The cancer patients' perspective on feasibility of using a fatigue diary and the benefits on self-management: results from a longitudinal study

Effects of a mobile health coaching intervention on symptom experience, self-management, and quality of life in breast cancer survivors: A quasi-experimental study

BACKGROUND

Patients diagnosed with breast cancer in South Korea have a longer post-diagnosis survival period compared to those in the United States and Europe. Therefore, it is essential to establish an effective posttreatment care system to enhance their quality of life (QOL). This study aimed to evaluate the effectiveness of a mobile health coaching intervention designed to improve symptom experience, self-management, and QOL in patients with breast cancer following the active phase of their treatment.

METHODS

This study was a quasi-experimental, pre-post design conducted with breast cancer patients receiving treatment at a tertiary general hospital in Korea from July 2021 to June 2022. Participants were sequentially assigned to the control and intervention groups. Those in the intervention group participated in a 12-week mobile health coaching intervention comprising education sessions, peer support groups, and recording a health diary. The outcome variables were symptom experience, self-management, and QOL. Data were collected at baseline (T0), after the intervention (T1), and 3 months after the intervention (T2) and compared using repeated analysis of variance.

RESULTS

Seventy-four participants (mean age 46.93 years) who had completed the active phase of cancer treatment were included. The intervention group showed a significant decrease in symptom experience, from 1.57 ± 0.46 (T0) to 1.03 ± 0.46 (T1) (P = .006), and a decrease in psychological symptoms from 1.71 ± 0.93 (T0) to 1.66 ± 0.69 (T2) (P = .049). Self-management scores significantly increased from 74.43 ± 10.72 (T0) to 76.90 ± 11.99 (T2) (P = .028). QOL improved from 95.83 ± 18.62 (T0) to 96.40 ± 15.35 (T2) (P = .015), and emotional well-being increased from 17.42 ± 4.91 (T0) to 17.50 ± 3.63 (T2) (P < .001), with all showing significant group × time interactions.

CONCLUSIONS

The 12-week mobile health coaching program significantly reduced symptoms, improved self-management, and enhanced overall QOL and emotional well-being in breast cancer survivors who had completed primary treatment. These findings highlight the program's potential to support posttreatment recovery. Further research is needed to assess its long-term effects across diverse patient populations and cancer types to validate its broader effectiveness.

Unraveling the fatigue puzzle: insights into the pathogenesis and management of IBD-related fatigue including the role of the gut-brain axis

A significant percentage of patients with an inflammatory bowel disease (IBD) encounter fatigue which can profoundly diminish patients' quality of life, particularly during periods of disease remission when gastrointestinal symptoms have receded. Various contributing risk factors have been identified including active inflammation, anemia, psychological, lifestyle and drug-related factors. While addressing these risk factors has been suggested as the initial approach to managing fatigue, a considerable number of patients still experience persisting symptoms, the primary causes of which remain incompletely understood. Recent insights suggest that dysfunction of the gut-brain axis may play a pathogenic role. This review provides an overview of established risk factors for fatigue, alongside emerging perspectives on the role of the gut-brain axis, and potential treatment strategies.

Turning a Curve: How People Use Everyday Resources to Negotiate Recovery From Cancer Treatment With Curative Intent

Many more cancers are treated with intent to cure now than in previous decades, but for most, this involves significant effects from which people need to recover psychologically and socially, as well as physically. This longitudinal photo-elicitation interview study uses grounded theory to explain how people discharged from specialist care made use of everyday social and material resources to manage this process at home. Recovery is presented as a curve in life's pathway requiring gradual reorientation, drawing on social worlds and domestic resources to calibrate this process. Findings are described in three stages: (1) responding to diagnosis and treatment, (2) using social resources for meaning-making, and (3) developing assets for recovery. During treatment, participants drew on past identities to reinforce their sense of self, and personalized health care communication supported this process. In the weeks after treatment, new frameworks of understanding were constructed from perspectives on cancer encountered in the family, workplace, and outpatient clinics. Recovery processes included the negotiation of personal change, the renegotiation of close relationships, and the use of everyday resources to regain three sensations: control, comfort, and continuity. Supportive care would benefit from an individualized exploration of the assets that can help people to negotiate this challenging phase as treatment comes to a close. Possibilities for self-care (the maintenance of health and well-being in the context of everyday life) can be explored and assessed through personalized discussion around the identities, social worlds, and everyday resources available to each individual.

Patient-physician communication about cancer-related fatigue: a survey of patient-perceived barriers

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.

Integrative Oncology Care of Symptoms of Anxiety and Depression in Adults With Cancer: Society for Integrative Oncology-ASCO Guideline

PURPOSE

To provide evidence-based recommendations to health care providers on integrative approaches to managing anxiety and depression symptoms in adults living with cancer.

METHODS

The Society for Integrative Oncology and ASCO convened an expert panel of integrative oncology, medical oncology, radiation oncology, surgical oncology, palliative oncology, social sciences, mind-body medicine, nursing, methodology, and patient advocacy representatives. The literature search included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2023. Outcomes of interest included anxiety or depression symptoms as measured by validated psychometric tools, and adverse events. Expert panel members used this evidence and informal consensus with the Guidelines into Decision Support methodology to develop evidence-based guideline recommendations.

RESULTS

The literature search identified 110 relevant studies (30 systematic reviews and 80 randomized controlled trials) to inform the evidence base for this guideline.

RECOMMENDATIONS

Recommendations were made for mindfulness-based interventions (MBIs), yoga, relaxation, music therapy, reflexology, and aromatherapy (using inhalation) for treating symptoms of anxiety during active treatment; and MBIs, yoga, acupuncture, tai chi and/or qigong, and reflexology for treating anxiety symptoms after cancer treatment. For depression symptoms, MBIs, yoga, music therapy, relaxation, and reflexology were recommended during treatment, and MBIs, yoga, and tai chi and/or qigong were recommended post-treatment.

DISCUSSION

Issues of patient-health care provider communication, health disparities, comorbid medical conditions, cost implications, guideline implementation, provider training and credentialing, and quality assurance of natural health products are discussed. While several approaches such as MBIs and yoga appear effective, limitations of the evidence base including assessment of risk of bias, nonstandardization of therapies, lack of diversity in study samples, and lack of active control conditions as well as future research directions are discussed.Additional information is available at www.asco.org/survivorship-guidelines.