Fatigue mediates the relationship between physical fitness and quality of life in cancer survivors

Walking capacity of Japanese patients with colorectal cancer relates to early postoperative health-related quality of life: a multi-center cohort study

PURPOSE

This study investigated the impact of surgical treatment on the health-related quality of life (HRQOL) of Japanese patients with colorectal cancer (CRC).

METHODS

This three-institution cohort study included 106 Japanese patients with CRC (69 men; mean age: 62.6 ± 12.4 years; age range = 30-85 years). HRQOL was evaluated using the Short-Form 36-Item Health Survey version 2 one to two days prior to surgery (baseline) and four weeks after surgery. Clinical characteristics, social characteristics, and HRQOL at baseline were investigated.

RESULTS

Physical functioning, role-physical, bodily pain, and social functioning decreased significantly at four weeks after surgery compared with baseline, whereas mental health significantly improved. Physical functioning and general health perception showed an especially strong relation with the six-minute walk test (6MWT) at four weeks after surgery and HRQOL scores at baseline. The cutoff value for the 6MWT for clinically relevant improvement was 552.5 meters for physical functioning (area under curve [AUC] = 0.780, 95% confidence interval [CI] = 0.692-0.867) and 480.3 meters for general health perception (AUC = 0.721, 95% CI = 0.626-0.817).

CONCLUSION

Patients with CRC could potentially improve their postoperative HRQOL by increasing their walking capacity post-surgery, and they may need follow-up interventions after discharge such as physical rehabilitation to do so. The results provide a potential pathway for improving HRQOL of Japanese patients with CRC.

Cancer-related fatigue mediates the relationships between physical fitness and attendance and quality of life after participation in a clinical exercise program for survivors of cancer

PURPOSE

Cancer-related fatigue (CRF) is a common and limiting symptom reported by survivors of cancer, negatively impacting health-related quality of life (HRQoL). Exercise improves CRF, HRQoL, and physical fitness in survivors. Prospective research trials have shown that exercise-associated fitness improvements effects on HRQoL are mediated by CRF; however, this has not been investigated in a pragmatic real-world setting. This study utilizes data from a large heterogenous population of survivors participating in a clinical exercise program to investigate this mediation effect, as well as effects of program attendance.

METHODS

Data were collected from 194 survivors completing the BfitBwell Cancer Exercise Program (July 2016-February 2020). Changes in HRQoL, CRF, and fitness were calculated and program attendance collected. Basic correlation analyses were performed. Linear regression analyses were performed to assess mediation by CRF.

RESULTS

All measures of CRF, HRQoL, and physical fitness significantly improved following the exercise program. Improvements in physical fitness were significantly correlated with improvements in HRQoL (r = 0.15-0.18), as was program attendance (r = 0.26) and CRF (r = 0.59). The effects of physical fitness and program attendance on HRQoL were at least partially mediated by the effects of CRF.

CONCLUSION

This study extends research findings on how exercise programs improve HRQoL in survivors of cancer to a real-world setting. Results indicate that clinical exercise programs should target reductions in CRF in survivors (during or after treatment) through improvements in physical fitness to improve HRQoL and that high attendance should be encouraged regardless of fitness changes.

Yifei sanjie Pills Alleviate Chemotherapy-Related Fatigue by Reducing Skeletal Muscle Injury and Inhibiting Tumor Growth in Lung Cancer Mice

Chemotherapy-related fatigue (CRF), one of the most severe adverse effects observed in cancer patients, has been theoretically related to oxidative stress, and antioxidant treatment might be one of the most valuable therapeutic approaches. However, there are still few effective pharmacological therapies. Yifei Sanjie pills (YFSJ), a classical formula used to treat lung cancer as complementary and alternative medicine, have been proved to alleviate CRF of lung cancer patients in clinical practices. However, the underlying mechanisms have not been clarified. In this study, our data showed that YFSJ alleviated CRF presented as reversing the decline of swimming time and locomotor activity induced by cisplatin (DDP). Moreover, YFSJ significantly reduces the accidence of mitophagy and mitochondrial damage and reduces apoptosis in skeletal muscle tissues caused by DDP. It probably works by decreasing the oxidative stress, inhibiting the activation of the AMPK/mTOR pathway, decreasing protein expression levels of Beclin1 and other autophagy-related proteins, and attenuating the activation of Cytochrome c (cyto. C), Cleaved Caspase-9 (c-Casp 9), and other apoptosis-related proteins. Furthermore, YFSJ enhanced DDP sensitivity by specifically promoting oxidative stress and activating apoptosis and autophagy in the tumor tissues of mice. It was also found that YFSJ reduced the loss of body weight caused by DDP, reversed the ascent of serum concentrations of alanine aminotransferase (ALT), aminotransferase (AST), and creatinine (CREA), increased the spleen index, and prolonged the survival time of mice. Taken together, these results revealed that YFSJ could alleviate CRF by reducing mitophagy and apoptosis induced by oxidative stress in skeletal muscle; these results also displayed the effects of YFSJ on enhancing chemotherapy sensitivity, improving quality of life, and prolonging survival time in lung cancer mice received DDP chemotherapy.

Factors that affect early postoperative health-related quality of life in patients with gastrointestinal cancer: a three-center cohort study

[Purpose] In this study, we investigated the preoperative and early postoperative health-related quality of life in patients who underwent surgical treatment for gastrointestinal cancer and also the factors that affect postoperative health-related quality of life. [Participants and Methods] The study included 198 patients who underwent elective surgery for gastrointestinal cancer (129 males and 69 females, age: 65.4 ± 11.8 years). Health-related quality of life was evaluated using the Short-Form 36-Item Health Survey version 2 at the following time points: 1–2 days preoperatively (baseline) and 4 weeks postoperatively. [Results] Compared with baseline levels, physical functioning, bodily pain, vitality, as well as physical, social, and emotional role functioning significantly decreased 4 weeks postoperatively. In contrast, compared with baseline levels, mental health significantly improved 4 weeks postoperatively. Physical functioning and general health evaluated 4 weeks postoperatively were significantly associated with income, baseline health-related quality of life, and the 6-minute walk test. [Conclusion] It is important to consider baseline income and health-related quality of life and increase postoperative exercise capacity to improve health-related quality of life in patients who undergo surgical treatment for gastrointestinal cancer.

Effects of exercise interventions for physical fitness, fatigue, and quality of life in adult hematologic malignancy patients without receiving hematopoietic stem cell transplantation: a systematic review and meta-analysis

PURPOSE

To investigate the effects of exercise interventions on the physical fitness, fatigue, and quality of life (QOL) in adults with hematological malignancy (HM) who did not receive hematopoietic stem cell transplantation (HSCT).

METHODS

We performed a systematic review with meta-analysis and qualitative evidence synthesis. We systematically searched 10 electronic databases including Medline, Allied and Complementary Medicine Database, Cochrane Central Register of Controlled Trials, Embase, CINAHL complete, SPORTDiscus, Web of Science, China Wan Fang Database, China National Knowledge Internet, and China Science and Technology Journal Database from their inception up to March 2021. The Cochrane guideline was followed, and a PRISMA checklist for reporting systematic reviews was completed.

RESULTS

Fifteen studies were included in this systematic review, of which 11 were included in the meta-analysis. There was a significant increase in the physical fitness between the exercise group and the control group, in terms of the 6-min walk test and peak oxygen consumption. There was a significant change in the peak oxygen consumption from the baseline to the endpoint in the exercise group. In the between-group analyses, there were no significant differences in the effect of exercise on the grip strength, fatigue, and QOL; however, in the within-group analysis, QOL was significantly increased in the combination exercise group.

CONCLUSION

Both aerobic exercise and combination exercise appear safe and feasible and can improve physical fitness in adult patients with HM who have not received HSCT. The combination exercise may have potential benefits for their QOL.

Minimal clinically important difference in postoperative recovery among patients with gastrointestinal cancer

PURPOSE

The minimal clinically important difference (MCID) based on patient-reported outcomes is the smallest outcome change sufficiently significant to influence management and is crucial to the design and interpretation of comparative effectiveness trials. The purpose of this study was to estimate the MCID for postoperative recovery metrics in gastrointestinal cancer patients.

METHODS

This was a three-institutional cohort study. Participants were 219 patients scheduled for gastrointestinal cancer elective surgery. Body mass index (BMI), isometric knee extension torque (IKET), 6-min walk test (6 MWT), and Short-Form 36-Item Health Survey (SF-36) version 2 were evaluated 1-2 days prior to surgery (baseline) and 4 weeks after surgery. Patients received postoperative rehabilitative care from a physical therapist during hospitalization. The MCID used anchor-based methods. The anchor was a score on the SF-36 physical functioning subscale greater or lower than the average score of the general Japanese population.

RESULTS

The receiver operating curve indicated a cutoff value on the 6 MWT of -7.8 m for clinically relevant decline (area under curve [AUC] = 0.67, 95% confidence interval [CI] = 0.599-0.741) or a 1.5% change. The cutoff value on the SF-36 role-physical subscale was -34.4 for clinically relevant decline (AUC = 0.691, 95% CI = 0.621-0.761) or a 36.6% decrease. No significant correlation was found between changes in BMI, IKET, and anchor.

CONCLUSION

Plausible MCIDs are present in patients with gastrointestinal cancer. These values can assist the interpretation of clinical trials and observation of the postoperative clinical course of gastrointestinal cancer surgery.

Increasing Physical Activity among Breast Cancer Survivors by Modulating Temporal Orientation with rTMS: Feasibility and Potential Efficacy

Maintaining adequate amounts of physical activity is a critical component of survivorship care for women with breast cancer. Increased physical activity is associated with increases in well-being, quality of life, and longevity, but women with cancer face unique, cancer-related factors that might affect physical activity. Consistent with the Competing Neurobehavioral Decision Systems model of decision making, we proposed to decrease delay discounting and increase physical activity by stimulating the executive function system via high-frequency repetitive transcranial magnetic stimulation (HF rTMS) of the left dorsolateral prefrontal cortex (LDLPFC). This randomized, sham-controlled, double-blinded trial examined the feasibility and potential efficacy of this approach to increase physical activity in breast cancer survivors. We hypothesized that active rTMS would significantly increase the mean number of steps per day and decrease delay discounting. Participants (n = 30) were primarily middle-aged (M = 53.7, SD = 7.9) and white with a mean BMI and body mass indices below 40. Indicators of feasibility and limited efficacy testing were positive. Although repeated-measures ANOVA revealed no significant changes in delay discounting, generalized estimating equations (GEE) found that participants in the active condition increased their mean daily steps by 400 steps per day, while those in the sham condition decreased this by nearly 600 steps per day. These findings indicate that the continued investigation of HF rTMS for increasing physical activity among women with breast cancer is justified.

Factors influencing early postoperative health-related quality of life in patients with alimentary system cancer

PURPOSE

The purpose of this study was to investigate changes in early postoperative health-related quality of life (HRQOL) in patients with gastrointestinal cancer and to examine the factors influencing such changes.

METHODS

Participants were 106 patients scheduled for elective surgery for gastrointestinal cancer (61 male and 45 females; aged 62.6 ± 12.0 years). HRQOL was evaluated using the Short-Form 36-Item Health Survey version 2 (SF-36) at two time points: 1-2 days prior to surgery (baseline) and 4 weeks after surgery. Clinical and social characteristics based on previous studies were investigated as potential factors influencing changes in early postoperative HRQOL.

RESULTS

Physical functioning, physical role functioning, bodily pain, vitality, social role functioning, and emotional role functioning significantly decreased at 4 weeks after surgery compared with baseline. Mental health at 4 weeks after surgery significantly improved compared with baseline. The scores on each SF-36 subscale at 4 weeks after surgery were significantly associated with gender, clinical stage of cancer, neoadjuvant therapy, surgical site, postoperative complications, HRQOL at baseline, and 6-min walk test at 4 weeks after surgery.

CONCLUSION

To increase early postoperative HRQOL in surgical patients with gastrointestinal cancer, it may be necessary to not only improve postoperative management but also increase exercise capacity after surgery and HRQOL before surgery.

[Effect of activities profile variations on health-related quality of life among breast cancer patients: Secondary exploratory analysis from PASAPAS study data]

INTRODUCTION

Lifestyle changes in breast cancer patients, by physical activity increasing, are becoming a main objective in supportive care. The objective of this study was to explore the impact of the daily activity profile evolution on the quality of life among this public.

METHODS

Sixty patients (18 to 75 years) with non-metastatic breast cancer were randomized to a 2:1 ratio (physical activity intervention; control) in the PASAPAS randomized clinical trial. Multiple linear regression analyzes were computed to explain quality of life scores 6 months after the start of adjuvant therapy. Variables retained were the baseline quality of life scores, the anxiety trait, the randomization arm, the variations of time spent in different physical activity classes ([3-4 [MET, [4-6 [MET, ≥6 MET) and in sedentary behaviors.

RESULTS

Only the decrease in time spent in sedentary behaviors really appeared as a predictor of the quality of physical life. Participation in the intervention group appeared as a predictor of quality of mental life.

DISCUSSION

Results plead in favor of sedentary life style decrease as part of the objectives of care program for women with breast cancer. It also highlights the need of collective supervised sessions implemented by competent staff. This research also suggests that the dynamics of daily activity profile variations should be studied further in association to quality of life.

Non-Exercise Based Estimation of Cardiorespiratory Fitness Mediates Associations between Comorbidities and Health-Related Quality of Life in Older Korean Adults with Diabetes

This study investigated whether non-exercise-based estimation of cardiorespiratory fitness (eCRF) mediates the association between health-related quality of life (HRQoL) and comorbidities in older Korean adults with diabetes. A total of 1371 Korean adults (56% women) aged 60 years and older with diabetes was drawn from those who participated in the 2008–2011 Korea National Health and Nutrition Examination Surveys IV and V. Data on comorbidities included hypertension, heart disease (acute myocardial infarction or angina), stroke, arthritis, and chronic renal disease. HRQoL was assessed using the EuroQoL group, which consists of a health-status descriptive system and a visual analogue scale. eCRF was determined with sex-specific algorithms. Age, sex, household income, education level, marital status, smoking, alcohol consumption, and regular exercise were additionally measured as covariates. HRQoL found to be inversely associated with number of comorbidities and positively associated with increasing eCRF category (from low to high) in older Korean patients with diabetes. The Sobel mediation test showed a significant indirect effect (Z = −4.632, p < 0.001), and the result of a bootstrap procedure corroborated the Sobel test result: a non-zero range in the 95% bias-corrected confidence interval (95% CI −1.104 to −0.453) indicated that eCRF mediates the impact of comorbidities on HRQoL. Overall, the current findings suggest that enhancing CRF can facilitate positive outcomes, including better HRQoL, for patients with diabetes.

Changes in Body Mass Index and Physical Activity Predict Changes in Vitality During a Weight Loss Trial in Breast Cancer Survivors

Background

Breast cancer survivors rank fatigue (e.g., decreased vitality) as their number one concern affecting quality of life. Excess adiposity is associated with decreased vitality in breast cancer survivors, yet weight loss intervention trials report inconsistent effects on this parameter.

Methods

This is a secondary analysis of the Exercise and Nutrition to Enhance Recovery and Good Health for You trial, in which 692 overweight or obese breast cancer survivors ≤5 years from diagnosis, initiated weight loss interventions, and completed assessments semi-annually for 2 years. Assessments included the Godin Leisure-Time Exercise Questionnaire and the SF-36 MOS vitality subscale as an inverse measure of fatigue. Multilevel structural equation models estimated the direct effects of physical activity on vitality and indirect effects through body mass index (BMI) changes.

Results

Within-person findings show that at assessments with greater physical activity, BMI was significantly lower (B = -0.07, p < 0.001) and vitality was higher (B = 0.22, p < 0.001). However, there was no direct relationship between lower BMI and higher vitality (B = -0.11, p = 0.262) after controlling for the relationship of physical activity with BMI and physical activity with vitality. The between-person indirect effect of physical activity change through BMI change to vitality was significant (B = 0.03, p < 0.001). Participants whose physical activity was above the mean (B = 0.37, p < 0.001) and whose BMI was below the mean (B = -1.05, p < 0.001) were more likely to report greater vitality.

Conclusion

Improvements in vitality are primarily associated with increases in physical activity rather than BMI changes in this trial. Vitality was lower among survivors with higher BMI, although within-individual changes in BMI had no effect on vitality. Physical activity and weight loss share mechanistic links to vitality with physical activity potentially increasing (e.g., in an additive or synergistic manner) the effect of BMI reduction on vitality.

Longitudinal Associations Between Fatigue and Perceived Work Ability in Cancer Survivors

Purpose To examine the associations between changes of fatigue and changes of perceived work ability in cancer survivors. Furthermore, to examine the effects of physical job demands on these associations. Methods Data from a feasibility study on a multidisciplinary intervention to enhance return to work in patients with cancer receiving chemotherapy was used. Fatigue (Multidimensional Fatigue Inventory) and perceived work ability (first item of the Work Ability Index) were assessed at baseline, and after 6, 12, and 18 months. Change scores (S1, S2, S3) from each assessment to the next were calculated, thus encompassing three separate time periods of 6 months. Regression analyses were used to quantify associations between change of perceived work ability and (model 1) change of general fatigue, and (model 2) change of mental and physical fatigue for each 6-month period separately. For model 2, interaction effects of perceived physical job demands were studied. Results A total of 89 participants were included for analysis, among which 84% with a diagnosis of breast cancer. On average, in model 1, a reduction of five points on general fatigue was associated with an improvement of one point in perceived work ability in all three 6-month periods. Model 2 showed, similarly, that change of physical fatigue (S1 and S2: B = - 0.225; p < .001 and B = - 0.162; p = .012) and change of mental fatigue (S3: B = - 0.177; p = .027) were significantly inversely associated with change of perceived work ability. Interaction effects were not significant. Conclusion The inverse, longitudinal association between fatigue and perceived work ability supports previous findings from cross-sectional studies and shows potential occupational impact of targeting fatigue in cancer rehabilitation.

Patients with Chronic Musculoskeletal Pain of 3-6-Month Duration Already Have Low Levels of Health-Related Quality of Life and Physical Activity

PURPOSE OF REVIEW

To determine the level of physical activity and health-related quality of life in patients with chronic musculoskeletal pain of 3-6-month duration who have not been diagnosed or treated before.

RECENT FINDINGS

Low levels of quality of life and physical activity have been reported for patients with musculoskeletal pain with a duration of longer than 6 months. This study assessed the levels of quality of life and physical activity at the beginning stage of chronic musculuskeletal pain. Prospective cross-sectional study carried out at a musculoskeletal and sports medicine clinic. Eighty-five consecutive patients with muskuloskeletal (i.e., spine, peripheral joint, muscle, tendon) pain of 3-6-month duration, not diagnosed before, age 14 and older, and from either gender were recruited. Short Form-36 Health Survey and International Physical Activity Questionnaire long were administered during assessments. Scores on subscales of Short Form-36 Health Survey and total scores of International Physical Activity Questionnaire were used as outcome measures. A total of 85 patients with an age range of 15-86 (51.22 ± 15.99) were enrolled. There were 23 male (27.06%) and 62 (72.94%) female subjects. Forty-six (54.11%) patients had three or less painful regions; 39 (45.88%) had more than three painful regions. Majority of the patients had low scores on both Short Form-36 Health Survey subscales and International Physical Activity Questionnaire. Forty-nine patients had low, 32 patients had moderate, and 4 patients had high level of physical activity. Overall, females had lower level of physical activity in all age groups. All patients had less than optimal scores on all subscales of Physical Health and Mental Health scales of the Short Form-36. The female patients had lower scores in role physical and bodily pain subscales of physical health. Patients with musculoskeletal pain duration of 3-6 months have low levels of physical activity and health-related quality of life at the time of their first evaluation.

Effects of high-intensity interval training on fatigue and quality of life in testicular cancer survivors

Background

Testicular cancer survivors (TCS) are at increased risk of cancer-related fatigue (CRF), psychosocial impairment, and poor mental health-related quality of life (HRQoL). Here, we examine the effects of high-intensity interval training (HIIT) on patient-reported outcomes (PROs) in TCS. Secondarily, we explore cardiorespiratory fitness as a mediator of intervention effects and select baseline characteristics as moderators of intervention effects.

Methods

TCS (n = 63) were randomly assigned to 12 weeks of supervised HIIT or usual care (UC). PROs included CRF, depression, anxiety, stress, self-esteem, sleep quality, and HRQoL assessed at baseline, post-intervention, and 3-month follow-up.

Results

TCS (median 7 years postdiagnosis) completed 99% of training sessions and achieved 98% of target training intensity. ANCOVA revealed that, compared to UC, HIIT significantly improved post-intervention CRF (p = 0.003), self-esteem (p = 0.029), and multiple HRQoL domains (ps ≤ 0.05). Effects on CRF (p = 0.031) and vitality (p = 0.015) persisted at 3-month follow-up. Cardiorespiratory fitness changes mediated CRF and HRQoL improvements. CRF effects were larger for TCS with an inactive lifestyle, lower fitness, higher testosterone, and clinical fatigue at baseline.

Conclusions

HIIT significantly improves CRF and HRQoL in TCS. Mediation by cardiorespiratory fitness and moderation by clinical characteristics suggests opportunities for targeted exercise interventions to optimise PROs in TCS.

Multidimensional fatigue in pulmonary hypertension: prevalence, severity and predictors

Pulmonary hypertension is a potentially fatal disease. Despite pharmacological advances in pulmonary hypertension, fatigue remains common in patients with pulmonary hypertension.

A convenience sample of 120 participants at an international patient conference completed the Multidimensional Fatigue Inventory (MFI)-20 scale. Data on New York Heart Association Functional Class, body mass index, oxygen use and medication type/use were also collected.

There was a high prevalence of “severe” to “very severe” fatigue for each dimension: General Fatigue (60%), Physical Fatigue (55.8%), Reduced Activity (41.7%), Reduced Motivation (32.5%) and Mental Fatigue (27.5%). The mean±sd overall MFI-20 score was 58±5.1. Dimensions with the highest averaged levels were General Fatigue (13.40±3.61), Physical Fatigue (13.23±3.67) and Reduced Activity (11.33±4.16). Body mass index correlated with higher fatigue scores. Phosphodiesterase inhibitor plus endothelin receptor antagonist combination negatively predicted General Fatigue, Physical Fatigue, Reduced Motivation and Reduced Activity. Triple therapy was a significant predictor of General Fatigue, Physical Fatigue and Reduced Activity. There were no significant predictors of Mental Fatigue.

Multidimensional fatigue is common and severe in patients with pulmonary hypertension. Phosphodiesterase inhibitor plus endothelin receptor antagonist combination resulted in lower scores in most fatigue dimensions. Comprehensive assessment of fatigue should be considered in the clinical care of patients with pulmonary hypertension and clinical research to develop formal interventions that target this disabling symptom.

Fatigue is common and severe in PH, and impacted by medications; targeted strategies to mitigate fatigue are neededhttp://ow.ly/EISN30i0WWU

Nutrition therapy with high intensity interval training to improve prostate cancer-related fatigue in men on androgen deprivation therapy: a study protocol

Background

Cancer-related fatigue is one of the most prevalent, prolonged and distressing side effects of prostate cancer treatment with androgen deprivation therapy. Preliminary evidence suggests natural therapies such as nutrition therapy and structured exercise prescription can reduce symptoms of cancer-related fatigue. Men appear to change their habitual dietary patterns after prostate cancer diagnosis, yet prostate-specific dietary guidelines provide limited support for managing adverse side effects of treatment. The exercise literature has shown high intensity interval training can improve various aspects of health that are typically impaired with androgen deprivation therapy; however exercise at this intensity is yet to be conducted in men with prostate cancer. The purpose of this study is to examine the effects of nutrition therapy beyond the current healthy eating guidelines with high intensity interval training for managing cancer-related fatigue in men with prostate cancer treated with androgen deprivation therapy.

Methods/design

This is a two-arm randomized control trial of 116 men with prostate cancer and survivors treated with androgen deprivation therapy. Participants will be randomized to either the intervention group i.e. nutrition therapy and high intensity interval training, or usual care. The intervention group will receive 20 weeks of individualized nutrition therapy from an Accredited Practising Dietitian, and high intensity interval training (from weeks 12–20 of the intervention) from an Accredited Exercise Physiologist. The usual care group will maintain their standard treatment regimen over the 20 weeks. Both groups will undertake primary and secondary outcome testing at baseline, week 8, 12, and 20; testing includes questionnaires of fatigue and quality of life, objective measures of body composition, muscular strength, cardiorespiratory fitness, biomarkers for disease progression, as well as dietary analysis. The primary outcomes for this trial are measures of fatigue and quality of life.

Discussion

This study is the first of its kind to determine the efficacy of nutrition therapy above the healthy eating guidelines and high intensity interval training for alleviating prostate-cancer related fatigue. If successful, nutrition therapy and high intensity interval training may be proposed as an effective therapy for managing cancer-related fatigue and improving quality of life in men during and after prostate cancer treatment.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12615000512527. Trial registered on the 22/5/2015.

Cancer-related fatigue: scientific progress has been made in 40 years

Cancer-related fatigue (CRF) is a distressing, persistent symptom that is experienced by survivors during and after treatment. Unsurprisingly, many early CRF studies were conducted by nurses. These studies included a look at patients receiving localized radiation treatment (Haylock & Hart, 1979); an exploration of fatigue as a conceptual approach to a clinical problem (Aistars, 1987); the development of a nursing theory focused on fatigue mechanisms (Piper, Lindsey, & Dodd, 1987); an examination of fatigue mechanisms (St Pierre, Kasper, & Lindsey, 1992), as well as of fatigue in advanced cancer (Bruera & MacDonald, 1988) and in non-small cell lung cancer (Sarna, 1993); and a description of fatigue and potential nursing interventions (Nail & King, 1987). Winningham et al. (1994) wrote a state-of-the-science article about fatigue in the cancer experience for the Oncology Nursing Forum, and Mock et al. (1997) was one of the first to conduct an exercise study regarding the effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Nurse scholars from the 1970s-2000s were pivotal in advancing the science of fatigue in various cancers and have provided a scientific foundation for those four decades. 
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A 3-week multimodal intervention involving high-intensity interval training in female cancer survivors: a randomized controlled trial

To compare the effects of a 3‐week multimodal rehabilitation involving supervised high‐intensity interval training (HIIT) on female breast cancer survivors with respect to key variables of aerobic fitness, body composition, energy expenditure, cancer‐related fatigue, and quality of life to those of a standard multimodal rehabilitation program. A randomized controlled trial design was administered. Twenty‐eight women, who had been treated for cancer were randomly assigned to either a group performing exercise of low‐to‐moderate intensity (LMIE; n = 14) or a group performing high‐intensity interval training (HIIT; n = 14) as part of a 3‐week multimodal rehabilitation program. No adverse events related to the exercise were reported. Work economy improved following both HIIT and LMIE, with improved peak oxygen uptake following LMIE. HIIT reduced mean total body fat mass with no change in body mass, muscle or fat‐free mass (best P < 0.06). LMIE increased muscle and total fat‐free body mass. Total energy expenditure (P = 0.45) did not change between the groups, whereas both improved quality of life to a similar high extent and lessened cancer‐related fatigue. This randomized controlled study demonstrates that HIIT can be performed by female cancer survivors without adverse health effects. Here, HIIT and LMIE both improved work economy, quality of life and cancer‐related fatigue, body composition or energy expenditure. Since the outcomes were similar, but HIIT takes less time, this may be a time‐efficient strategy for improving certain aspects of the health of female cancer survivors.

Resistance training improves fatigue and quality of life in previously sedentary breast cancer survivors: a randomised controlled trial

The primary aim of this study was to evaluate the benefits of resistance training (RT) on quality of life (QOL) and fatigue in breast cancer survivors as an adjunct to usual care. We recruited 39 women who had survived breast cancer [mean age (y) 51.9 ± 8.8; time since diagnosis (m) 11.6 ± 13.2]. Primary outcomes were fatigue as assessed by the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT) scale and QOL as assessed by the Functional Assessment of Cancer Therapy - General (FACT-G) scale. ANCOVA was used to assess the change in the primary outcomes while controlling for baseline values, with effect sizes (ES) displayed as partial Eta squared. The experimental group received supervised RT 3 days per week in a university clinic for 16 weeks. Perceptions of fatigue improved significantly in the RT group compared to controls [mean (SD) 6.7 (7.5) points vs. 1.5 (3.7) points], (P = 0.006, ES = 0.20) as did QOL [6.9 (8.5) points vs. 1.6 (4.4) points], (P = 0.015, ES = 0.16). We demonstrated both statistically and clinically important improvements in fatigue and QOL in response to RT in breast cancer survivors.

Randomized controlled trial of the effects of high intensity and low-to-moderate intensity exercise on physical fitness and fatigue in cancer survivors: results of the Resistance and Endurance exercise After ChemoTherapy (REACT) study

BACKGROUND

International evidence-based guidelines recommend physical exercise to form part of standard care for all cancer survivors. However, at present, the optimum exercise intensity is unclear. Therefore, we aimed to evaluate the effectiveness of a high intensity (HI) and low-to-moderate intensity (LMI) resistance and endurance exercise program compared with a wait list control (WLC) group on physical fitness and fatigue in a mixed group of cancer survivors who completed primary cancer treatment, including chemotherapy.

METHODS

Overall, 277 cancer survivors were randomized to 12 weeks of HI exercise (n = 91), LMI exercise (n = 95), or WLC (n = 91). Both interventions were identical with respect to exercise type, duration and frequency, and only differed in intensity. Measurements were performed at baseline (4-6 weeks after primary treatment) and post-intervention. The primary outcomes were cardiorespiratory fitness (peakVO2), muscle strength (grip strength and 30-second chair-stand test), and self-reported fatigue (Multidimensional Fatigue Inventory; MFI). Secondary outcomes included health-related quality of life, physical activity, daily functioning, body composition, mood, and sleep disturbances. Multilevel linear regression analyses were performed to estimate intervention effects using an intention-to-treat principle.

RESULTS

In the HI and LMI groups, 74 % and 70 % of the participants attended more than 80 % of the prescribed exercise sessions, respectively (P = 0.53). HI (β = 2.2; 95 % CI, 1.2-3.1) and LMI (β = 1.3; 95 % CI, 0.3-2.3) exercise showed significantly larger improvements in peakVO2 compared to WLC. Improvements in peakVO2 were larger for HI than LMI exercise (β = 0.9; 95 % CI, -0.1 to 1.9), but the difference was not statistically significant (P = 0.08). No intervention effects were found for grip strength and the 30-second chair-stand test. HI and LMI exercise significantly reduced general and physical fatigue and reduced activity (MFI subscales) compared to WLC, with no significant differences between both interventions. Finally, compared to WLC, we found benefits in global quality of life and anxiety after HI exercise, improved physical functioning after HI and LMI exercise, and less problems at work after LMI exercise.

CONCLUSIONS

Shortly after completion of cancer treatment, both HI and LMI exercise were safe and effective. There may be a dose-response relationship between exercise intensity and peakVO2, favoring HI exercise. HI and LMI exercise were equally effective in reducing general and physical fatigue.

TRIAL REGISTRATION

This study was registered at the Netherlands Trial Register [ NTR2153 ] on the 5th of January 2010.

Effect of caffeine on exercise capacity and function in prostate cancer survivors

PURPOSE

This study aimed to examine the acute effect of caffeine on exercise capacity, exercise-related fatigue, and functional performance in prostate cancer survivors.

METHODS

In this randomized, placebo-controlled, double-blind crossover study, 30 prostate cancer survivors (age, 70.3 ± 7.7 yr; body mass, 80.5 ± 13.0 kg; mean ± SD) consumed 6.04 ± 0.16 mg·kg(-1) of anhydrous caffeine or a placebo 1 h before completing a battery of exercise capacity and functional performance tests. Testing sessions were separated by 3-4 wk. Immediate fatigue and perceived exertion were measured directly pre- and postexercise at both testing sessions.

RESULTS

Caffeine increased exercise capacity by 7.93 s (+3.0%; P = 0.010); however, postexercise fatigue and perception of exertion were comparable with the placebo session (P = 0.632 and P = 0.902, respectively). Increases in isometric grip strength trended toward significance in both dominant (+2.9%; P = 0.053) and nondominant (+2.1%; P = 0.061) hands in the caffeine trial compared with placebo. Caffeine ingestion did not result in improvements in performance for any of the remaining functional measures, including the timed up-and-go test, repeated chair stands, 6-m fast walk, and 6-m backward tandem walk. Systolic blood pressure and HR were significantly increased (P = 0.006 and P = 0.040, respectively) upon completion of the testing battery when compared with placebo.

CONCLUSIONS

Consumption of caffeine 1 h before exercise induced improvements in exercise capacity and muscular strength in prostate cancer survivors. However, there was no change in exercise-related fatigue when compared with placebo despite reduction in timed performance of the 400-m walk. Caffeine seems to enhance exercise tolerance through improved performance with no subsequent increase in fatigue or perception of exertion and may be an appropriate strategy to promote exercise participation in prostate cancer survivors.

The effect, moderators, and mediators of resistance and aerobic exercise on health-related quality of life in older long-term survivors of prostate cancer

BACKGROUND

The current study examined effects, moderators (for whom), and mediators (working mechanisms) of 12 months of exercise on health-related quality of life (HRQoL) in older long-term survivors of prostate cancer.

METHODS

In total, 100 men aged 71.7 years (standard deviation, 6.4 years) were randomly assigned to 6 months of supervised aerobic and resistance exercise followed by 6 months of a home-based exercise maintenance program (EX group) or printed education material regarding physical activity for 12 months (PA group). Assessments took place at baseline and after 6 and 12 months. Generalized estimating equations were used to study the effects of EX versus PA on HRQoL at 6 and 12 months, adjusting for baseline HRQoL. The authors examined potential sociodemographic and clinical moderators by adding interaction terms, and potential physical and psychological mediators using the product-of-coefficients test.

RESULTS

At 6 months, significant beneficial effects were found for global QoL, physical function, and social function in the EX group compared with the PA group. For physical function, beneficial effects were sustained at 12 months. Moderation analyses demonstrated larger effects of EX versus PA for patients who were married, started exercising sooner after their diagnosis, and previously used bisphosphonates. Changes in lower body functional performance significantly mediated the effect of EX on global QoL, physical function, and social function. No mediating effects on HRQoL were found for aerobic fitness, physical activity, fatigue, distress, or falls self-efficacy.

CONCLUSIONS

Aerobic and resistance exercise appears to have beneficial effects on HRQoL among older, long-term survivors of prostate cancer. Effects were moderated by marital status, time since diagnosis, and use of bisphosphonates, and were mediated by lower body functional performance.

Association between physical fitness, quality of life, and depression in stage II-III colorectal cancer survivors

PURPOSE

The impact of cancer on quality of life and depression is an important issue. The purpose of this study was to identify the impact of physical fitness on quality of life and depression in stage II-III colorectal cancer survivors.

METHODS

Participants in the current study included 122 stage II-III colorectal cancer survivors (57 females; 56.67 ± 9.16 years of age and 55 males; 54.69 ± 9.78 years of age). Fitness was assessed using the 6-min walk test, chair stand test, and push-up test. Quality of life and depression were measured using the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale and a 9-item patient health questionnaire interview, respectively.

RESULTS

There was a significant association between physical fitness and quality of life and depression in colorectal cancer survivors. The 6-min walk test results were associated with FACT-C total (r = 0.298, p < 0.05), physical well-being (r = 0.230, p < 0.05), functional well-being (r = 0.234, p < 0.05), colorectal cancer concern (r = 0.229, p < 0.05), and depression (r = -0.228, p < 0.05), and the chair stand test results were associated with functional well-being (r = 0.231, p < 0.05), colorectal cancer concern (r = 0.242, p < 0.05), and depression (r = -0.227, p < 0.05) even after controlling for all potentially confounding variables. A multiple regression analysis indicated that the 6-min walk was a significant predictor of health-related quality of life, and participants in the lowest tertile of the 6-min walk test results had lower quality of life and greater depression than those in the highest tertile.

CONCLUSION

Improving and maintaining physical fitness are important for quality of life and depression in stage II-III colorectal cancer survivors.

[Mindfulness, depression, quality of life, and cancer: The nonlinear, indirect effect of mindfulness on the quality of life of cancer patients]

OBJECTIVES

This study investigates the relationships between mindfulness, depression, and quality of life (QoL) in cancer patients.

METHODS

A total of 51 cancer patients were assessed with the FreiburgMindfulness Inventory (FFA;Walach et al. 2004), the Hospital Anxiety and Depression Scale (HADS-D; Herrmann et al. 1994), and the Schedule for the Evaluation of Individual Quality of Life -DW (SEI QoLDW; Browne et al. 1997). The nonlinear relationships were analyzed using the instantaneous indirect effect procedure by Hayes and Preacher (2010).

RESULTS

The relationship between mindfulness and QoL is mediated by depression. Because the relationship between mindfulness and depression is squared, the total effect of mindfulness on QoL is not constant. Increasing the level of mindfulness results in a decrease in its effect on the QoL of cancer patients.

CONCLUSIONS

Cancer patients benefit from mindfulness up to a medium level through a decrease in depression, resulting in higher QoL. Patients with very higher mindfulness show more depressive symptoms, which leads to a neutralization of the effect of mindfulness on QoL.

Biobehavioral factors mediate exercise effects on fatigue in breast cancer survivors

PURPOSE

This study aimed to examine mediators of fatigue response to an exercise intervention for breast cancer survivors in a pilot randomized controlled trial.

METHODS

Postmenopausal breast cancer survivors (n = 46; ≤stage 2), off primary treatment, and reporting fatigue and/or sleep dysfunction were randomized to a 3-month exercise intervention (160 min·wk of moderate-intensity aerobic walking, twice weekly resistance training with resistance bands) or control group. Six discussion group sessions provided behavioral support to improve adherence. Fatigue, serum cytokines, accelerometer physical activity, cardiorespiratory fitness, sleep dysfunction, and psychosocial factors were assessed at baseline and 3 months.

RESULTS

The exercise intervention effect sizes for fatigue were as follows: fatigue intensity d = 0.30 (P = 0.34), interference d = -0.38 (P = 0.22), and general fatigue d = -0.49 (P = 0.13). Using the Freedman-Schatzkin difference-in-coefficients tests, increase in fatigue intensity was significantly mediated by interleukin 6 (IL-6) (82%), IL-10 (94%), IL-6/IL-10 (49%), and tumor necrosis factor-α (TNF-α):IL-10 (78%) with reduced sleep dysfunction increasing the relationship between intervention and fatigue intensity rather than mediating intervention effects (-88%). Decrease in fatigue interference was mediated by sleep dysfunction (35%), whereas IL-10 and pro-anti-inflammatory cytokine ratios increased the relationship between intervention and interference (-25% to -40%). The reduction in general fatigue was significantly mediated by minutes of physical activity (76%), sleep dysfunction (45%), and physical activity enjoyment (40%), with IL-10 (-40%) and IL-6/IL-10 (-11%) increasing the intervention-fatigue relationship. In the intervention group, higher baseline fatigue, anxiety, depression, and perceived exercise barrier interference predicted a greater decline in fatigue interference and/or general fatigue during the intervention.

CONCLUSIONS

Biobehavioral factors mediated and enhanced intervention effects on fatigue, whereas psychosocial factors predicted fatigue response. Further study is warranted to confirm our results and to improve understanding of relationships that mediate and strengthen the intervention-fatigue association.

Physical activity and cancer survivorship

There has been an increase in the cancer survivor population in the United States over the past several decades primarily due to improvements in early detection of first malignancies and effective treatment modalities. A wealth of evidence has demonstrated that regular physical activity is associated with a lower risk of death, all-cause mortality, cancer recurrence, and several chronic diseases, including type 2 diabetes and cardiovascular disease, common comorbid conditions in people who have survived cancer. Physical activity also is a central component of weight management.

METHODS

This review summarizes the current physical activity recommendations and the evidence linking physical activity to improvements in weight management, physiological effects, and psychological health outcomes for cancer survivors.

RESULTS

The available literature suggests physical activity is safe and is positively associated with weight management, cardiorespiratory fitness, muscular strength and endurance, quality of life, fatigue, and other psychosocial factors in cancer survivors. Yet relationships related to specific cancer diagnoses, treatments, and underlying cardiometabolic mechanisms associated with survival have not been thoroughly examined in randomized controlled trials. Furthermore, factors that influence adherence to physical activity behaviors must be identified to develop effective exercise programs. The use of objective measures of physical activity and the standardization of reporting outcome measures within intervention trials are needed to complement this effort.

CONCLUSIONS

Healthcare providers should consider individual differences among cancer survivors and tailor physical activity programs to meet the individual needs of the patient to assist in the adoption and maintenance of a physically active lifestyle.

Mediators of the resistance and aerobic exercise intervention effect on physical and general health in men undergoing androgen deprivation therapy for prostate cancer

BACKGROUND

The objective of the current study was to identify mediators of the effects of a combined resistance and aerobic exercise program on perceived physical and general health in men undergoing androgen deprivation therapy for prostate cancer.

METHODS

In total, 57 patients with prostate cancer undergoing androgen deprivation therapy were randomly assigned to 12 weeks of resistance and aerobic exercise or usual care. The outcome measures of physical and general health were assessed by standardized questionnaires. Linear regression analyses were conducted on the residual change scores of the variables. The mediating effects of fatigue, muscle strength, and functional performance on the intervention's effect on physical and general health were examined using the product of coefficients method. Bootstrapping was used to calculate the 95% confidence intervals (95% CIs).

RESULTS

The exercise intervention was found to significantly improve physical (beta, 5.03; 95% CI, 1.01-9.04) and general health (beta, 12.89; 95% CI, 2.24-23.54). Upper body muscle strength and walking speed significantly mediated the intervention effect on physical health (beta, 2.65; 95% CI, 0.64-5.54), accounting for 53% of the total effect. Walking speed and fatigue were found to be mediators in the intervention effect on general health (beta, 7.52; 95% CI, 2.16-16.92), accounting for 51% of the total effect.

CONCLUSIONS

The intervention effects on physical and general health were explained by different mediating mechanisms. Walking speed mediated the intervention effect on both physical and general health. The intervention effect on physical health was further mediated by upper body strength, whereas the effect on general health was mediated by fatigue.

Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS): rationale and design for meta-analyses of individual patient data of randomized controlled trials that evaluate the effect of physical activity and psychosocial interventions on health-related quality of life in cancer survivors

BACKGROUND

Effective interventions to improve quality of life of cancer survivors are essential. Numerous randomized controlled trials have evaluated the effects of physical activity or psychosocial interventions on health-related quality of life of cancer survivors, with generally small sample sizes and modest effects. Better targeted interventions may result in larger effects. To realize such targeted interventions, we must determine which interventions that are presently available work for which patients, and what the underlying mechanisms are (that is, the moderators and mediators of physical activity and psychosocial interventions). Individual patient data meta-analysis has been described as the 'gold standard' of systematic review methodology. Instead of extracting aggregate data from study reports or from authors, the original research data are sought directly from the investigators. Individual patient data meta-analyses allow for adequate statistical analysis of intervention effects and moderators of such effects.Here, we report the rationale and design of the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) Consortium. The primary aim of POLARIS is 1) to conduct meta-analyses based on individual patient data to evaluate the effect of physical activity and psychosocial interventions on the health-related quality of life of cancer survivors; 2) to identify important demographic, clinical, personal, or intervention-related moderators of the effect; and 3) to build and validate clinical prediction models identifying the most relevant predictors of intervention success.

METHODS/DESIGN

We will invite investigators of randomized controlled trials that evaluate the effects of physical activity and/or psychosocial interventions on health-related quality of life compared with a wait-list, usual care or attention control group among adult cancer survivors to join the POLARIS consortium and share their data for use in pooled analyses that will address the proposed aims. We are in the process of identifying eligible randomized controlled trials through literature searches in four databases. To date, we have identified 132 eligible and unique trials.

DISCUSSION

The POLARIS consortium will conduct the first individual patient data meta-analyses in order to generate evidence essential to targeting physical activity and psychosocial programs to the individual survivor's characteristics, capabilities, and preferences.

REGISTRATION PROSPERO

International prospective register of systematic reviews, CRD42013003805.

Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions

Physical activity during and after cancer treatment has beneficial effects on a number of physical and psychosocial outcomes. This paper aims to discuss the existing physical activity guidelines for cancer survivors and to describe future research directions to optimize prescriptions. Studies on physical activity during and after cancer treatment were searched in PubMed, Clinicaltrials.gov, Australian New Zealand Clinical Trials Registry, and Dutch Trial registry. Physical activity guidelines for cancer survivors suggest that physical activity should be an integral and continuous part of care for all cancer survivors. However, the development of these guidelines has been limited by the research conducted. To be able to develop more specific guidelines, future studies should focus on identifying clinical, personal, physical, psychosocial, and intervention moderators explaining 'for whom' or 'under what circumstances' interventions work. Further, more insight into the working mechanisms of exercise interventions on health outcomes in cancer survivors is needed to improve the efficacy and efficiency of interventions. Finally, existing programs should embrace interests and preferences of patients to facilitate optimal uptake of interventions. In conclusion, current physical activity guidelines for cancer survivors are generic, and research is needed to develop more personalized physical activity guidelines.