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Low SLK, Ho GF, Liu B, Koh ES, Fei Y, Teo CS, Zhu X. Exploring Guolin Qigong (Mind-Body Exercise) for Improving Cancer Related Fatigue in Cancer Survivors: A Mixed Method Randomized Controlled Trial Protocol. Integr Cancer Ther 2024; 23:15347354241252698. [PMID: 38757745 PMCID: PMC11102686 DOI: 10.1177/15347354241252698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 04/05/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Cancer-related fatigue and its associated symptoms of sleep disorder and depression are prevalent in cancer survivors especially among breast, lung, and colorectal cancer survivors. While there is no gold standard for treating cancer-related fatigue currently, studies of mind-body exercises such as Qigong have reported promise in reducing symptoms. This study was designed to evaluate the feasibility and effect of Guolin Qigong on cancer-related fatigue and other symptoms in breast, lung and colorectal cancer survivors while exploring their perceptions and experiences of Guolin Qigong intervention. METHODS This is an open-label randomized controlled trial with 60 participants divided into 2 study groups in a 1:1 ratio. The intervention group will receive 12 weeks of Guolin Qigong intervention with a 4-week follow-up while control will receive usual care under waitlist. The primary outcome will be feasibility measured based on recruitment and retention rates, class attendance, home practice adherence, nature, and quantum of missing data as well as safety. The secondary subjective outcomes of fatigue, sleep quality and depression will be measured at Week-1 (baseline), Week-6 (mid-intervention), Week-12 (post-intervention), and Week-16 (4 weeks post-intervention) while an objective 24-hour urine cortisol will be measured at Week-1 (baseline) and Week-12 (post-intervention). We will conduct a semi-structured interview individually with participants within 3 months after Week-16 (4 weeks post-intervention) to obtain a more comprehensive view of practice adherence. DISCUSSION This is the first mixed-method study to investigate the feasibility and effect of Guolin Qigong on breast, lung, and colorectal cancer survivors to provide a comprehensive understanding of Guolin Qigong's intervention impact and participants' perspectives. The interdisciplinary collaboration between Western Medicine and Chinese Medicine expertise of this study ensures robust study design, enhanced participant care, rigorous data analysis, and meaningful interpretation of results. This innovative research contributes to the field of oncology and may guide future evidence-based mind-body interventions to improve cancer survivorship. TRIAL REGISTRATION This study has been registered with ANZCTR (ACTRN12622000688785p), was approved by Medical Research Ethic Committee of University Malaya Medical Centre (MREC ID NO: 2022323-11092) and recognized by Western Sydney University Human Research Ethics Committee (RH15124).
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Affiliation(s)
- Sara L. K. Low
- Western Sydney University, Penrith South, NSW, Australia
| | - Gwo Fuang Ho
- University Malaya Medical Centre, Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | | | - Eng-Siew Koh
- University of New South Wales, Liverpool, NSW, Australia
| | - Yutong Fei
- Beijing University of Chinese Medicine, Beijing, China
| | | | - Xiaoshu Zhu
- Western Sydney University, Penrith South, NSW, Australia
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Fatigue in patients on oral targeted or chemotherapy for cancer and associations with anxiety, depression, and quality of life. Palliat Support Care 2021; 18:141-147. [PMID: 31535613 PMCID: PMC7489872 DOI: 10.1017/s147895151900066x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Oral treatment (targeted or chemotherapy) for cancer is being increasingly used. While fatigue is a known side effect of intravenous chemotherapy, the rate of fatigue and the impact of fatigue on other patient-reported outcomes are not well described. METHOD At Massachusetts General Hospital Cancer Center, 180 adult patients prescribed oral targeted or chemotherapy for various malignancies enrolled in a randomized controlled trial of adherence and symptom management. Patients completed baseline self-reported measures of fatigue (Brief Fatigue Inventory; BFI), anxiety and depressive symptoms (Hospital Anxiety and Depression Scale; HADS), and quality of life, including subscales for physical, social, emotional, and functional well-being ([QOL] Functional Assessment of Cancer Therapy - General; FACT-G). We examined clinically relevant fatigue using a validated cut-off score for moderate-severe fatigue (BFI global fatigue ≥4) and tested the associations with anxiety symptoms, depressive symptoms, and QOL with independent samples t-tests. RESULTS At baseline, 45 of 180 participants (25.0%) reported moderate-severe fatigue. Fatigued patients experienced more anxiety symptoms (mean diff. 3.73, P < 0.001), more depressive symptoms (mean diff. 4.14, P < 0.001), and worse QOL on the total FACT-G score (mean diff. -19.58, P < 0.001) and all subscales of the FACT-G compared to patients without moderate-severe fatigue. SIGNIFICANCE OF RESULTS One in four patients on oral treatment for cancer experienced clinically relevant fatigue that is associated with greater anxiety and depressive symptoms and worse QOL.
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Al Maqbali M, Al Sinani M, Al Naamani Z, Al Badi K, Tanash MI. Prevalence of Fatigue in Patients With Cancer: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2021; 61:167-189.e14. [PMID: 32768552 DOI: 10.1016/j.jpainsymman.2020.07.037] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 12/11/2022]
Abstract
CONTEXT Fatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness among patients with cancer. OBJECTIVES The objective of this meta-analysis is to examine the present status of fatigue prevalence in patients with cancer. METHODS The following databases were searched: PubMed, MEDLINE, EMBASE, PsycINFO, Cochrane Library, from inception up to February 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. RESULTS A total of 129 studies (N = 71,568) published between 1993 and 2020 met the inclusion criteria. The overall prevalence of fatigue was 49% (34,947 of 71,656 participants, 95% CI = 45-53) with significant heterogeneity between studies (P < 0.000; τ2 = 0.0000; I2 = 98.88%). Subgroup analyses show that the prevalence of fatigue related to type of cancer ranged from 26.2% in patients with gynecological cancer to 56.3% in studies that included mixed types of cancer. In advanced cancer stage patients, the highest prevalence of fatigue (60.6%) was reported. Fatigue prevalence rates were 62% during treatment and 51% during mixed treatment status. The prevalence of fatigue decreased from 64% in studies published from 1996 to 2000 to 43% in studies published from 2016 to 2020. Metaregression identified female gender as a significant moderator for higher prevalence of fatigue, whereas mean age is not associated with fatigue. CONCLUSION This meta-analysis highlights the importance of developing optimal monitoring strategies to reduce fatigue and improve the quality of life of patients with cancer.
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Affiliation(s)
| | - Mohammed Al Sinani
- Reproductive and Developmental Biology Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Zakariya Al Naamani
- School of Nursing and Midwifery, Queen's University Medical Biology Centre, Belfast, Northern Ireland
| | - Khalid Al Badi
- Al Khawarizmi International College, Abu Dhabi, United Arab Emirates
| | - Mu'ath Ibrahim Tanash
- Department of Adult Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Yeun EJ, Jeon M. Attitudes About Coping With Fatigue in Patients With Gastric Cancer: A Q-Methodology Study. Gastroenterol Nurs 2020; 43:97-105. [PMID: 31990878 DOI: 10.1097/sga.0000000000000390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cancer-related fatigue is the most common symptom in patients with cancer. Coping methods for cancer-related fatigue differ from those of patients without cancer, as the situations faced by patients with cancer are unique. This study aimed to identify subjectivity concerning coping with fatigue in Korean patients with gastric cancer. Q-methodology was used to examine subjective perceptions regarding coping with fatigue among Korean patients with gastric cancer. A convenience sample of 33 participants, who had been hospitalized in 2 university hospitals in South Korea, was recruited to participate in the study and 37 selected Q-samples were classified into a normal forced distribution using a 9-point bipolar grid. The obtained data were analyzed by using PC-QUANL for Windows. Three factors representing distinct attitudes about coping with fatigue emerged among Korean patients with gastric cancer: an optimistic mind, dependency on medicine, and exercise preference. The 3 factors explained 39.4% of the total variance (23.7%, 7.9%, and 7.8%, respectively). Based on the study findings, it is important to develop customized nursing interventions that consider the characteristics of each patient group with gastric cancer. Health professionals should assess the attitudes of patients with gastric cancer about coping with fatigue, explore their situation, and consider their lifestyle.
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Affiliation(s)
- Eun Ja Yeun
- Eun Ja Yeun, PhD, RN, is Professor, Department of Nursing, Konkuk University, Chungju, Chungbuk, Republic of Korea. Misoon Jeon, PhD, RN, is Professor, Department of Nursing, Baekseok University, Cheonan, Chungnam, Republic of Korea
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Prevalence and risk factors of cancer-related fatigue: A systematic review and meta-analysis. Int J Nurs Stud 2020; 111:103707. [DOI: 10.1016/j.ijnurstu.2020.103707] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 06/02/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022]
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ÖCALAN S, ÜZAR ÖZÇETİN YS. Kanser Deneyiminde Ruminasyon, Tükenmişlik ve Psikolojik Sağlamlık. PSIKIYATRIDE GUNCEL YAKLASIMLAR 2020. [DOI: 10.18863/pgy.664396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Penson A, van Deuren S, Worm-Smeitink M, Bronkhorst E, van den Hoogen FHJ, van Engelen BGM, Peters M, Bleijenberg G, Vercoulen JH, Blijlevens N, van Dulmen-den Broeder E, Loonen J, Knoop H. Short fatigue questionnaire: Screening for severe fatigue. J Psychosom Res 2020; 137:110229. [PMID: 32890861 DOI: 10.1016/j.jpsychores.2020.110229] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/10/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine psychometric properties, a cut-off score for severe fatigue and normative data for the 4-item Short Fatigue Questionnaire (SFQ) derived from the multi-dimensional fatigue questionnaire Checklist Individual Strength (CIS). METHODS Data of previous studies investigating the prevalence of fatigue in ten chronic conditions (n = 2985) and the general population (n = 2288) was used to determine the internal consistency (Cronbach's alpha) of the SFQ, its relation with other fatigue measures (EORTC QLQ-30 fatigue subscale and digital fatigue diary), a cut-off score for severe fatigue (ROC analysis) and to examine whether the four SFQ items truly measure the same construct. Norms were calculated for ten patient groups and the Dutch general population. RESULTS Cronbach's alpha of the SFQ were excellent in almost all groups. Pearson's correlations between the SFQ and the EORTC-QLQ-C30 fatigue subscale and a fatigue diary were respectively 0.76 and 0.68. ROC analysis showed an area under the curve of 0.982 (95% CI: 0.979-0.985) and cut-off score of 18 was suggested which showed a good sensitivity (0.984) and specificity (0.826) as well as excellent values for the positive and negative prediction values within all groups using the CIS as golden standard. Factor analysis showed a one factor solution (Eigenvalue: 3.095) with factor loadings of all items on the factor being greater than 0.87. CONCLUSION The SFQ is an easy to use, reliable and valid instrument to screen for severe fatigue in clinical routine and research.
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Affiliation(s)
- Adriaan Penson
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sylvia van Deuren
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Margreet Worm-Smeitink
- Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ewald Bronkhorst
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Marlies Peters
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jan H Vercoulen
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eline van Dulmen-den Broeder
- Department of Pediatric Oncology/Hematology, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public health research institute, Amsterdam, The Netherlands.
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Solvik E, Ytrehus S, Utne I, Grov EK. Pain, fatigue, anxiety and depression in older home-dwelling people with cancer. Nurs Open 2020; 7:430-438. [PMID: 31871728 PMCID: PMC6918018 DOI: 10.1002/nop2.406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 10/07/2019] [Indexed: 11/22/2022] Open
Abstract
Aim Globally, cancer incidence counts for more than 14 million cases and the number increases with age. The aim of this study was to investigate the occurrence of pain, fatigue, anxiety and depression in association with demographic and clinical factors. Design A cross-sectional descriptive design was used. Methods We performed descriptive statistics to analyse the questionnaires completed from 174 older home-dwelling people with cancer. Results The people with cancer reported low occurrence of pain, fatigue, anxiety and depression. We found strong correlation between anxiety and depression. Women reported significantly higher scores of anxiety and depression than men. A higher pain score was associated with higher scores of fatigue and anxiety. Conclusions Home care personnel meeting older home-dwelling people with cancer should emphasize these people' mental health problems and be aware that pain, fatigue and anxiety may occur at the same time.
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Affiliation(s)
- Elena Solvik
- Department of Emergency ReceptionOstfold Hospital Trust, KalnesGrålumNorway
| | - Siri Ytrehus
- Faculty of HealthWestern Norway University of Applied SciencesBergenNorway
| | - Inger Utne
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOslo Metropolitan UniversityOsloNorway
| | - Ellen Karine Grov
- Faculty of Health SciencesInstitute of Nursing and Health PromotionOslo Metropolitan UniversityOsloNorway
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Worm-Smeitink M, Gielissen M, Bloot L, van Laarhoven HWM, van Engelen BGM, van Riel P, Bleijenberg G, Nikolaus S, Knoop H. The assessment of fatigue: Psychometric qualities and norms for the Checklist individual strength. J Psychosom Res 2017; 98:40-46. [PMID: 28554371 DOI: 10.1016/j.jpsychores.2017.05.007] [Citation(s) in RCA: 201] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The Checklist Individual Strength (CIS) measures four dimensions of fatigue: Fatigue severity, concentration problems, reduced motivation and activity. On the fatigue severity subscale, a cut-off score of 35 is used. This study 1) investigated the psychometric qualities of the CIS; 2) validated the cut-off score for severe fatigue and 3) provided norms. METHODS Representatives of the Dutch general population (n=2288) completed the CIS. The factor structure was investigated using an exploratory factor analysis. Internal consistency and test-retest reliability were determined. Concurrent validity was assessed in two additional samples by correlating the CIS with other fatigue scales (Chalder Fatigue Questionnaire, MOS Short form-36 Vitality subscale, EORTC QLQ-C30 fatigue subscale). To validate the fatigue severity cut-off score, a Receiver Operating Characteristics analysis was performed with patients referred to a chronic fatigue treatment centre (n=5243) and a healthy group (n=1906). Norm scores for CIS subscales were calculated for the general population, patients with chronic fatigue syndrome (CFS; n=1407) and eight groups with other medical conditions (n=1411). RESULTS The original four-factor structure of the CIS was replicated. Internal consistency (α=0.84-0.95) and test-retest reliability (r=0.74-0.86) of the subscales were high. Correlations with other fatigue scales were moderate to high. The 35 points cut-off score for severe fatigue is appropriate, but, given the 17% false positive rate, should be adjusted to 40 for research in CFS. CONCLUSION The CIS is a valid and reliable tool for the assessment of fatigue, with a validated cut-off score for severe fatigue that can be used in clinical practice.
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Affiliation(s)
- M Worm-Smeitink
- Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - M Gielissen
- Academic Medical Center (AMC), University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - L Bloot
- Department of Medical Psychology, Isala Klinieken, Zwolle, The Netherlands
| | - H W M van Laarhoven
- Department of Medical Oncology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands
| | - P van Riel
- IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - S Nikolaus
- Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - H Knoop
- Expert Centre for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Academic Medical Center (AMC), University of Amsterdam, Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
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Poort H, Kaal SEJ, Knoop H, Jansen R, Prins JB, Manten-Horst E, Servaes P, Husson O, van der Graaf WTA. Prevalence and impact of severe fatigue in adolescent and young adult cancer patients in comparison with population-based controls. Support Care Cancer 2017; 25:2911-2918. [PMID: 28528350 PMCID: PMC5527068 DOI: 10.1007/s00520-017-3746-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 05/08/2017] [Indexed: 12/12/2022]
Abstract
Purpose The current study determined the prevalence of severe fatigue in adolescent and young adult (AYA) cancer patients (aged 18–35 years at diagnosis) consulting a multidisciplinary AYA team in comparison with gender- and age-matched population-based controls. In addition, impact of severe fatigue on quality of life and correlates of fatigue severity were examined. Methods AYAs with cancer (n = 83) completed questionnaires including the Checklist Individual Strength (CIS-fatigue), Quality of Life (QoL)-Cancer Survivor, Hospital Anxiety and Depression Scale (reflecting psychological distress), and the Cancer Worry Scale (reflecting fear of cancer recurrence or progression). Results The vast majority of participants had been treated with chemotherapy (87%) and had no active treatment at the time of participation (73.5%). Prevalence of severe fatigue (CIS-fatigue score ≥35) in AYAs with cancer (48%, n = 40/83) was significantly higher in comparison with matched population-based controls (20%, n = 49/249; p < .001). Severely fatigued AYAs with cancer reported lower QoL compared to non-severely fatigued AYAs with cancer (p < .05). Female gender, being unemployed, higher disease stage (III–IV) at diagnosis, receiving active treatment at the time of study participation, being treated with palliative intent, having had radiotherapy, higher fear of recurrence or progression, and higher psychological distress were significantly correlated with fatigue severity (p < .05). Conclusions Severe fatigue based on a validated cut-off score was highly prevalent in this group of AYAs with cancer. QoL is significantly affected by severe fatigue, stressing the importance of detection and management of this symptom in those patients affected by a life-changing diagnosis of cancer in late adolescence or young adulthood.
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Affiliation(s)
- Hanneke Poort
- Department of Medical Psychology, Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Suzanne E J Kaal
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam Public Health research institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Psychology, Expert Center for Chronic Fatigue, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Rosemarie Jansen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eveliene Manten-Horst
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petra Servaes
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olga Husson
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.,The Institute of Cancer Research, United Kingdom and the Royal Marsden NHS Foundation Trust, London, UK
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Poort H, Peters MEWJ, Gielissen MFM, Verhagen CAHHVM, Bleijenberg G, van der Graaf WTA, Wearden AJ, Knoop H. Fatigue in Advanced Cancer Patients: Congruence Between Patients and Their Informal Caregivers About Patients' Fatigue Severity During Cancer Treatment With Palliative Intent and Predictors of Agreement. J Pain Symptom Manage 2016; 52:336-44. [PMID: 27233137 DOI: 10.1016/j.jpainsymman.2016.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 01/31/2016] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Informal caregivers (ICs) are increasingly involved in the monitoring of symptoms during advanced cancer patients' treatment with palliative intent. A common but subjective symptom during this extended treatment phase is fatigue. OBJECTIVES This exploratory longitudinal study aimed to determine agreement between patients and ICs about patients' fatigue severity. In addition, predictors of agreement over time were studied. METHODS A sample of 107 patients with advanced cancer (life expectancy ≥ six months) and their ICs completed the subscale fatigue severity of the Checklist Individual Strength based on the patient's status at baseline and six months later. This eight-item subscale has a validated cutoff to determine the presence of clinically relevant levels of fatigue. ICs' own fatigue severity, strain, self-esteem, and relationship satisfaction were examined as predictors of agreement. RESULTS A total of 107 dyads completed measures at baseline and 69 dyads six months later. At baseline, ICs' significantly overestimated patients' fatigue severity (P < 0.001) with a moderate amount of bias (Cohen's d = 0.48). In 81 of the 107 dyads (76%), there was congruence about the presence or absence of severe fatigue. On a group level, congruence did not significantly change over time. On a dyad level, there was a tendency to either remain congruent or reach congruence. Next to baseline congruence, ICs' fatigue severity and strain predicted ICs' fatigue ratings (R(2) = 0.22). CONCLUSION Most ICs accurately predict presence or absence of clinically relevant levels of patients' fatigue. ICs' own fatigue severity and strain should be taken into account as they influence agreement.
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Affiliation(s)
- Hanneke Poort
- Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Marlies E W J Peters
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke F M Gielissen
- Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Gijs Bleijenberg
- Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Winette T A van der Graaf
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands; The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison J Wearden
- School of Psychological Sciences and Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom
| | - Hans Knoop
- Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Nijhof LN, van de Putte EM, Wulffraat NM, Nijhof SL. Prevalence of Severe Fatigue Among Adolescents With Pediatric Rheumatic Diseases. Arthritis Care Res (Hoboken) 2016; 68:108-14. [PMID: 26314390 DOI: 10.1002/acr.22710] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/12/2015] [Accepted: 08/18/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine the prevalence of severe fatigue and fatigue-related limitations among adolescents with juvenile idiopathic arthritis (JIA) and other pediatric rheumatic diseases (PRDs). In addition, we assessed the effect of disease activity and pain on the severity of fatigue. METHODS This cross-sectional study included 175 patients (ages 10-18 years) who visited the pediatric rheumatology and immunology outpatient clinic at Wilhelmina Children's Hospital from April through July 2013. Patients completed validated questionnaires regarding fatigue, physical functioning, and school attendance. Disease activity in JIA patients was measured using the Juvenile Arthritis Disease Activity Score including 27 joints. The results were compared against a healthy control group. RESULTS The prevalence of severe fatigue among patients with PRDs was 25.1%, which was significantly higher than among the healthy control group (P < 0.001). Fatigued patients had significantly lower levels of physical functioning compared to nonfatigued patients (62.1% versus 89.0%, respectively; P < 0.001) and a significantly higher percentage of school absences (21.2% versus 11.6%, respectively; P = 0.005). Among JIA patients, the level of pain was significantly correlated with fatigue. Finally, disease activity was not a predictor for fatigue. CONCLUSION Fatigue is a common problem among teenagers with PRDs, with a higher prevalence among these patients than in the general population. Severe fatigue leads to significant impairments, including increased school absences and decreased physical functioning. Interestingly, fatigue was associated with pain, but not with the disease activity. Therefore, in this patient population, fatigue may be a promising therapeutic target for improving functioning, school attendance, and possibly pain as well.
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Affiliation(s)
- Linde N Nijhof
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Elise M van de Putte
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
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The need for social support provided by the non-profit cancer societies throughout different phases in the cancer trajectory and its integration into public healthcare. Eur J Oncol Nurs 2016; 21:97-104. [DOI: 10.1016/j.ejon.2016.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 04/27/2015] [Accepted: 02/03/2016] [Indexed: 11/23/2022]
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Fatigue and its associated psychosocial factors in cancer patients on active palliative treatment measured over time. Support Care Cancer 2015; 24:1349-55. [PMID: 26335403 PMCID: PMC4729797 DOI: 10.1007/s00520-015-2909-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/16/2015] [Indexed: 11/16/2022]
Abstract
Purpose Fatigue is a frequently reported symptom by patients with advanced cancer, but hardly any prospective information is available about fatigue while on treatment in the palliative setting. In a previous cross-sectional study, we found several factors contributing to fatigue in these patients. In this study, we investigated the course of fatigue over time and if psychosocial factors were associated with fatigue over time. Methods Patients on cancer treatment for incurable solid tumors were observed over 6 months. Patients filled in the Checklist Individual Strength monthly to measure the course of fatigue. Baseline questionnaires were used to measure disease acceptance, anxiety, depressive mood, fatigue catastrophizing, sleeping problems, discrepancies in social support, and self-reported physical activity for their relation with fatigue over time. Results At baseline 137 patients and after 6 months 89 patients participated. The mean duration of participation was 4.9 months. At most time points, fatigue scores were significantly higher in the group dropouts in comparison with the group participating 6 months (completers). Overall fatigue levels remained stable over time for the majority of participants. In the completers, 42 % never experienced severe fatigue, 29 % persisted being severely fatigued, and others had either an increasing or decreasing level. Of the investigated factors, low reported physical activity and non-acceptance of cancer were associated significantly to fatigue. Conclusion A substantial number of participants never experienced severe fatigue and fatigue levels remained stable over time. For those who do experience severe fatigue, non-acceptance of having incurable cancer and low self-reported physical activity may be fatigue-perpetuating factors.
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Mitchell SA, Hoffman AJ, Clark JC, DeGennaro RM, Poirier P, Robinson CB, Weisbrod BL. Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment. Clin J Oncol Nurs 2015; 18 Suppl:38-58. [PMID: 25427608 DOI: 10.1188/14.cjon.s3.38-58] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer-related fatigue (CRF) has deleterious effects on physical, social, cognitive, and vocational functioning, and causes emotional and spiritual distress for patients and their families; however, it remains under-recognized and undertreated. This article critically reviews and integrates the available empirical evidence supporting the efficacy of pharmacologic and nonpharmacologic treatment approaches to CRF, highlighting new evidence since 2007 and 2009 Putting Evidence Into Practice publications. Interventions that are recommended for practice or likely to be effective in improving fatigue outcomes include exercise; screening for treatable risk factors; management of concurrent symptoms; yoga; structured rehabilitation; Wisconsin ginseng; cognitive-behavioral therapies for insomnia, pain, and depression; mindfulness-based stress reduction; and psychoeducational interventions such as anticipatory guidance, psychosocial support, and energy conservation and activity management. This information can be applied to improve the management of CRF, inform health policy and program development, shape the design of clinical trials of new therapies for CRF, and drive basic and translational research.
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Affiliation(s)
- Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Center, Bethesda, MD
| | - Amy J Hoffman
- College of Nursing, Michigan State University, East Lansing
| | - Jane C Clark
- Georgia Center for Oncology Research and Education in Atlanta
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Perceptions about cancer-related fatigue among cancer patients using Q methodology. Eur J Oncol Nurs 2015; 20:64-70. [PMID: 26059322 DOI: 10.1016/j.ejon.2015.03.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/24/2015] [Accepted: 03/27/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE Cancer-related fatigue (CRF) is a common subjective feeling and disabling symptom complex experienced by patients with cancer. This study aimed to identify the subjective perceptions of Korean patients with cancer about CRF to help the development of basic intervention strategies for these patients. METHODS Q methodology was used to examine the subjective perceptions of patients with cancer about CRF. Thirty-one patients with cancer, hospitalized at a university hospital in Seoul, Korea, were recruited into this study and classified 41 selected Q statements using a nine-point scale. Data were analysed using PC-QUANL for Windows. RESULTS Data analysis revealed that distinct perceptions about CRF do exist among Korean patients with cancer. Three types of perceptions were identified: dominant self-reliance, positive-conformist and self-deprecating exhaustion. These three types explained 53.0% of the variance (40.2%, 8.2% and 4.6%, respectively). CONCLUSIONS This study identified three types of perceptions about CRF among Korean patients with cancer. These findings provide baseline data to develop customised interventions for caring strategies. This study also informs health professionals in other countries about the perceptions of Korean patients with cancer about CRF.
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Peters MEWJ, Goedendorp MM, Verhagen SAHHVM, Smilde TJ, Bleijenberg G, van der Graaf WTA. A prospective analysis on fatigue and experienced burden in informal caregivers of cancer patients during cancer treatment in the palliative phase. Acta Oncol 2015; 54:500-6. [PMID: 25291079 DOI: 10.3109/0284186x.2014.953254] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although fatigue is the most frequently occurring symptom in patients with cancer, hardly anything is known about fatigue of their informal caregivers and the impact fatigue might have on perceived burden with providing care. We investigated the presence of fatigue in caregivers, its course and the relation of fatigue severity between caregivers and patients. Furthermore, we explored in caregivers whether fatigue severity was correlated to experienced burden. MATERIAL AND METHODS Informal caregivers and patients on cancer treatment in the palliative phase completed questionnaires at baseline and follow-up (6 months later). To measure fatigue severity, both groups completed the Checklist Individual Strength. Additionally, caregivers completed the Caregivers Strain Index to assess experienced burden with providing care. Descriptive analyses, paired t-tests, χ(2)-tests, Pearson's correlations and regression analysis were performed. RESULTS At baseline 111 couples (patients and caregivers) participated, at follow-up 75 couples. At both time points 23% of caregivers were severely fatigued. There was no significant correlation between patients and caregivers on fatigue. Higher fatigue in both patients and caregivers was correlated with higher burden in caregivers and over 30% of burden could be explained by fatigue. CONCLUSION Almost a quarter of caregivers of patients on active palliative treatment were severely fatigued, which figure remained stable over time. Fatigue in both patients and caregivers was related to caregivers' burden. This observation should be taken into account with the growing demand on caregivers and the increase in cancer treatment options in the palliative setting.
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Affiliation(s)
- Marlies E W J Peters
- Radboud university medical center, Department of Medical Oncology (452) , Nijmegen , The Netherlands
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Schlemmer M, Suchner U, Schäpers B, Duerr EM, Alteheld B, Zwingers T, Stehle P, Zimmer HG. Is glutamine deficiency the link between inflammation, malnutrition, and fatigue in cancer patients? Clin Nutr 2015; 34:1258-65. [PMID: 25614125 DOI: 10.1016/j.clnu.2014.12.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/10/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Evaluation of potential associations between plasma glutamine levels and the incidence of cancer related fatigue, physical performance, poor nutritional status, and inflammation in patients with solid tumors. STUDY DESIGN Mono-center cross-sectional study recruiting 100 (34 women) consecutive patients (September 2009-March 2011; ≥18 y) with solid tumors and causal tumor therapy. METHODOLOGY Fasting venous blood was harvested for routine clinical chemistry, amino acid (HPLC) and inflammation marker analyses. Clinical assessments included global, physical, affective and cognitive fatigue (questionnaire) and Karnofsky performance status. Nutritional status was evaluated using bioelectrical impedance analysis, the Prognostic Inflammatory and Nutritional Index and plasma protein levels. Regression analyses were performed to correlate continuous variables with plasma glutamine (95% confidence intervals). RESULTS Nutritional status was impaired in 19% of the patients. Average plasma glutamine concentration (574.0 ± 189.6 μmol/L) was within normal range but decreased with impaired physical function. Plasma glutamine was linked to the ratio extracellular to body cell mass (p < 0.044), CRP (p < 0.001), physical (p = 0.014), affective (p = 0.041), and global fatigue (p = 0.030). Markers of inflammation increased with low physical performance. CONCLUSIONS The data support our working hypothesis that in cancer patients systemic inflammation maintains a catabolic situation leading to malnutrition symptoms and glutamine deprivation, the latter being associated with cancer related fatigue.
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Affiliation(s)
- Marcus Schlemmer
- Department of Internal Medicine III, Ludwig-Maximilians-University-Großhadern, Munich, Germany
| | | | | | - Eva-Maria Duerr
- Department of Internal Medicine III, Ludwig-Maximilians-University-Großhadern, Munich, Germany
| | - Birgit Alteheld
- Department of Nutrition and Food Sciences - Nutritional Physiology, University of Bonn, Bonn, Germany
| | | | - Peter Stehle
- Department of Nutrition and Food Sciences - Nutritional Physiology, University of Bonn, Bonn, Germany.
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Peters MEWJ, Goedendorp MM, Verhagen SAHHVM, van der Graaf WTA, Bleijenberg G. Exploring the contribution of psychosocial factors to fatigue in patients with advanced incurable cancer. Psychooncology 2014; 23:773-9. [DOI: 10.1002/pon.3481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 12/16/2013] [Accepted: 12/17/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Marlies E. W. J. Peters
- Department of Medical Oncology; Radboud University, Medical Center; Nijmegen The Netherlands
| | - Martine M. Goedendorp
- Expert Center Chronic Fatigue; Radboud University Medical Center; Nijmegen The Netherlands
- Department of Health Sciences; University of Groningen, University Medical Center Groningen; Groningen The Netherlands
| | | | | | - Gijs Bleijenberg
- Expert Center Chronic Fatigue; Radboud University Medical Center; Nijmegen The Netherlands
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