Causal relationships among factors associated with cancer-related fatigue

Mindfulness-Based Cancer Recovery (MBCR) training: the efficacy on fatigue and sleep quality of Iranian female patients with cancer

OBJECTIVE

The present study aimed to examine the efficacy of Mindfulness-Based Cancer Recovery (MBCR) training on fatigue and sleep quality of Iranian female patients with cancer.

METHOD

Thirty female patients with cancer were randomized to one of the MBCR and control groups. Subjects of the MBCR group received 8 sessions of MBCR training, while subjects of the control group received a 1-day didactic stress management seminar (SMS). All participants responded to the Cancer Fatigue Scale (CFT) and the Pittsburgh Sleep Quality Scale (PSQL) as pre- and post-test measures.

RESULTS

Using MANCOVA for analyzing data revealed a significant improvement in the level of fatigue among subjects of the MBCR group compared to the controls; however, MBCR had no significant effect on the level of sleep quality.

CONCLUSION

The Mindfulness-Based Cancer Recovery program can be considered an effective approach to reducing fatigue for Iranian female patients with cancer. The clinical implications of this finding require further investigation.

TRIAL REGISTRATION

The study was registered with the Iranian Registry of Clinical Trials (IRCT) on 24 June 2024; see [IRCT20240315061296N1].

Change in cancer-related fatigue over time predict health-related quality of life in ovarian cancer patients

OBJECTIVE

There is limited research examining how change in cancer-related fatigue (CRF) over time predicts change in health-related quality of life (HRQOL), and no studies have examined this relationship in ovarian cancer patients, specifically. The purpose of this study was to explore the prevalence and trajectory of CRF over time and examine how change in CRF over time predicts change in HRQOL in ovarian cancer patients.

METHODS

Ovarian cancer patients (N = 202) were recruited from Princess Margaret Cancer Centre in Toronto, Canada. Consenting participants completed measures at baseline (beginning of study) and again three months later. Data were analyzed using a longitudinal multilevel mixed model design.

RESULTS

Four groups of CRF trajectories emerged. Fifty-four percent reported CRF as always present, 16% reported CRF subsided, 21% reported CRF developed, and 9% reported CRF as never present. As CRF developed, functional and physical wellbeing decreased. As CRF subsided, functional, physical, and emotional wellbeing improved. CRF trajectory was not associated with change in social wellbeing over time.

CONCLUSIONS

Our findings suggest CRF negatively impacts all domains of HRQOL except for social wellbeing in ovarian cancer patients. Among patients who reported that CRF improved over time, all HRQOL domains impacted by CRF showed recovery to normal endorsement rates. Among patients who reported development of CRF, impacted HRQOL domains significantly declined over time. Implications from this research indicate that fatigue management should be prioritized during and after cancer treatment to ensure optimal physical, functional, and emotional wellbeing.

Pain or fatigue: which correlates more with suffering in hospitalized cancer patients?

BACKGROUND

The association of pain and suffering seems intuitive, but evidence substantiating this association is lacking. In studies of cancer patients, fatigue, rather than pain, is the most prevalent and debilitating symptom. This study aimed to compare the correlation of pain and fatigue to suffering, and identify other potential sources of suffering in cancer patients treated in a palliative care unit.

METHODS

One hundred fifty cancer patients were surveyed. Fifteen variables were measured on a 0- to 10-point scale: suffering, pain, level of acceptable pain, effect of pain on quality of life, fatigue, level of acceptable fatigue, effect of fatigue on quality of life, and specific types of suffering. Univariable associations with suffering were made with Pearson correlation (continuous variables) or t test (binary predictors). Multivariable associations with suffering were assessed with linear regression analysis and bootstrapping.

RESULTS

In multivariable analysis, highest pain (parameter estimate 0.38) had a greater impact on suffering than highest fatigue (parameter estimate 0.21). When other variables were assessed, 38% of the variability in suffering was accounted for by pain "now", fatigue in the past 24 hours, and age.

CONCLUSION

The most important predictors of greater suffering in hospitalized cancer patients are pain, younger age, and fatigue. Despite their significant effect on suffering, other underlying contributors to suffering have yet to be identified. Designing interventions to reduce fatigue, in addition to pain management, may help in alleviating overall suffering.

Correlates of Physical Activity in Colorectal Cancer Patients Based on Health Promotion Model

BACKGROUND

Increasing attention is being given to physical activity in colorectal cancer patients. Some studies have explored a few correlates of physical activity separately. A contemporary study based on the Health Promotion Model may systematically broaden the understanding of physical activity in colorectal cancer patients.

OBJECTIVE

To understand the status of physical activity in Chinese colorectal cancer patients and to explore the correlated factors.

METHODS

A total of 168 adults with colorectal cancer were recruited at 3 tertiary hospitals in China. Participant data were collected on demographics, physical activity, biological factors, anxiety and depression, benefits/barriers to physical activity, self-efficacy, and social support. SAS 8.2 was used for statistical analysis, including descriptive analysis, correlation analysis, single factor analysis, and multiple stepwise regression analysis.

RESULTS

Only 25.60% of colorectal cancer survivors reached the requirements of the Colorectal Cancer Survivorship Care Guidelines. Employment states, number of complications, fatigue, body image, depression, perception of benefits/barriers, and self-efficacy were closely correlated with physical activity in Chinese colorectal cancer patients.

CONCLUSIONS

The physical activity status of patients with colorectal cancer is not optimal. The correlated factors that nurses can take measures to improve are fatigue, body image, depression, perception of benefits/barriers, and self-efficacy, which may improve physical activity in colorectal cancer patients in China. Additional research is needed to determine if improving factors correlated with physical activity will assist with directly increasing physical activity.

IMPLICATIONS FOR PRACTICE

Nurses should evaluate physical activity of colorectal cancer patients timely and play an active role in health promotion programs to improve colorectal cancer patients' physical activity.

The effect of exercise on cancer-related fatigue in cancer survivors: a systematic review and meta-analysis

OBJECTIVE

The objective of the study was to conduct systematic review and meta-analysis to establish the effect of exercise interventions on cancer-related fatigue (CRF) in cancer survivors, compared to non-exercise intervention controls.

METHODS

Trials published between January 1st 2000 and August 17th 2016 were included through PubMed database search and search of references. Eligible trials compared the effect of an exercise intervention on CRF compared to non-exercise intervention controls, with CRF as primary outcome and measured by validated self-report questionnaire, in cancer survivors not receiving palliative care. We evaluated risk of bias of individual trials following Cochrane Quality criteria. We performed a random-effects meta-analysis in the low risk of bias trials with intervention type, exercise intensity, adherence, and cancer type as moderators, and also performed meta-regression analyses and a sensitivity analysis including the high risk of bias trials.

RESULTS

Out of 274 trials, 11 met the inclusion criteria, of which six had low risk of bias. Exercise improved CRF with large effect size (Cohen's d 0.605, 95% CI 0.235-0.975) with no significant difference between types of cancer. Aerobic exercise (Δ=1.009, CI 0.222-1.797) showed a significantly greater effect than a combination of aerobic and resistance exercises (Δ=0.341, CI 0.129-0.552). Moderator and meta-regression analyses showed high adherence yielding best improvements.

CONCLUSION

Exercise has a large effect on CRF in cancer survivors. Aerobic interventions with high adherence have the best result.

Do Cancer-Related Fatigue and Physical Activity Vary by Age for Black Women With a History of Breast Cancer?

INTRODUCTION

Cancer-related fatigue (CRF) is the most uncomfortable symptom among women with a history of breast cancer. Black women are more likely than women of other racial/ethnic groups to have CRF risk factors, such as physical inactivity and obesity, yet CRF studies have not focused on black women. We conducted a cross-sectional analysis to assess CRF and physical activity among black women survivors of breast cancer.

METHOD

In May and July of 2012, 267 members (mean age, 54 y) of the Sisters Network, Inc, completed an online survey of sociodemographic characteristics, medical characteristics, and physical activity, and a fatigue instrument (the Functional Assessment of Chronic Illness Therapy [FACIT]). Multiple linear regression assessed fatigue and physical activity compliance (ie, 150 minutes of moderate to vigorous physical activity per week).

RESULTS

Participants had an average FACIT score of 32.3, Fatigue was greater (P < .001) among the 56% of women not meeting physical activity guidelines. In multivariable analysis, correlates of fatigue showed that physical activity compliance (β = 3.20, P < .001) and older age group (50-59 y: β = 3.98, P = .001; ≥60 y,: β = 3.76, P = .003) were associated with less fatigue. The interaction between age and fatigue was also significant: mean differences in fatigue by physical activity level were obvious only among women younger than 50 years. (P < .001).

CONCLUSION

Physical activity compliance was associated with a lower level of fatigue. However, the effect of physical activity on fatigue may differ by age. Interventions aimed at curbing CRF in black women should consider age-appropriate strategies that can be integrated into existing lifestyles.

Prevalence and Associated Factors of Cancer-Related Fatigue Among Cancer Patients in Eastern China

BACKGROUND

Cancer-related fatigue (CRF) is a subjective and distressing symptom, and its associated factors in developing countries remain ambiguous. The goal of this study was to determine the prevalence of and factors associated with CRF among cancer patients in China.

METHODS

This study was designed as a cross-sectional study to determine the prevalence of and factors associated with CRF among cancer patients in eastern China, regardless of their diagnoses. Data were collected by using a questionnaire survey (including demographic information and brief fatigue inventory) after informed written consent was obtained. A chi-square test was used to analyze the correlations between single categorical factors and CRF, and multiple logistic regression analysis was used to evaluate the associations of potential risk factors with the presence of CRF.

RESULTS

Out of a total population of 1,938 cancer patients, 1,749 had completed the study questionnaire; 52.07% (n = 904) reported clinically significant fatigue (score ≥4 on Brief Fatigue Inventory). Four hundred twenty-seven (48.47%) patients younger than age 58 years (the median age) and 475 (55.69%) patients age 58 years or older reported clinically significant fatigue. In multivariate analysis, higher sleep quality (p < .01) was negatively associated with CRF, whereas never engaging in physical exercise (p < .01) and higher clinical stage of cancer (p < .01) were positively associated factors that could increase the odds of CRF.

CONCLUSION

The results of this study suggest that effective management of the two changeable contributing factors of CRF may reduce CRF and thus could be used as references for CRF management.

IMPLICATIONS FOR PRACTICE

The two modifiable factors of cancer-related fatigue (CRF)-sleep disturbance and physical exercise-should be specifically assessed and managed to mitigate CRF.

The course of fatigue and its correlates in colorectal cancer survivors: a prospective cohort study of the PROFILES registry

PURPOSE

Colorectal cancer (CRC) survivors who remain fatigued during long-term follow-up are at risk for worse health outcomes and need relevant interventions most. The aim of this study is to prospectively assess cancer-related fatigue (CRF) and four categories of CRF correlates (clinical characteristics, demographic characteristics, behavior/well-being, functional status).

METHODS

CRC survivors diagnosed between 2000 and 2009, as registered in the population-based Eindhoven Cancer Registry, completed the Fatigue Assessment Scale at three annual time points. Linear mixed models were used to assess the course of CRF and identify its correlates.

RESULTS

CRF levels were relatively stable over time. Being female, young (≤65 years of age), and single; having a low educational level; treatment with chemotherapy; and having one or more comorbid conditions were associated with higher CRF scores. Years since diagnosis, radiotherapy, and disease stage were not related to CRF over time. Significant between- and within-subject effects were found for all well-being factors (social, emotional, and cognitive functioning, and global quality of life), symptoms (anxiety, depression, pain, and insomnia), and functional status (physical and role functioning, physical activity levels) in relation to CRF. The differences in CRF levels could, for a large part, be attributed to differences in behavior/well-being (59 %), functional status (37 %), and, to a lesser extent, to sociodemographic (4 %) and clinical characteristics (8 %).

CONCLUSION

This study showed that sociodemographic and clinical factors were associated with CRF levels over time among CRC survivors; however, behavior/well-being and functional status explained a larger part of the variance in levels of CRF.

Prevalence and predictors of fatigue in haemo-oncological patients

BACKGROUND

Fatigue is a common symptom in patients with advanced malignancy, and has been associated with both physiological and psychological factors in patients with solid tumours.

AIM

This study sought to explore the predictors of fatigue in a population with haematological malignancy.

METHODS

Consecutive outpatients and inpatients attending a haematology centre completed the Memorial Symptom Assessment Scale, and clinical, treatment and demographic information were noted.

RESULTS

Of 180 patients, fatigue was present in 69%, and causing considerable distress in 26%. Univariate analysis revealed fatigue was associated with poor performance status, low haemoglobin, feeling sad, worried, irritable and nervous. Multivariate modeling revealed that those factors predictive of fatigue were poor performance status, having active disease, feeling sad and irritable, while haemoglobin level was not predictive of fatigue.

CONCLUSIONS

Fatigue is a multidimensional symptom in patients with haematological malignancy whose presence must prompt a holistic assessment of potential contributors that goes beyond correction of haemoglobin levels.

Impact of cancer-related fatigue on chemotherapy-induced nausea and vomiting in Asian cancer patients

INTRODUCTION

Cancer-related fatigue (CRF) has been suggested to be associated with the occurrence of chemotherapy-induced nausea and vomiting (CINV). This study aims to evaluate the potential of CRF in predicting the occurrence of CINV.

METHOD

This is a prospective, observational study. Recruited patients received moderately to highly emetogenic single-day chemotherapy regimens. On the day of chemotherapy, patients were instructed to provide a score (Likert scale of 0-10) to describe how CRF interfered with his or her ability to engage in daily activities and a score for how severe it was. Patients were then given a standardized 5-day diary to document their CINV events.

RESULTS

A total of 473 eligible patients (median age: 55 years, interquartile range (IQR): 48-61 years) were recruited, with most of the patients diagnosed with gastrointestinal (45%) and breast (37%) cancers. The median score of fatigue interference was 3 (IQR: 0-5). After confounders were adjusted for, patients with low fatigue interference scores (≤3) were more likely to achieve complete protection (no nausea, no vomiting, and no breakthrough antiemetics) of CINV (adjusted odds ratio = 1.57, 95%CI [1.05, 2.35], p = 0.027).

CONCLUSION

This is the largest study to date to evaluate the association between CRF and CINV. Patients experiencing CRF possessed a higher risk of poor control for CINV.

Factors associated with the severity and improvement of fatigue in patients with advanced cancer presenting to an outpatient palliative care clinic

Background

The aim of this study was to determine factors associated with the severity of cancer related fatigue (CRF) and predictors of improvement of CRF at the first follow-up visit in patients with advanced cancer referred to outpatient palliative care clinic (OPC).

Methods

We reviewed the records of consecutive patients with advanced cancer presenting to OPC. Edmonton Symptom Assessment System (ESAS) scores were obtained at the initial and subsequent visits between January 2003 and December 2008. All patients received interdisciplinary care led by palliative medicine specialists following an institutional protocol. Fatigue improvement was defined as a reduction of ≥2 points in ESAS score relative to the baseline. Descriptive statistics were used to summarize patient characterstics. Univariate analyses were performed and only significant variables were included in multivariate regression analysis to determine factors associated with severity and improvement in CRF.

Results

A total of 1778 evaluable patients were analyzed (median age, 59 years; 52% male). The median time between visits was 15 days. Median fatigue scores on the ESAS were 6 at baseline and 5 at follow-up. Severity of all ESAS items and low serum albumin were associated with fatigue at baseline (p < 0.0001). The improvement of fatigue was observed in 586 patients (33%). The hierarchical model showed that fatigue improved over time (b = −0.009; p = 0.0009). low appetite (odds ratio [OR] = 1.09 per point; p = 0.0113) and genitourinary cancer (OR = 1.74 per point; p = 0.0458) were significantly associated with improvement of fatigue.

Conclusions

CRF is strongly associated with physical and emotional symptoms. Genitourinary cancer and low appetite at baseline were associated with successful improvement of fatigue.