined the feasibility of a specific recommendation, while a consumer focus group examined experiences and preferences for managing CRF. Audio recordings were analysed using a rapid method of content analysis designed to accelerate implementation research. Strategies for implementation were guided by the Consolidated Framework for Implementation Research. RESULTS Five consumers and 31 multidisciplinary HPs participated in eight interviews and five focus groups. Key HP barriers to fatigue management were insufficient knowledge and time; and lack of accessible screening and management tools or referral pathways. Consumer barriers included priority for cancer control during short health consultations, limited stamina for extended or extra visits addressing fatigue, and HP attitudes towards fatigue. Enablers of optimal fatigue management were alignment with existing healthcare practices, increased HP knowledge of CRF guidelines and tools, and improved referral pathways. Consumers valued their HPs addressing fatigue as part of treatment, with a personal fatigue prevention or management plan including self-monitoring. Consumers preferred fatigue management outside clinic appointments and use of telehealth consultations. CONCLUSIONS Strategies that reduce barriers and leverage enablers to guideline use should be trialled. Approaches should include (1) accessible knowledge and practice resources for busy HPs, (2) time efficient processes for patients and their HPs and (3) alignment of processes with existing practice. Funding for cancer care must enable best practice supportive care.
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Affiliation(s)
- Elizabeth J Pearson
- Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia.
| | - Linda Denehy
- Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Lara Edbrooke
- Health Services Research and Implementation Science, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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11
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Müller K, Fischer I, Koller M, Besseler M. [Special Consultation Hour for Patients with Cancer-Related Fatigue: Study Protocol of an Observational Study of a Nationwide Health Care Structure by the Bavarian Cancer Society (BKG) in Bavaria]. Psychother Psychosom Med Psychol 2023; 73:231-239. [PMID: 36720232 DOI: 10.1055/a-1970-6457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cancer-related fatigue (CRF) is a burdensome condition of persistent tiredness, weakness, and lack of energy on physical, emotional, and cognitive level. CRF occurs in the context of cancer and/or its therapy and correlates with limitations in everyday life functioning, quality of life, and survival time. Up to now, medical care in Germany is inadequate. German wide institutions are lacking, which are specialised in identifying treatable factors influencing CRF as well as in counselling of adequate, evidence-based treatments. Since 2013, the Bavarian Cancer Society (BCS) implemented a nationwide health care structure with ten psychosocial cancer counselling centers in Bavaria. At these locations, the BCS offers for cancer patients with CRF special consultation hours with well-founded diagnostic and guidance. During the conception and further development of the consultation hour, all relevant guidelines have been considered. All consultation hours are directed by physicians with oncological and psycho-oncological experience. All of them took part in an extensive CRF training. The aim of this prospective, multicentre, observational study is the evaluation of the actual state of the TF-consultation including the analyses of offer and need for TF-consultation hours, of patient-reported TF before TF-consultation and ten weeks later, of realization of the recommended interventions to reduce TF as well as the analysis of strengths and potentials for improvement of the current system. The results will help to implement a German wide care structure.
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Affiliation(s)
- Karolina Müller
- Zentrum für Klinische Studien, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Irene Fischer
- Institut für Tumor-Fatigue-Forschung, Emskirchen, Germany.,Deutsche Fatigue Gesellschaft, Köln, Germany
| | - Michael Koller
- Zentrum für Klinische Studien, Universitätsklinikum Regensburg, Regensburg, Germany
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12
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Wang S, Jiang N, Song Y, Ma L, Niu Y, Song J, Jiang X. Correlates of Cancer-Related Fatigue among Colorectal Cancer Patients Undergoing Postoperative Adjuvant Therapy Based on the Theory of Unpleasant Symptoms. Curr Oncol 2022; 29:9199-9214. [PMID: 36547134 PMCID: PMC9777281 DOI: 10.3390/curroncol29120720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/18/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is a common and burdensome symptom in cancer patients that is influenced by multiple factors. Identifying factors associated with CRF may help in developing tailored interventions for fatigue management. This study aimed to examine the correlates of CRF among colorectal cancer patients undergoing postoperative adjuvant therapy based on the theory of unpleasant symptoms. METHODS A cross-sectional study was implemented, and finally, a sample of 363 participants from one tertiary general hospital and one tertiary cancer hospital was purposively recruited. Data were collected using the general information questionnaire, cancer fatigue scale, the distress disclosure index, Herth hope index, and perceived social support scale. Univariate analysis and multiple linear regression analysis were performed to determine the correlates of CRF. RESULTS The mean score of CRF among colorectal cancer patients was 21.61 (SD = 6.16, 95% CI 20.98-22.25), and the fatigue degree rating was "moderate". The multiple linear regression model revealed that 49.1% of the variance in CRF was explained by hope, sleep disorder, internal family support, self-disclosure, pain, and time since operation. CONCLUSIONS Our study identified several significant, modifiable factors (self-disclosure, hope, internal family support, pain, and sleep disorder) associated with CRF. Understanding these correlates and developing targeted psychosocial interventions may be associated with the improvement of CRF in patients with colorectal cancer.
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Affiliation(s)
- Song Wang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ning Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuanyuan Song
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Lihua Ma
- Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou 730013, China
| | - Ying Niu
- School of Nursing, Xinxiang Medical University, Xinxiang 453003, China
| | - Jing Song
- School of Stomatology, Bengbu Medical College, Bengbu 233030, China
| | - Xiaolian Jiang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu 610041, China
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13
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Navigante A, Cresta Morgado P, Daud ML, Dos Santos Regis H, Kolberg M, Marazzi C, Lobbe V, González AA, De Simone G. Physical exercise and fatigue in advanced gastrointestinal cancer during chemotherapy. BMJ Support Palliat Care 2022; 13:218-227. [PMID: 35738869 DOI: 10.1136/bmjspcare-2021-003516] [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: 12/23/2021] [Accepted: 05/25/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study was aimed to analyse the effect of a patient-oriented modality of physical exercise (programmed and directed physical exercise (PDPE)) on cancer-related fatigue (CRF) and quality of life (QoL). The secondary aim was to evaluate changes in body composition and skeletal muscle function during the study in patients with and without PDPE. METHODS A prospective randomised study was conducted to analyse the impact of PDPE on CRF and QoL. Patients were selected before the development of CRF to set the intervention before its appearance. A high probability CRF population was chosen: patients with advanced gastrointestinal cancer undergoing chemotherapy with weight loss (≥5%) over the last 6 months. PDPE consisted of a programme of exercise delivered weekly and adjusted to patients' medical conditions. Four visits were planned (weeks 0, 4, 8 and 12). QoL, CRF, body composition and skeletal muscle function were evaluated in each visit. RESULTS From 101 patients recruited, 64 were considered evaluable, with three or four visits completed (n=30 control, n=34 PDPE group). Satisfactory compliance of ≥50% to the PDPE programme was seen in 47%. A reduction in the severity of fatigue was detected in the PDPE group (p=0.019), being higher in the subgroup of satisfactory compliance (p<0.001). This latter group showed better results of QoL in comparison with the control group (p=0.0279). A significant increase in endurance was found in the PDPE group (p<0.001). CONCLUSION PDPE reduced the severity of fatigue and improved QoL. The difference in endurance would explain the results seen in the severity of fatigue.
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Affiliation(s)
- Alfredo Navigante
- Pallium Latinoamérica Association, Buenos Aires, Argentina .,Translational Research Unit, Institute of Oncology Angel H Roffo, Buenos Aires, Argentina
| | - Pablo Cresta Morgado
- Translational Research Unit, Institute of Oncology Angel H Roffo, Buenos Aires, Argentina
| | - María Laura Daud
- Pallium Latinoamérica Association Buenos Aires, AR, CABA, Argentina
| | - Helca Dos Santos Regis
- Section of Rehabilitation and Physiotherapist, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Martín Kolberg
- Pallium Latinoamérica Association Buenos Aires, AR, CABA, Argentina
| | - Carla Marazzi
- Section of Rehabilitation and Physiotherapist, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Velia Lobbe
- Nutrition Department, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Andrea Alejandra González
- Section of Palliative Care, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
| | - Gustavo De Simone
- Pallium Latinoamérica Association, Buenos Aires, Argentina.,Section of Palliative Care, Gastroenterology Hospital Dr Carlos Bonorino Udaondo, Buenos Aires, Argentina
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Harrington SE, Fisher MI, Lee JQ, Cohn J, Malone D. Knowledge regarding cancer-related fatigue: a survey of physical therapists and individuals diagnosed with cancer. Physiother Theory Pract 2022:1-10. [PMID: 35353642 DOI: 10.1080/09593985.2022.2056554] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cancer-related fatigue (CRF) is a common side effect and remains under-diagnosed. Screening of CRF by physical therapists (PTs) and patient perspectives of their experiences has not been comprehensively examined. PURPOSE To survey PTs to understand the frequency of CRF screening, and to assess the knowledge and experiences of survivors as it relates to CRF. METHODS Two separate electronic surveys developed by the authors were distributed. One targeted oncology PTs, the other for adult survivors of cancer. RESULTS Of the 199 PT respondents, 36% reported screening for CRF at every encounter. Screening included interviews (46%) and/or standardized questionnaires (37%). The most common barriers to receiving treatment for CRF was lack of physician referrals and time constraints. Of patient responses (n = 61), 84% reported CRF as an important ongoing issue; 77% reported that they initiated the discussion about CRF with their provider, and 23% reported being told there were treatment options for CRF. CONCLUSION CRF is common among cancer survivors. However, consistent screening by PTs is lacking. Patients with CRF frequently initiated the conversation with their providers because of symptoms and many patients were not told of treatment options. These findings represent a substantial gap in clinical practice regarding CRF screening and management.
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Affiliation(s)
- Shana E Harrington
- Department of Exercise Science, Physical Therapy Program, University of South Carolina, Columbia, SC, USA
| | - Mary I Fisher
- Department of Physical Therapy, University of Dayton, Dayton, OH, USA
| | - Jeannette Q Lee
- in Physical Therapy, University of California San Francisco/San Francisco State University, Sfsu CampusGraduate Program , San Francisco, CA, USA
| | - Joy Cohn
- Good Shepherd Penn Partners, Philadelphia, PA, USA
| | - Daniel Malone
- Physical Therapy Program, University of Colorado - Anschutz Medical Campus, Aurora, CO, USA
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15
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Boldyrev L, Ghebremichael MS, Lotz MM, Kovarie G, Kennedy K, Keates S, Pories SE. Sleepless and Spent in Survivorship: Fatigue and Insomnia in Breast Cancer Survivors. Am Surg 2022; 88:2730-2736. [PMID: 35282702 DOI: 10.1177/00031348221078949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is estimated that there are 3.8 million breast cancer survivors in the United States. Addressing survivors' post-treatment needs is critical to providing quality healthcare. METHODS A standardized questionnaire for breast cancer survivors was employed to assess the health status, challenges, and concerns of our breast cancer patients at their survivorship visits, which were conducted 4 months after surgery. All patients were seen in the breast center at one community hospital over a 6-year period. RESULTS Responses to a standardized questionnaire that was administered to 505 consecutive breast cancer patients at their survivorship visits 4 months after surgery were evaluated. The most striking finding was that 35% reported symptoms of insomnia, 26% had persistent fatigue, and 19% experienced fatigue that interfered with their usual activities. There was a significant association between symptoms of insomnia and radiation treatment (P = .004), pain (P < .001), hormone therapy (P < .01), and side effects of hormone therapy (P < .0001). There was also a significant association between fatigue and pain (P < .001) as well as side effects from hormone treatment (P = .0036). CONCLUSIONS Over a third (35%) of breast cancer patients suffer from insomnia, while over a quarter (26%) complain of fatigue at their survivorship assessments. Contributing factors include radiation treatment, pain, and hormonal therapy. Careful assessment and treatment of fatigue and symptoms of insomnia in breast cancer patients is needed to improve quality of life for survivors.
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Affiliation(s)
- Laura Boldyrev
- Hoffman Breast Center, Department of Surgery, RinggoldID:14319Mount Auburn Hospital, Cambridge, MA, USA
| | - Musie S Ghebremichael
- RinggoldID:200750The Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Margaret M Lotz
- Hoffman Breast Center, Department of Surgery, RinggoldID:14319Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Gabrielle Kovarie
- Hoffman Breast Center, Department of Surgery, RinggoldID:14319Mount Auburn Hospital, Cambridge, MA, USA
| | - Kelly Kennedy
- Hoffman Breast Center, Department of Surgery, RinggoldID:14319Mount Auburn Hospital, Cambridge, MA, USA
| | - Sarah Keates
- Hoffman Breast Center, Department of Surgery, RinggoldID:14319Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susan E Pories
- Hoffman Breast Center, Department of Surgery, RinggoldID:14319Mount Auburn Hospital, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
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Venkataramu VN, Ghotra HK, Chaturvedi SK. Management of psychiatric disorders in patients with cancer. Indian J Psychiatry 2022; 64:S458-S472. [PMID: 35602367 PMCID: PMC9122176 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | - Santosh K Chaturvedi
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India.,Leicestershire Partnership NHS Trust, Thurmaston, Leicestershire, UK E-mail:
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17
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Cancer-related fatigue: benefits of information booklets to improve patients' knowledge and empowerment. Support Care Cancer 2022; 30:4813-4821. [PMID: 35147759 PMCID: PMC8853058 DOI: 10.1007/s00520-022-06833-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate cancer patients' knowledge and attitudes regarding fatigue and the potential benefits and acceptability of a brief information booklet. METHODS The CARPE DIEM study assessed knowledge and attitudes regarding fatigue in a diverse group of 50 cancer patients before (T0) and about one (T1) and four months (T2) after reading the booklet. At T1, participants additionally rated its usefulness. RESULTS At baseline, 37.5% of respondents did not know the term "fatigue" or what it meant. Those who already knew something about fatigue mainly had obtained their information from booklets, books, or articles (63.3%) and/or the internet (46.7%). Overall, knowledge gaps existed, particularly about potential fatigue treatment options and whether fatigue is an indicator of cancer progression. Furthermore, 56.4% felt poorly informed, and 46.1% reported feeling helpless in the face of fatigue. Lower knowledge at baseline was significantly associated with lower education and older age. At T1 and T2, there were significant improvements in several knowledge questions and attitudes. Patient-reported benefits included getting new information about fatigue (91.1%), awareness of not being alone with their problems (89.7%), taking appropriate actions (72.9%), and encouragement to talk about their fatigue with family/friends (55.3%) or with a health professional (52.7%). CONCLUSIONS Specific gaps were identified in the provision of information and education for cancer patients about fatigue. A low-cost intervention asking to read a brief information booklet was associated with improved knowledge. This could be considered as a first step offered as part of a bundle of further efforts to improve knowledge and care of fatigue.
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18
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Tolotti A, Bonetti L, Pedrazzani C, Bianchi M, Moser L, Pagnucci N, Sari D, Valcarenghi D. Nursing management of fatigue in cancer patients and suggestions for clinical practice: a mixed methods study. BMC Nurs 2021; 20:182. [PMID: 34583693 PMCID: PMC8477483 DOI: 10.1186/s12912-021-00699-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/19/2021] [Indexed: 01/29/2023] Open
Abstract
Background Fatigue is a complex and frequent symptom in cancer patients, influencing their quality of life, but it is still underestimated and undertreated in clinical practice. The aims of this study were to detect the presence of fatigue in cancer patients, describe how patients and nurses perceived it and how nurses managed fatigue. Methods This is a mixed methods study. Data were collected in two oncological wards using the Brief Fatigue Inventory (BFI), an ad hoc questionnaire, patient interviews, focus groups with nurses and the review of nursing records. Interviews and focus groups were analysed through thematic analysis. We used SPSS 22.0 for quantitative data and Nvivo 10 for qualitative data analysis. Results A total of 71 questionnaires were analysed (39 males, mean age 65.7 years). Fatigue was reported 5 times (7%) in nursing records, while in 17 cases (23.9%) problems associated to it were reported. Twelve patients were interviewed. Five themes were identified: feeling powerless and aggressive, my strategies or what helps me, feeling reassured by the presence of family members, feeling reassured by nurses’ gestures, and being informed. Three themes were identified through the focus groups: objectivity and subjectivity in the assessment of fatigue, nurses’ contribution to the multidisciplinary management of fatigue, and difficulty in evaluating outcomes. Conclusions The approach to the management of fatigue was unstructured. Patients were satisfied with the care they received but needed more information and specific interventions. Useful aspects were identified that could be used to change health professionals’ approach towards the management of fatigue. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00699-9.
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Affiliation(s)
- Angela Tolotti
- Nursing Research and Development Unit, Oncology Institute of Southern Switzerland (IOSI), Via Gallino, 12, 6500, Bellinzona, Switzerland
| | - Loris Bonetti
- Nursing Research and Development Unit, Oncology Institute of Southern Switzerland (IOSI), Via Gallino, 12, 6500, Bellinzona, Switzerland. .,Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland.
| | - Carla Pedrazzani
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland
| | - Monica Bianchi
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland (SUPSI), Manno, Switzerland
| | - Laura Moser
- Clinical Trial Unit, Oncology Institute of Southern Switzerland (IOSI), Via Gallino, 12, 6500, Bellinzona, Switzerland
| | - Nicola Pagnucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - Davide Sari
- Department of Nursing, Oncology Institute of Southern Switzerland (IOSI), Via Gallino, 12, 6500, Bellinzona, Switzerland
| | - Dario Valcarenghi
- Nursing Research and Development Unit, Oncology Institute of Southern Switzerland (IOSI), Via Gallino, 12, 6500, Bellinzona, Switzerland
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Abstract
A diagnosis of cancer is a major life stressor that can affect the physiological, psychological and physical state of the person concerned. Fatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness. The aim of this review is to provide background information on cancer-related fatigue. This review discusses cancer-related fatigue (CRF) in terms of the definition, prevalence, risk factors, aetiology, and the measurement scales used. The differences between definitions of symptoms and relevant theories will be explored and discussed to help explain the variety of instruments used in its measurement. The prevalence of fatigue will be assessed by looking critically at the evidence of fatigue and the factors that affect it. Potential treatment and management strategies for CRF will also be discussed. Finally, there will be an overview of the instruments used to measure fatigue. This review also provides important evidence for measuring and managing CRF that can help nurses to understand fatigue among patients with cancer. Assessing CRF should be routinely undertaken in clinical settings to help identify the proper interventions, treatments and management to reduce fatigue among cancer patients.
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Affiliation(s)
- Mohammed Al Maqbali
- Research Assistant, School of Applied Social and Policy Sciences, Ulster University, Magee Campus, Derry-Londonderry
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20
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Pearson EJ, Drosdowsky A, Edbrooke L, Denehy L. Exploring the Use of Two Brief Fatigue Screening Tools in Cancer Outpatient Clinics. Integr Cancer Ther 2021; 20:1534735420983443. [PMID: 33522317 PMCID: PMC7871054 DOI: 10.1177/1534735420983443] [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] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Cancer fatigue guidelines recommend routine fatigue screening, with further assessment for people reporting moderate to severe fatigue. There is neither a gold-standard, nor a broadly accepted screening method, and knowledge about the impact of screening on care processes is limited. This study aimed to explore the feasibility of 2 fatigue screening methods and current clinical practice in cancer outpatient clinics. METHODS Hospital outpatients attending cancer clinics during 1 week completed a five-item survey: a numeric scale for current tiredness, 2 categorical pictorial scales rating tiredness last week and the impact of fatigue (Fatigue Pictogram), screening tool preference and help needed for survey completion. Participant demographics and fatigue documentation by clinical staff for that appointment were extracted from medical records. Analyses used descriptive statistics. Groups were compared using appropriate statistical tests. RESULTS Over 75% of participants rated their fatigue consistently as mild or significant on both screening tools. Of 1709 eligible outpatients, 533 (31%) completed the survey. Records were audited for 430 (81%) identifiable participants. Over half of the participants reported moderate or severe tiredness either "now" (237, 57%) and/or "last week" (226, 53%). Clinician documentation of fatigue seldom matched self-reports. Fatigue was rated as severe by 103 participants (24%), yet was noted in only 21 (20%) of these individuals' clinical notes. Both screening tools were equally preferred. CONCLUSION The numeric rating scale and Fatigue Pictogram are equally applicable for screening fatigue in cancer outpatient care. There is a high prevalence of clinically significant fatigue in a hospital outpatient setting that is not documented. Adequate care pathways for further management should be established alongside fatigue screening.
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Affiliation(s)
- Elizabeth J Pearson
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Allison Drosdowsky
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Lara Edbrooke
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Linda Denehy
- The University of Melbourne, Melbourne, Victoria, Australia.,Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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21
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van der Borg WE, Verdonk P, de Jong-Camerik J, Abma TA. How to relate to dialysis patients' fatigue - perspectives of dialysis nurses and renal health professionals: A qualitative study. Int J Nurs Stud 2021; 117:103884. [PMID: 33631400 DOI: 10.1016/j.ijnurstu.2021.103884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although fatigue among the dialysis population is known as a severe and debilitating health problem, this symptom is often under recognized and undertreated. OBJECTIVE This qualitative study aimed to gain a better understanding of how dialysis nurses and renal health professionals perceive and address dialysis patient's fatigue in renal care practice. DESIGN We conducted a qualitative descriptive study to explore how nurses and renal health professionals perceive and address dialysis patients' fatigue in their daily health care practices. A constructivist grounded theory approach guided analysis and conceptualisation of findings. SETTING(S) This study took place at 13 academic and regional settings across the Netherlands. The study was approved by the Medical Ethics Committee (2015.049), on behalf of VU University medical center in Amsterdam. PARTICIPANTS Twenty-one renal health professionals of various disciplines took part in interviews: ten dialysis nurses, four nephrologists, two physician assistants, five medical social workers. METHODS Semi-structured interviews were conducted in order to gain in-depth insight into the perspectives of dialysis nurses and renal health professionals. An inductive thematic analysis provided insight into health professionals' stances toward dialysis patients' fatigue in light of their daily care context and practices. RESULTS Two main themes emerged; 1) 'Fatigue in the background': Shows there is strong focus on medical-technical aspects of the disease. All health professionals perceive fatigue as an intangible symptom that is difficult to address, and falls outside their scope of responsibility and competence. Communication about fatigue among professionals and with patients is limited, pushing fatigue further into the background. 2) 'Vulnerabilities in the background': Especially nurses and social workers signal the accumulating vulnerabilities of dialysis patients and associate these with fatigue (old age, multimorbidities, financial and social problems). Although the need for psychological support is acknowledged, multiple vulnerabilities increase the complexity and intensity of care, and further strengthens the medical-technical focus of care and treatment. CONCLUSIONS There is a need to enable renal health professionals to communicate about the complex nature of fatigue in renal patients and stimulate interdisciplinary exchange and shared responsibility. Dialysis nurses have frequent contact with patients during dialysis treatment and are the first to notice when patients' fatigue increases and their overall condition deteriorates. They can play an important role to go beyond the technological imperative of care and understand the lived experiences of patients within their social contexts.
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Affiliation(s)
- Wieke E van der Borg
- Amsterdam UMC, location VUmc, Department of Ethics, Law and Humanities, Amsterdam, the Netherlands.
| | - Petra Verdonk
- Amsterdam UMC, location VUmc, Department of Ethics, Law and Humanities, Amsterdam, the Netherlands
| | - Judith de Jong-Camerik
- Amsterdam UMC, location VUmc, Department of Ethics, Law and Humanities, Amsterdam, the Netherlands
| | - Tineke A Abma
- Amsterdam UMC, location VUmc, Department of Ethics, Law and Humanities, Amsterdam, the Netherlands
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22
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Martin E, Zingarello A, Di Meglio A, Baciarello G, Matias M, Charles C, Arvis J, Dumas A, Menvielle G, Vaz-Luis I. A qualitative evaluation of the use of interventions to treat fatigue among cancer survivors: A healthcare provider's view. Eur J Cancer Care (Engl) 2020; 30:e13370. [PMID: 33191520 DOI: 10.1111/ecc.13370] [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: 04/14/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cancer-related fatigue (CRF) is among the most common and distressing side effects of cancer treatment. Different types of interventions, including physical activity (PA), psychosocial and mind-body interventions, have been shown to reduce CRF. We aimed to explore HCPs' practices and barriers to refer patients towards interventions to reduce CRF. METHODS We performed a qualitative study using key informant interviews among a sample of 20 HCPs including medical, surgical and radiation oncologists, pain specialists, nurses, psychologists, psychiatrists and physiotherapists recruited from breast, prostate and colorectal cancer disease groups from a comprehensive cancer centre. RESULTS Most interviewees reported not to address CRF spontaneously during consultations. When the topic of CRF was brought up by patients, all interviewees acknowledged to recommend PA, whereas few would recommend psychosocial or mind-body interventions. Barriers to recommend interventions to manage CRF included: lack of knowledge about CRF and its treatment, lack of time and complexity of the referral due to their accessibility and cost. CONCLUSION In a diverse sample of HCPs, most acknowledged not to address CRF proactively with their patients, but identified several actionable barriers. Specific training on screening and management of CRF and improving the referral network dedicated to interventions need to be implemented.
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Affiliation(s)
- Elise Martin
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Anna Zingarello
- Hôpital Saint-Camille, Unité de Soins Médicaux en Oncologie (USMO), Bry-sur-Marne, France
| | - Antonio Di Meglio
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France
| | - Giulia Baciarello
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Margarida Matias
- Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
| | - Cécile Charles
- Psycho-Oncology Unit, Institut Gustave Roussy, Villejuif, France
| | | | - Agnès Dumas
- Inserm Unit 1123, Unité ECEVE, Université de Paris, Paris, France
| | - Gwenn Menvielle
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et Santé Publique (IPLESP), Paris, France
| | - Ines Vaz-Luis
- Institut Gustave Roussy, Université Paris-Saclay, Inserm, Biomarqueurs Prédictifs et Nouvelles Stratégies Thérapeutiques en Oncologie, Villejuif, France.,Medical Oncology Department, Institut Gustave Roussy, Villejuif, France
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23
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Willmott E, Loades M, Baker L, Spathis A. Cancer-related fatigue in teenage and young adult cancer patients: Clinicians' perspectives, practice and challenges. Eur J Cancer Care (Engl) 2020; 30:e13337. [PMID: 33015937 DOI: 10.1111/ecc.13337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/20/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cancer-related fatigue (CRF) is a common and distressing symptom experienced by teenage and young adult cancer patients (TYAs). This study aimed to explore clinicians' perspectives, practices and challenges in supporting TYAs with CRF. METHOD Ten clinicians from a TYA multidisciplinary team (MDT) participated in semi-structured interviews which were thematically analysed. RESULTS Clinicians perceived CRF as a common, but individual experience for TYAs and framed the broad impact of CRF in the context of TYAs' development. Clinicians' assessment and management of CRF for TYAs varied. Clinicians described a range of challenges affecting their practice in supporting TYAs with CRF, including limited knowledge, difficulties engaging TYAs, inadequate time in consultations and a lack of age-appropriate resources. CONCLUSIONS Despite clinicians' good insight into TYAs' unique experiences of CRF, the assessment and management of CRF for TYAs are complicated by numerous challenges. The development of evidence-based interventions and guidelines, clear pathways of care, and TYA-friendly resources, measures and programmes, is vital to support clinicians, and TYAs, in managing CRF.
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Affiliation(s)
- Emma Willmott
- Department of Psychology, University of Bath, Bath, UK
| | - Maria Loades
- Department of Psychology, University of Bath, Bath, UK.,Bristol Medical School, University of Bristol, Bristol, UK
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24
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Simon H, Ganem G, Touboul C, Lhomel C, Morère J. Patient perspectives on supportive care in cancer: Results of the Calista 2 study. Eur J Cancer Care (Engl) 2020; 29:e13299. [DOI: 10.1111/ecc.13299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/03/2020] [Accepted: 08/07/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Hélène Simon
- Institut de Cancérologie et d’Hématologie Brest France
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25
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A perfect storm and patient-provider breakdown in communication: two mechanisms underlying practice gaps in cancer-related fatigue guidelines implementation. Support Care Cancer 2020; 29:1873-1881. [PMID: 32793998 DOI: 10.1007/s00520-020-05676-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a debilitating symptom experienced by many cancer patients. Although guidelines provide evidence-based recommendations for screening, assessing, and managing CRF, there is limited evidence of their implementation in practice. This study aimed to explore patients', healthcare providers' (HCPs), community support providers' (CSPs) experiences and opinions on CRF guidelines and the underlying causes of CRF treatment gaps following the Knowledge-to-Action model. METHODS A total of 62 participants were recruited-16 patients, 32 HCPs, and 14 CSPs-for a total of 9 focus groups and 4 individual interviews. Sessions were recorded and transcribed verbatim. Transcripts were analyzed using thematic analysis. RESULTS There were gaps in the application of CRF guidelines and patient dissatisfaction with care. Two underlying mechanisms may contribute to these gaps. First, professionals' lack of knowledge and resources paired with systemic obstacles created difficult conditions to adequately address CRF-A Perfect Storm. Further, patient-provider communication gaps lead to patients feeling discouraged to report issues to their healthcare teams and turning to community services for help-A Breakdown in Communication. CONCLUSIONS There is little indication that CRF guidelines are routinely implemented in clinical practice. This study provides insights from various perspectives to aid understanding of the critical issues that require consideration to increase implementation of CRF guidelines by HCPs. As patients are currently dissatisfied with CRF-related care, implementation of CRF guidelines is needed.
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26
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Rau KM, Shun SC, Chiou TJ, Lu CH, Ko WH, Lee MY, Huang WT, Yeh KH, Chang CS, Hsieh RK. A nationwide survey of fatigue in cancer patients in Taiwan: an unmet need. Jpn J Clin Oncol 2020; 50:693-700. [PMID: 32303764 PMCID: PMC7284537 DOI: 10.1093/jjco/hyaa038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/03/2020] [Accepted: 03/05/2020] [Indexed: 11/15/2022] Open
Abstract
Background Cancer-related fatigue (CRF) is an emerging clinical issue, although its prevalence and impact on quality of life (QOL) in cancer patients in Taiwan remain unclear. The present nationwide cross-sectional study was conducted to provide a thorough overview of the prevalence, related factors and impact of CRF in Taiwan. Methods In this multi-center survey, data were collected using the International Classification of Diseases 10th Revision (ICD-10) Fatigue evaluation, Brief Fatigue Inventory–Taiwan (BFI-T), the Chinese version of the Symptom Distressed Scale and a fatigue experience survey. Logistic regression was used to determine the correlations between fatigue characteristics and the factors studied. Results A total of 1207 cancer patients were recruited from 23 hospitals in Taiwan. Fatigue was the most distressing symptom in Taiwanese cancer patients. The distress score was higher if CRF was diagnosed using ICD-10 compared with BFI-T. Rest and nutritional supplementation were the most common non-pharmacological treatments; blood transfusion was the most common pharmacological treatment. There were 45% of patients reported not receiving a timely intervention for fatigue. Conclusions Fatigue is the most bothersome symptom reported by Taiwanese cancer patients. Caregivers should be aware of the impact of CRF on QOL in cancer patients, constantly measure the severity of fatigue and provide appropriate interventions.
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Affiliation(s)
- Kun-Ming Rau
- Department of Hematology-Oncology, E-Da Cancer Hospital, Kaohsiung, Taiwan.,I-Shou University, Collage of Medicine, Kaohsiung, Taiwan
| | | | - Tzeon-Jye Chiou
- Cancer Center, Taipei Municipal Wanfang Hospital, Taipei, Taiwan
| | - Chang-Hsien Lu
- Division of Hematology-Oncology, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Wei-Hsu Ko
- Anfa Clinic, Taipei, Taiwan.,Division of Gastroenterology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Ming-Yang Lee
- Department of Hematology and Oncology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wen-Tsung Huang
- Department of Hematology and Oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kun-Huei Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Cheng-Shyong Chang
- Division of Hematology-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.,Division of Hematology-Oncology, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ruey-Kuen Hsieh
- Department of Hematology and Oncology, MacKay Memorial Hospital, Taipei, Taiwan
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27
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Ingham G, Urban K. How Confident Are We at Assessing and Managing Fatigue in Palliative Care Patients? A Multicenter Survey Exploring the Current Attitudes of Palliative Care Professionals. Palliat Med Rep 2020; 1:58-65. [PMID: 34223457 PMCID: PMC8241319 DOI: 10.1089/pmr.2020.0005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 12/26/2022] Open
Abstract
Background: Fatigue is a common and significant problem for palliative care (PC) patients, affecting up to 80% of patients. Health care professionals (HCPs) commonly underestimate its significance and lack the confidence in how to manage it, resulting in poor quality of life. It is currently not known how PC professionals manage fatigue in clinical practice or what the barriers to implementation are. Objective: To determine the current attitudes of HCPs toward fatigue management in patients with a life-limiting illness. Design/Setting: An electronic survey, created on REDCap, was distributed to all staff working directly with PC patients in both the community and inpatient setting within the Sydney Local Health District. The study duration was for four weeks (May 1-30, 2018). Results: Participants recognized that fatigue is common, but only 58.5% recognized that severe fatigue is more distressing than pain. A total of 77.2% of participants do not find fatigue an easy symptom to manage and less than half (46.9%) feel confident assessing and managing it. There was no consistent systematic approach to management although exercise, education, and pacing/energy conservation were recognized as important interventions. Themes identified as potential barriers to management included lack of resources, poor patient and staff understanding, and patient/disease factors. Conclusions: HCPs lack confidence in assessing fatigue and completing an individualized management plan; the approaches adopted are highly variable. This justifies the need for further education, as well as further research assessing the efficacy of a multimodal intervention and a guideline to assist in management.
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Affiliation(s)
- Gemma Ingham
- Department of Palliative Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Katalin Urban
- Department of Palliative Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
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28
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Jones G, Rutkowski N, Trudel G, St-Gelais C, Ladouceur M, Brunet J, Lebel S. Translating guidelines to practice: a training session about cancer-related fatigue. ACTA ACUST UNITED AC 2020; 27:e163-e170. [PMID: 32489265 DOI: 10.3747/co.27.5681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Cancer-related fatigue (crf) is the highest unmet need in cancer survivors. The Canadian Association of Psychosocial Oncology (capo) has developed guidelines for screening, assessment, and intervention in crf; however, those guidelines are not consistently applied in practice because of patient, health care provider (hcp), and systemic barriers. Notably, previous studies have identified a lack of knowledge of crf guidelines as an impediment to implementation. Methods In this pilot study, we tested the preliminary outcomes, acceptability, and feasibility of a training session and a knowledge translation (kt) tool designed to increase knowledge of the capo crf guidelines among hcps and community support providers (csps). A one-time in-person training session was offered to a diverse sample of hcps and csps (n = 18). Outcomes (that is, knowledge of the capo crf guidelines, and intentions and self-efficacy to apply guidelines in practice) were assessed before and after training. Acceptability and feasibility were also assessed after training to guide future testing and implementation of the training. Results After training, participants reported increased knowledge of the capo crf guidelines and greater self-efficacy and intent to apply guidelines in practice. Participant satisfaction with the training session and the kt tool was high, and recruitment time, participation, and retention rates indicated that the training was acceptable and feasible. Conclusions The provided training is both acceptable to hcps and csps and feasible. It could increase knowledge of the capo crf guidelines and participant intentions and self-efficacy to implement evidence-based recommendations. Future studies should investigate actual changes in practice and how to optimize follow-up assessments. To promote practice uptake, kt strategies should be paired with guideline development.
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Affiliation(s)
- G Jones
- School of Psychology, University of Ottawa, Ottawa, ON
| | - N Rutkowski
- School of Psychology, University of Ottawa, Ottawa, ON
| | - G Trudel
- School of Psychology, University of Ottawa, Ottawa, ON
| | | | - M Ladouceur
- Ottawa Regional Cancer Foundation, Ottawa, ON
| | - J Brunet
- School of Psychology, University of Ottawa, Ottawa, ON.,School of Human Kinetics, University of Ottawa, Ottawa, ON
| | - S Lebel
- School of Psychology, University of Ottawa, Ottawa, ON
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29
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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: 3] [Impact Index Per Article: 0.6] [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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30
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Hashemi BM, Sarabian S, Kashani Lotfabadi M, Hosseini S, Mohammadi A. The Effect of Spiritual Intelligence Training on Human Dignity in Patients with Cancer: Clinical Trial. ACTA ACUST UNITED AC 2019. [DOI: 10.30699/ajnmc.27.4.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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31
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Howlett O, McKinstry C, Lannin NA. Using the cognitive interviewing process to improve survey design by allied health: A qualitative study. Aust Occup Ther J 2017; 65:126-134. [DOI: 10.1111/1440-1630.12445] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Owen Howlett
- La Trobe Rural Health School; La Trobe University; Bendigo Victoria Australia
- Outpatient Rehabilitation Services; Bendigo Health; Bendigo Victoria Australia
| | - Carol McKinstry
- La Trobe Rural Health School; La Trobe University; Bendigo Victoria Australia
| | - Natasha A. Lannin
- College of Science, Health and Engineering; School of Allied Health; La Trobe University; Melbourne Victoria Australia
- Occupational Therapy; Alfred Health; Melbourne Victoria Australia
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32
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Pearson EJM, Morris ME, McKinstry CE. Cancer related fatigue: implementing guidelines for optimal management. BMC Health Serv Res 2017; 17:496. [PMID: 28720109 PMCID: PMC5516360 DOI: 10.1186/s12913-017-2415-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/28/2017] [Indexed: 01/28/2023] Open
Abstract
Background Cancer-related fatigue (CRF) is a key concern for people living with cancer and can impair physical functioning and activities of daily living. Evidence-based guidelines for CRF are available, yet inconsistently implemented globally. This study aimed to identify barriers and enablers to applying a cancer fatigue guideline and to derive implementation strategies. Methods A mixed-method study explored the feasibility of implementing the CRF guideline developed by the Canadian Association for Psychosocial Oncology (CAPO). Health professionals, managers and consumers from different practice settings participated in a modified Delphi study with two survey rounds. A reference group informed the design of the study including the surveys. The first round focused on guideline characteristics, compatibility with current practice and experience, and behaviour change. The second survey built upon and triangulated the first round. Results Forty-five health practitioners and managers, and 68 cancer survivors completed the surveys. More than 75% of participants endorsed the CAPO cancer related fatigue guidelines. Some respondents perceived a lack of resources for accessible and expert fatigue management services. Further barriers to guideline implementation included complexity, limited practical details for some elements, and lack of clinical tools such as assessment tools or patient education materials. Recommendations to enhance guideline applicability centred around four main themes: (1) balancing the level of detail in the CAPO guideline with ease of use, (2) defining roles of different professional disciplines in CRF management, (3) how best to integrate CRF management into policy and practice, (4) how best to ensure a consumer-focused approach to CRF management. Conclusions Translating current knowledge on optimal management of CRF into clinical practice can be enhanced by the adoption of valid guidelines. This study indicates that it is feasible to adopt the CAPO guidelines. Clinical application may be further enhanced with guideline adaptation, professional education and integration with existing practices. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2415-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth J M Pearson
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, 3552, Australia. .,La Trobe University, School of Allied Health, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia.
| | - Meg E Morris
- La Trobe University, School of Allied Health, Kingsbury Drive, Bundoora, Melbourne, VIC, 3086, Australia.,Office of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Carol E McKinstry
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, 3552, Australia
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33
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Fischer I, Riedner C, Bojko P, Heim ME, Rüffer JU, Besseler M, Heußner P, Milani V, Rinas N, Schlimok G, Schneider E, Koller M. Consultation Program for Patients with Cancer-Related Fatigue: A Systematic Evaluation of the Experiences of the Bavarian Cancer Society. Oncol Res Treat 2016; 39:646-651. [PMID: 27710976 DOI: 10.1159/000448907] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/05/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Irene Fischer
- Institut für Tumor-Fatigue-Forschung, Emskirchen, Germany
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34
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Aapro M, Scotte F, Bouillet T, Currow D, Vigano A. A Practical Approach to Fatigue Management in Colorectal Cancer. Clin Colorectal Cancer 2016; 16:275-285. [PMID: 29066018 DOI: 10.1016/j.clcc.2016.04.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 04/08/2016] [Accepted: 04/27/2016] [Indexed: 01/06/2023]
Abstract
Cancer-related fatigue is serious and complex, as well as one of the most common symptoms experienced by patients with colorectal cancer, with the potential to compromise quality of life, activities of daily living, and ultimately survival. There is a lack of consensus about the definition of cancer-related fatigue; however, definitions have been put forward by the European Association for Palliative Care (EAPC) and the National Comprehensive Cancer Network (NCCN). Numerous cancer- and treatment-related factors can contribute to fatigue, including disease progression, comorbidities, medical complications such as anemia, side effects of other medications, and a number of physical and psychologic factors. This underlines the importance of tackling factors that may contribute to fatigue before reducing the dose of treatment. NCCN guidelines and the EAPC have proposed approaches to managing fatigue in cancer patients; however, relatively few therapeutic agents have been demonstrated to reduce fatigue in randomized controlled trials. It is recognized that physical activity produces many beneficial physiologic modifications to markers of physical performance that can help to counteract various causes of fatigue. In appropriately managed and monitored patients with colorectal cancer, emerging evidence indicates that exercise programs may have a favorable influence on cancer-related fatigue, quality of life, and clinical outcomes, and therefore may help patients tolerate chemotherapy. This review assesses fatigue in patients with colorectal cancer and proposes updates to a treatment algorithm that may help clinicians manage this common problem.
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Affiliation(s)
- Matti Aapro
- Multidisciplinary Oncology Institute, Clinique de Genolier, Genolier, Switzerland.
| | - Florian Scotte
- Oncology Department, Georges Pompidou European Hospital, Paris, France
| | - Thierry Bouillet
- Oncology Department, University Hospital Avicenne, Bobigny, France
| | - David Currow
- Palliative and Supportive Services, Flinders University, Adelaide, Australia
| | - Antonio Vigano
- McGill Nutrition and Performance Laboratory and Division of Supportive and Palliative Care, McGill University Health Centre, Montreal, Canada
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35
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Pearson EJM, Morris ME, McKinstry CE. Cancer-related fatigue: appraising evidence-based guidelines for screening, assessment and management. Support Care Cancer 2016; 24:3935-42. [PMID: 27116014 DOI: 10.1007/s00520-016-3228-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE There is inconsistent management of cancer-related fatigue (CRF) by health professionals worldwide. This research aims to identify the most appropriate guidelines for the management of cancer-related fatigue. METHODS A systematic search of international literature identified evidence-based clinical practice guidelines for CRF. Four reviewers independently appraised the highest quality guidelines using the AGREE-II instrument and National Heath and Medical Research Council (NHMRC) guideline standards. RESULTS Five guidelines met the inclusion criteria. Of these, the 2015 Canadian Association of Psychosocial Oncology (CAPO) CRF guidelines and the 2014 American Society of Clinical Oncology (ASCO) fatigue guidelines for cancer survivors were selected for in-depth appraisal. The CAPO guideline scored higher than the ASCO for five domains of the AGREE-II. For one domain, the differences were statistically significant (p ≤ 0.05). The CAPO guideline met 37 of 47 NHMRC mandatory guideline standards and the ASCO guideline met 20. The difference in the proportion of standards met was statistically significant for one domain (p ≤ 0.05). Both guidelines had low scores for applicability and implementation. CONCLUSIONS Currently, the CAPO guideline for cancer-related fatigue has the strongest evidence for use. To enhance implementation, further strategies for guideline dissemination and application are needed.
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Affiliation(s)
| | - Meg E Morris
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Carol E McKinstry
- Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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