A nationwide survey of fatigue in cancer patients in Taiwan: an unmet need

Care process for breast cancer patients with sleep disturbances: a best practice implementation project

INTRODUCTION

Patients with breast cancer are 50% more likely to experience sleep disturbances during treatment. Sleep disturbances may affect physiological and psychological functions and even induce cancer recurrence. Screening, assessment, and management of sleep disturbances improves sleep quality in breast cancer patients.

OBJECTIVES

This project aimed to establish a care process for breast cancer patients with sleep disturbances in a cancer ward.

METHODS

The project was implemented using the JBI Evidence Implementation Framework, which is grounded in audit and feedback. A baseline audit examined the existing care for sleep disturbances in breast cancer patients undergoing chemotherapy. Eight criteria were applied to evaluate compliance with best practice recommendations. A JBI Getting Research into Practice (GRiP) analysis was conducted, and five barriers to recommended practices were identified. Fourteen improvement strategies were then implemented and a follow-up audit was conducted to measure changes in practice.

RESULTS

The baseline audit showed that the sleep screening rate was 71% (Criterion 1). However, for the remaining criteria (2-8), the compliance rate was 0%. After project implementation, all criteria improved. Thus, 100% of nurses received education on sleep disturbance; the screening rate increased to 90%; 100% of screened patients received comprehensive sleep assessment; and 100% of assessed patients received tailored, multimodal sleep management based on their assessment results.

CONCLUSIONS

This project improved compliance with evidence-based practices in caring for breast cancer patients with sleep disturbances. Process orientation, interdisciplinary collaboration, and leadership contributed to project success. Further studies in digitalized sleep assessment are needed to ensure the efficiency and sustainability of sleep care.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A300.

Prevalence and associated factors of cancer-related fatigue among adult patients with cancer attending oncology units: an institution-based cross-sectional study design in the Amhara region, Ethiopia, 2022

Introduction

Cancer-related fatigue (CRF) continues to be a common problem among most patients with cancer. It is a subjective feeling of tiredness, weakness or lack of energy. CRF has a significant impact on social interactions, everyday activities and the general quality of life of patients with cancer worldwide. However, little is known about CRF in Ethiopia as well as in the current study area. Therefore, the aim of this study was to assess the prevalence and associated factors of CRF among adult patients attending oncology units at the comprehensive specialised hospitals in the Amhara regional state of Ethiopia.

Methods

An institution-based cross-sectional study was conducted among adult patients with cancer undergoing treatment. A systematic random sampling technique was employed to select the study participants. An interviewer-administered questionnaire and participants' medical charts were used to collect the data. The questionnaire consisted of eight subsections, including sociodemographic characteristics, behavioural characteristics, Brief Fatigue Inventory, Performance Status Scale, Oslo Social Support Status, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and clinical and medical factors. The data were entered into EpiData V.4.6 and exported into SPSS V.26 for analysis. The participants' characteristics were compiled using descriptive statics. Bivariable and multivariable logistic regressions were used to identify associations between dependent and independent variables. Variables with a value of p<0.05 were considered statistically significant.

Result

A total of 326 randomly selected patients with cancer, undergoing treatment, participated in this study; the response rate was 94%. The prevalence of CRF was found to be 63.93% (95% CI 58.5% to 69.25%). Depression (adjusted OR (AOR) 1.975, 95% CI 1.009 to 3.865), poor sleep quality (AOR 3.309, 95% CI 1.057 to 10.345), poor performance status (AOR 1.983, 95% CI 1.176 to 4.70), cancer stage (AOR 3.242, 95% CI 1.016 to 10.342) and admitted patients with cancer (AOR 2.047, 95% CI 1.122 to 3.734) were associated with CRF.

Conclusion and recommendation

The prevalence of CRF was found to be high. Stage of cancer, poor sleep quality, poor performance status, depression and hospital admission were significant factors. The results show that healthcare providers should focus on risk factors as well as CRF through early screening and management.

Prevalence of cancer-related fatigue, associated factors and adult cancer patients' experiences at Hawassa University Comprehensive Specialized Hospital in Ethiopia: a mixed methods study

Purpose

Cancer-related fatigue is a prevalent issue affecting 50-90% of cancer patients who experience fatigue at diagnosis, during therapy, and often for months or years after the completion of therapy. This study aimed to explore the prevalence of cancer-related fatigue, associated factors, and adult cancer patients' experiences at Hawassa University Comprehensive Specialized Hospital in Ethiopia.

Methods

A mixed-method study was conducted from February 25 to May 15, 2023, via cross-sectional descriptive and phenomenological approaches. The validated Amharic Brief Fatigue Inventory scale and semistructured interview guide were used. The data were processed via Epi-data version 4.4.3.1 and SPSS version 24, with logistic regression analysis. The interview records and field notes were transcribed and translated from Amharic to English and then analysed thematically.

Results

All participants (100%) completed the study, with 77.4% reporting significant fatigue. Fatigue was strongly associated with uninsured medical expenses (P = 0.008, OR = 3.22), late-stage cancer (P = 0.000, OR = 6.11), anaemia (P = 0.009, OR = 3.71), and comorbidities (P = 0.000, OR = 7.22). From the in-depth interviews with 16 participants, two main themes emerged: financial strain (giving up basics, and inability to work) and disease progression (intensified symptoms, increased treatment side effects, and managing multiple conditions).

Conclusion

This study revealed that 77.4% of cancer patients experience significant fatigue, which is linked to a lack of medical insurance, late-stage cancer, anaemia, and comorbid conditions. Financial strain limits access to care, whereas disease progression and managing multiple conditions intensify fatigue. Early intervention, financial support, and integrated care are crucial for reducing fatigue and improving quality of life. Future research should focus on multicentre and longitudinal studies to improve generalizability and track fatigue progression over time.

Astragalus polysaccharides improve adjuvant chemotherapy-induced fatigue for patients with early breast cancer

This study aimed to evaluate the effect of Astragalus polysaccharides (PG2) on reducing chemotherapy-induced fatigue (CIF) and toxicity, thereby encouraging compliance to chemotherapy. This was a randomized, placebo-controlled, phase 2 study. Patients with stage II/III early breast cancer planning to undergo adjuvant anthracycline-based chemotherapy were randomly assigned to receive PG2 500 mg or placebo on days 1, 3, and 8 every 21 days. The fatigue global score (FGS) was assessed using the brief fatigue inventory (BFI)-Taiwan. The Breast Cancer-Specific Module of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires-Core30 evaluated the health-related quality of life during the first four cycles of adjuvant chemotherapy. Overall, 66 eligible patients were equally randomized into the PG2 and placebo groups between March 01, 2018, and March 09, 2021. The mean change in the FGS and fatigue intensity did not significantly differ between both groups. However, the FGS and fatigue intensity were less aggravated in the first four cycles in the premenopausal-PG2 group than in the placebo group. Our study concluded PG2 combined with adjuvant chemotherapy can reduce CIF, insomnia, the negative effect on future perspectives, and improve global health status, especially for premenopausal patients with breast cancer. Trial registration number: NCT03314805 registered on 19/10/2017.

Fatigue Prevalence Among Palliative Care Cancer Patients in Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia: A Cross-Sectional Study

Objective: The aims of the current study are to assess the prevalence of cancer-related fatigue, to examine the difference in cancer-related fatigue severity in relation to patients' characteristics (age, gender, type of cancer, and palliative performance status), and to explore the correlation between cancer-related fatigue and pain, dyspnea, insomnia, and depression among palliative care patients. Methods: A cross-sectional descriptive observational study conducted at Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia. The study included cancer patients who received palliative care services from January 2016 to December 2021. Clinical data of study participants were retrospectively collected from Palliative Care department patient registry. Symptoms were assessed and scored using Edmonton Symptom Assessment Scale. Data analysis was performed using SPSS statistical software. Results: A total of 2616 patients were included in the study, 52.3% were females and 47.7% were males. The median age of study participants was 56 years (range: 2-101 years). Among all study population, the highest reported cancer type was gastrointestinal malignancy (33.5%), while the least was unknown primary malignancy (1.4%). With regards to Edmonton Symptom Assessment Scale, pain (86.4%) and fatigue (83%) were the highest reported symptom in comparison to constipation (17.3%) and insomnia (7.1%). Conclusion: Cancer-related fatigue is a prevalent and concerning issue among palliative care patients. It is essential that healthcare providers recognize the prevalence of fatigue among patients with life-limiting illnesses, assess patients for fatigue routinely, incorporate strategies for managing fatigue, work closely with affected individuals and their families in order to guide the establishment of a personalized care plan that addresses the patient's unique needs and preferences.

The content and effectiveness of physical activity for cancer-related fatigue among colorectal cancer survivors: Systematic review and meta-analysis

AIMS

To review the content and efficacy of physical activity (PA) for cancer-related fatigue (CRF) among colorectal cancer survivors.

DESIGN

Systematic review.

METHODS

A comprehensive search for randomized controlled trials from inception to April 1, 2022, of the following database was performed: EMBASE, PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data and China Biology Medicine (CBM). RevMan5.4 software was used for performing meta-analysis.

RESULTS

A total of eight qualified randomized controlled trials that included 542 survivors were included. PA interventions significantly reduced the CRF (SMD = -0.46; 95% CI: [-0.76, -0.15], Z = 2.67, p = 0.003); Subgroup analysis showed that fatigue was significantly improved when the length of interventions was at least 6 months and the weekly duration of PA was less than 150 min/week (SMD = -0.54; 95% CI: [-0.81, -0.27], Z = 3.87 and p = 0.0001; SMD = -0.67; 95% CI: [-1.15, -0.19], Z = 2.74 and p = 0.006); PA intervention with the length of <6 months and the volume of ≥150 min/week did not reduce fatigue (p > 0.05).

Corticosteroids for the management of cancer-related fatigue in adults with advanced cancer

BACKGROUND

Fatigue is the most commonly reported symptom in people with advanced cancer. Cancer-related fatigue (CRF) is pervasive and debilitating, and can greatly impact quality of life (QoL). CRF has a highly variable clinical presentation, likely due to a complex interaction of multiple factors. Corticosteroids are commonly used to improve CRF, but the benefits are unclear and there are significant adverse effects associated with long-term use. With the increasing survival of people with metastatic cancer, the long-term effects of medications are becoming increasingly relevant. Since the impact of CRF can be immensely debilitating and can negatively affect QoL, its treatment warrants further review.

OBJECTIVES

To determine the benefits and harms of corticosteroids compared with placebo or an active comparator in adults with advanced cancer and CRF.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, Science Citation Index (ISI Web of Science), LILACS, and two clinical trial registries from inception to 18 July 2022.  SELECTION CRITERIA: We included randomised controlled trials in adults aged ≥18 years. We included participants with advanced cancer who were suffering from CRF. We included trials that randomised participants to corticosteroids at any dose, by any route, administered for the relief of CRF; compared to placebo or an active comparator, including supportive care or non-pharmacological treatments.

DATA COLLECTION AND ANALYSIS

Three review authors independently assessed titles identified by the search strategy; two review authors assessed risk of bias; and two extracted data. We extracted the primary outcome of participant-reported fatigue relief using validated scales and secondary outcomes of adverse events, serious adverse events and QoL. We calculated the risk ratio with 95% confidence intervals (CIs) between groups for dichotomous outcomes. We measured arithmetic mean and standard deviation, and reported the mean difference (MD) with 95% CI between groups for continuous outcomes. We used standardised mean difference (SMD) with 95% CIs when an outcome was measured with different instruments measuring the same construct. We used a random-effects model to meta-analyse the outcome data. We rated the certainty of the evidence using GRADE and created two summary of findings tables.  MAIN RESULTS: We included four studies with 297 enroled participants; data were available for only 239 participants. Three studies compared corticosteroid (equivalent ≤ 8 mg dexamethasone) to placebo. One study compared corticosteroid (dexamethasone 4 mg) to an active comparator (modafinil 100 mg). There were insufficient data to evaluate subgroups, such as dose and duration of treatment. One study had a high risk of performance and detection bias due to lack of blinding, and one study had a high risk of attrition bias. Otherwise, we assessed risks of bias as low or unclear. Comparison 1: corticosteroids compared with placebo Participant-reported fatigue relief The was no clear difference between corticosteroids and placebo (SMD -0.46, 95% CI -1.07 to 0.14; 3 RCTs, 165 participants, very low-certainty evidence) for relief of fatigue at one week of the intervention. We downgraded the certainty of the evidence three times for study limitations due to unclear risk of bias, imprecision, and inconsistency. Adverse events There was no clear difference in the occurrence of adverse events between groups, but the evidence is very uncertain (3 RCTs, 165 participants; very low-certainty evidence). Serious adverse events There was no clear difference in the occurrence of serious adverse events between groups, but the evidence is very uncertain (2 RCTs, 118 participants; very low-certainty evidence). Quality of lIfe One study reported QoL at one week using the Edmonton Symptom Assessment System (ESAS) well-being, and found no clear difference in QoL between groups (MD -0.58, 95% CI -1.93 to 0.77). Another study measured QoL using the Quality of Life Questionnaire for Cancer Patients Treated with Anticancer Drugs (QoL-ACD), and found no clear difference between groups. There was no clear difference between groups for either study, but the evidence is very uncertain (2 RCTs, 118 participants; very low-certainty evidence).  Comparison 2: corticosteroids compared with active comparator (modafinil) Participant-reported fatigue relief There was improvement in fatigue from baseline to two weeks in both groups (modafinil MD 10.15, 95% CI 7.43 to 12.87; dexamethasone MD 9.21, 95% CI 6.73 to 11.69), however no clear difference between the two groups (MD -0.94, 95% CI -4.49 to 2.61; 1 RCT, 73 participants, very low-certainty evidence). We downgraded the certainty of the evidence three times for very serious study limitations and imprecision. Adverse events There was no clear difference in the occurrence of adverse events between groups, but the evidence is very uncertain (1 RCT, 73 participants; very low-certainty evidence).  Serious adverse events There were no serious adverse events reported in either group (1 RCT, 73 participants; very low-certainty evidence).  Quality of lIfe One study measured QoL at two weeks, using the ESAS-well-being. There was marked improvement in QoL from baseline in both groups (modafinil MD -2.43, 95% CI -2.88 to -1.98; dexamethasone MD -2.16, 95% CI -2.68 to -1.64), however no clear difference between the two groups (MD 0.27, 95% CI -0.39 to 0.93; 1 RCT, 73 participants, very low-certainty evidence).

AUTHORS' CONCLUSIONS

There is insufficient evidence to support or refute the use of systemic corticosteroids in adults with cancer and CRF. We included four small studies that provided very low-certainty of evidence for the efficacy of corticosteroids in the management of CRF. Further high-quality randomised controlled trials with larger sample sizes are required to determine the effectiveness of corticosteroids in this setting.

Management of cancer-related fatigue in Taiwan: an evidence-based consensus for screening, assessment and treatment

BACKGROUND

Cancer-related fatigue is one of the most common and persistent issues experienced by cancer patients. Cancer-related fatigue is a distinct form of fatigue that is subjective, long-lasting and unalleviated by rest or sleep. Studies have shown that almost all cancer patients experience severe fatigue that disrupts the quality of life and physical function, but cancer-related fatigue remains under-addressed in clinical care, and only about half of all patients receive treatment.

METHODS

To increase the awareness of cancer-related fatigue and improve current management, the Taiwan Society of Cancer Palliative Medicine and the Taiwan Oncology Nursing Society convened a consensus committee to develop recommendations for the screening, assessment and treatment of cancer-related fatigue.

RESULTS

Thirteen consensus recommendations were subsequently developed based on the best available evidence and the clinical experience of committee members.

CONCLUSIONS

These recommendations are expected to facilitate the standardization of cancer-related fatigue management across Taiwan and may also serve as a reference for other clinicians.

Simultaneous care in oncology: Assessment of benefit in relation to symptoms, sex, and age in 753 patients

BACKGROUND

Early activation of palliative care for patients with advanced cancer is central in the treatment trajectory. At the Veneto Institute of Oncology, a simultaneous-care outpatient clinic (SCOC) has been active since 2014, where patients are evaluated by an oncologist together with a palliative care team. Recently, we reported on consecutive patients admitted at SCOC from 2018 to 2021 in terms of appropriateness, process, and outcome indicators. Here, we report further analysis in the same group of 753 patients, evaluating other parameters and the correlation between symptom intensity, gender, age, and survival.

METHODS

SCOC data were retrieved from a prospectively maintained database.

RESULTS

Among the patients, 42.2% were women, and the median age was 68 years, with 46.7% of patients aged ≥70 years. The most prevalent disease type was gastrointestinal cancer (75.2%), and 90.9% of the patients had metastatic disease. The median score for the distress thermometer was 4; the vast majority of the patients (98.6%) reported physical problems, and 69.4% presented emotional issues. Younger women demonstrated a significantly greater median distress than other patients (p=0.0018). Almost all symptoms had a higher prevalence on the 0-3 Edmonton Symptom Assessment Scale (ESAS) score, except for fatigue. About 43.8% of the patients received systemic anticancer treatment (SAT) in the last 60 days of life, 15.0% of whom received SAT in the last month and 3.1% in the last 2 weeks. For some symptoms, women frequently had more ESAS >3. Pain and nausea were significantly less reported by older patients compared with younger adults. Men had a lower risk of having MUST score ≥ 2 (p=0.0311). Men and older patients showed a lower prognosis awareness (p=0.0011 and p=0.0049, respectively). Older patients received less SAT within the last 30 days of life (p=0.0006) and had death risk decreased by 20.0%.

CONCLUSION

Our study identified two subgroups of patients with advanced cancer who require special attention and support due to important symptoms' burden detected by Patient Reported Outcome Measures tests: women and younger adults. These categories of patients require special attention and should be provided early access at SCOC. The role of an oncologist remains crucial to intercept all patients in need of early palliative care and balancing trade-offs of anticancer treatment in advanced metastatic disease.

The effect of Benson relaxation application ('Bens app') on reducing fatigue in patients with breast cancer undergoing chemotherapy: A quasi-experimental study

Background

Fatigue is the most common symptom in patients with breast cancer undergoing chemotherapy. Benson's relaxation technique is considered effective to reduce fatigue, but its effect in combination with smartphone technology is limited.

Objective

This study aimed to analyze and determine the effect of the Benson relaxation application (Bens app) on fatigue in patients with breast cancer undergoing chemotherapy.

Methods

A quasi-experimental design with a pretest-posttest comparison group was used. Fifty-six patients were included using consecutive sampling technique, of which 28 were assigned to the experimental group (received Benson relaxation technique using Bens app) and comparison group (obtained Benson relaxation technique using booklet). The Benson relaxation was done two times per day for seven days, and the Brief Fatigue Inventory questionnaire was used to measure the patients' fatigue levels. Data were analyzed using paired and independent t-tests.

Results

The experimental group (p = 0.001) and the comparison group (p = 0.015) showed a significant reduction in fatigue after receiving the Benson relaxation for seven days. However, there was a statistically significant difference in fatigue between the experiment and comparison groups after the intervention (t55 = 2.481, p = 0.016).

Conclusion

Benson relaxation could reduce fatigue in patients with breast cancer using the Bens app and booklet. However, the Bens app is considered more effective than a booklet. Therefore, the Bens app can be viewed as an alternative to help patients perform Benson relaxation and integrated into the nurse palliative care program for patients with cancer.

A Cross-sectional Study of Patients and Physicians on the Impact of Myeloproliferative Neoplasms on Patient Health: The Landmark Survey From Taiwan

Patients with myeloproliferative neoplasm (MPN), including myelofibrosis, polycythemia vera, and essential thrombocythemia, experience a pronounced symptom burden. This study aimed to collect information from physicians and patients in Taiwan to explore their perceptions regarding MPN, treatment goals, and satisfaction with disease management. A cross-sectional, online survey was conducted among patients and physicians from September 2018 to November 2018 in Taiwan as a subset of the expansion of the Landmark survey. Overall, 50 patients with MPN and 30 physicians participated in this study. The symptom burden was low, with the mean number of symptoms experienced being 1.8. The most frequent symptom per physicians’ perception was fatigue, whereas it is not the most common symptom from MPN patients’ perspective. Blood count was the key indicator to determine treatment success from patients’ view, whereas presence of a new symptom was the key indicator from physicians’ perspective. Concordant with previous studies, our study revealed a lack of alignment between physician and patient perceptions relating to treatment goals and disease management. Nevertheless, the physical, emotional, work/activities and financial impacts on patients were minimal in Taiwan.

Subgroups of patients undergoing chemotherapy with distinct cognitive fatigue and evening physical fatigue profiles

PURPOSE

The purpose was to model cognitive fatigue and evening physical fatigue together to determine subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles. Once these profiles were identified, differences among the subgroups in demographic and clinical characteristics, co-occurring symptoms, and quality of life outcomes were evaluated.

METHODS

Oncology patients (n = 1332) completed self-report measures of cognitive fatigue and evening physical fatigue, six times over two cycles of chemotherapy. Latent profile analysis, which combined the two symptom scores, was done to identify subgroups of patients with distinct cognitive fatigue AND evening physical fatigue profiles.

RESULTS

Three distinct profiles (i.e., Low [20.5%], Moderate [39.6%], and High [39.6%]) were identified. Compared to the Low class, patients in the High class were younger, female, and more likely to live alone and had a higher comorbidity burden and a lower functional status. In addition, these patients had a higher symptom burden and a poorer quality of life.

CONCLUSION

Based on clinically meaningful cutoff scores, 80% of the patients in this study had moderate to high levels of both cognitive fatigue and evening physical fatigue. In addition, these patients experienced high levels of other common symptoms (e.g., anxiety, depression, sleep disturbance, and pain). These co-occurring symptoms and other modifiable characteristics associated with membership in the Moderate and High classes may be potential targets for individualized symptom management interventions.