Effects of exercise interventions on cancer-related fatigue and quality of life among cancer patients: a meta-analysis

Assessing cancer-related fatigue: Validation of the Korean version of the cancer fatigue scale among cancer survivors

Objective

This study aimed to validate the Korean version of the Cancer Fatigue Scale (CFS-K) as a reliable tool for assessing cancer-related fatigue (CRF) for cancer survivors.

Methods

A total of 208 cancer survivors who completed active treatment participated in evaluating the reliability, construct validity, and factor structure of the CFS-K through confirmatory factor analysis (CFA). Correlations with the Functional Assessment of Chronic Illness Therapy-Fatigue (FACT-F) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) scales were analyzed to assess construct validity.

Results

The CFS-K demonstrated strong psychometric properties, with high internal consistency (Cronbach's α ​= ​0.875) and CFA validated a three-factor structure (physical, cognitive, and affective fatigue) with acceptable model fit indices (normed χ2 ​= ​2.62, CFI ​= ​0.899, TLI ​= ​0.878, RMSEA ​= ​0.088, SRMR ​= ​0.069). The standardized factor loadings for all items exceeded 0.5. Construct validity was confirmed through strong correlations with FACT-F (r ​= ​0.43-0.73) and significant correlations with EORTC QLQ-C30 subscales. Cancer survivors reported significantly higher fatigue levels across all subscales than controls.

Conclusions

The CFS-K is a reliable and valid tool for assessing multidimensional CRF in cancer survivors.

The impact of different timing of mouth opening exercises on trismus in postoperative radiotherapy patients with oral cancer

OBJECTIVE

To compare the effects of starting mouth opening exercises at two different times on trismus in postoperative radiotherapy patients with oral cancer.

METHODS

Through a prospective randomized controlled trial, purposive sampling was used to select 76 patients undergoing postoperative radiotherapy for oral cancer from March 2023 to January 2024 at the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Patients were randomly divided into an experimental group (n = 38) and a control group (n = 38) using a random number table at a ratio of 1:1. The experimental group began mouth opening exercises in the second week after surgery (before radiotherapy), while the control group began in the fourth week after surgery (at the start of radiotherapy). The primary outcome measure was maximum interincisal opening (MIO). Secondary outcome measures included pain visual analog scale (VAS) scores and quality of life scores (UW-QOL), assessed at baseline, the second week post-surgery (before radiotherapy), the fourth week post-surgery (at the start of radiotherapy), the ninth week post-surgery (end of radiotherapy), and the twelfth week post-surgery (three weeks after the end of radiotherapy).

RESULTS

A total of 72 patients completed all assessments, with 36 in each group, resulting in an overall sample attrition rate of 5.26 % (less than 15 %). There were no statistically significant differences in general demographic and clinical characteristics between the two groups. Repeated measures ANOVA showed significant differences in MIO, VAS, and UW-QOL scores between groups, over time, and in group-time interactions (P < 0.001). From the fourth week post-surgery (at the start of radiotherapy), the experimental group had significantly higher MIO (P < 0.001), significantly lower VAS scores (P < 0.001), and significantly higher UW-QOL scores (P < 0.001) compared to the control group. These differences persisted at subsequent assessment points.

CONCLUSION

Initiating mouth opening exercises in the second week post-surgery (before radiotherapy) can significantly improve mouth opening, reduce pain, and enhance the quality of life in postoperative radiotherapy patients with oral cancer. This provides important evidence for clinical practice, although further research is needed to verify the long-term effects.

Exploratory outcomes of the DHA WIN randomized controlled trial: Supplementing women with docosahexaenoic acid did not reduce the impact of neoadjuvant breast cancer chemotherapy on quality of life or exercise behaviour

Supplementation of omega-3 (n-3) polyunsaturated fatty acids has been associated with reduced side effects and improved quality of life (QoL) in breast cancer patients receiving chemotherapy. The current study reports secondary outcomes from the DHA WIN randomized controlled trial which was designed to evaluate docosahexaenoic acid (DHA) supplementation (4.4 g/day) in conjunction with six cycles of neoadjuvant chemotherapy (NAC) (3 weeks/cycle) in women with non-metastatic breast cancer (n = 49). The objective of the current study was to assess the effects of DHA supplementation on QoL and exercise behaviour in women undergoing NAC for breast cancer. Self-administered questionnaires were used to measure QoL and exercise behaviour before starting chemotherapy (baseline), before each chemotherapy cycle (exercise), and after completing chemotherapy. DHA supplementation did not significantly affect QoL, aerobic exercise volume or resistance training frequency during treatment. However, mean aerobic exercise volume was significantly lower at week 12 (-53.5 minutes/week; 95% CI, -100.5 to -6.3; p = 0.02) and week 18 (-70.8 minutes/week; 95% CI, -123.0 to -18.6; p = 0.01) compared to baseline. Mean resistance training frequency was lower at week 12 (-0.57 times/week; 95% CI, -1.0 to -0.13; p = 0.02) compared to baseline. Meeting exercise guidelines during chemotherapy was not associated with better QoL. In the current exploratory study, QoL and exercise decreased during treatment regardless of DHA supplementation, highlighting the need for supportive care and potential therapies that may mitigate these declines in breast cancer patients receiving NAC. Adequately powered studies are needed to determine if DHA supplementation improves these two indices of health. The trial is registered at ClinicalTrials.gov (NCT03831178).

Exercise to Manage Fatigue During and After Chemotherapy in Adolescents and Young Adults With Cancer: A Systematic Review and Meta-Analysis

PROBLEM IDENTIFICATION

There is a gap in knowledge about the efficacy of exercise in managing cancer-related fatigue (CRF) in adolescents and young adults (AYAs) during and after chemotherapy.

LITERATURE SEARCH

A systematic search was conducted in Scopus®, PubMed®, and CINAHL®, as well as citation searching, for studies about the impact of exercise on CRF in the AYA population. Abstract and full-text screening of 2,234 studies produced 15 studies for systematic review and 13 for meta-analysis.

DATA EVALUATION

Effect size was calculated using standardized mean difference and confidence intervals. Subgroup analysis was conducted to assess the impact of various exercise types on CRF. A meta-regression was performed using exercise frequency, intensity, and duration as predictors to determine relationships with effect size on CRF and adherence to exercise.

SYNTHESIS

Exercise had a large effect size on CRF in AYAs. No difference in effect size estimates for exercise type subgroups was observed. A linear association was found between exercise duration and CRF (p = 0.005), and exercise intensity and adherence (p = 0.037).

IMPLICATIONS FOR PRACTICE

Exercise is effective in managing CRF among AYAs, and efforts should be aimed toward including it in routine oncologic care.

Symptom clusters, fear of disease progression, and quality of life in postoperative gastric cancer patients: a cross-sectional study

BACKGROUND

Gastric cancer is a common tumor globally. Surgery is the preferred treatment for gastric cancer. Yet, little is known about its symptom clusters, fear of disease progression, and quality of life (QoL). This study aims to investigate the severity of symptom clusters, fear of disease progression, and quality of life of postoperative gastric cancer patients; to analyze the correlation between symptom clusters, fear of disease progression, and quality of life of postoperative gastric cancer patients; and to provide theoretical bases for the development of an intervention plan to enhance the quality of life of postoperative gastric cancer patients.

METHODS

A convenience sampling method was used to select 158 postoperative gastric cancer patients from a tertiary hospital in Xiamen City from January 2023 to April 2023 for the study. Data were collected using the General Information Evaluation Form, M.D. Anderson Symptom Inventory-Gastrointestinal Cancer Module (MDASI-GI), Fear of Progression Questionnaire-Short Form (FoP-Q-SF), and Functional Assessment of Cancer Therapy-General (FACT-G). Data were analyzed with EpiData 3.1 and SPSS 26.0. Symptom clusters were extracted via exploratory factor analysis. Differences in QoL based on patient characteristics were analyzed using t tests or one-way analysis of variance (ANOVA). Pearson correlation and multiple linear regression analyses were used to explore relationships among symptom clusters, fear of disease progression, and QoL.

RESULTS

The overall quality of life score in the FACT-G scale was (52.32 ± 10.58), of which the social/family status score was (16.47 ± 3.62), the physical status score was (14.24 ± 5.66), the functional status was (11.35 ± 4.48), and the emotional status score was (10.25 ± 3.53). The fear of disease progression score of postoperative gastric cancer patients was (37.37 ± 6.37), of which the physical health dimension score was (21.58 ± 4.01), and the social/family dimension score was (15.74 ± 4.07). Two symptom clusters were identified: physical/emotional sickness and gastrointestinal symptom cluster. The results of Pearson correlation analysis showed that symptom cluster severity was negatively correlated with quality of life (r =  - 0.508, P < 0.01); symptom cluster severity was significantly positively correlated with fear of disease progression (r = 0.260, P < 0.01); and fear of disease progression was significantly negatively correlated with quality of life (r =  - 0.194, P < 0.05). Multiple linear regression analyses showed that the physical/emotional sickness symptom cluster, physical health fears, and physical state of postoperative gastric cancer patients were the affecting factors of quality of life (P < 0.001).

CONCLUSION

Two symptom clusters were identified in postoperative gastric cancer patients in mainland China. Fear of disease progression was at a medium-high level, and QoL was at a medium level. Common symptoms included fatigue, pain, and worry. The physical state, physical health, and the physical/emotional sickness symptom cluster affect the quality of life of postoperative gastric cancer patients. Targeted clinical interventions are necessary to improve QoL in postoperative gastric cancer patients.

Cardiovascular training for fatigue in people with cancer

RATIONALE

Cancer-related fatigue (CRF) is the most prevalent and severe symptom among people with cancer. It can be attributed to the cancer itself or to anticancer therapies. CRF affects the individual physically and mentally, and cannot be alleviated by rest. Studies show a positive effect of exercise on CRF.

OBJECTIVES

To evaluate the effects of cardiovascular training on cancer-related fatigue (CRF), quality of life (QoL), adverse events, anxiety, and depression in people with cancer, with regard to their stage of anticancer therapy (before, during, or after), up to 12 weeks, up to six months, or longer, postintervention.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and World Health Organization ICTRP to identify studies that are included in the review. The latest search date was October 2023.

ELIGIBILITY CRITERIA

We included randomised controlled trials (RCTs) evaluating cardiovascular training for CRF or QoL, or both, in people with cancer. Trials were eligible if training was structured, included at least five sessions, and instruction was face-to-face (via video tools or in person). We excluded studies with fewer than 20 randomised participants per group and where only an abstract was available.

OUTCOMES

Our critical outcomes were: short-, medium-, long-term CRF and QoL. Important outcomes were adverse events, and short-, medium-, long-term anxiety and depression.

RISK OF BIAS

We used the Cochrane RoB 1 tool to assess bias in RCTs.

SYNTHESIS METHODS

We used standard Cochrane methodology. We synthesised results for each outcome using meta-analysis where possible (inverse variance or Mantel-Haenszel; random-effects model). We pooled data for the respective assessment periods above. We used GRADE to assess certainty of evidence for each outcome.

INCLUDED STUDIES

We included 23 RCTs with 2135 participants, of whom 96.6% originated from high-income countries; 1101 participants were randomised to cardiovascular training and 1034 to no training. Studies included mostly females who were diagnosed with breast cancer. We also identified 36 ongoing and 12 completed studies that have not yet published (awaiting assessment). We only present findings on CRF, QoL and adverse events. For details regarding anxiety and depression, see full text.

SYNTHESIS OF RESULTS

Cardiovascular training before anticancer therapy versus no training for people with cancer We identified no studies for inclusion in this comparison. Cardiovascular training during anticancer therapy versus no training for people with cancer We included 10 studies (1026 participants); eight studies contributed data to quantitative analyses (860 participants). Cardiovascular training probably reduces short-term CRF slightly (mean difference (MD) 2.85, 95% confidence interval (CI) 1.16 to 4.55, on the Functional Assessment of Cancer Therapy - Fatigue (FACT-F), scale 0 to 52, higher values mean better outcome; minimally important difference (MID) 3; 6 studies, 593 participants) and probably results in little to no difference in short-term QoL (MD 3.56, 95% CI 0.21 to 6.90, on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ C-30), scale 0 to 100, higher values mean better outcome, MID 10; 6 studies, 612 participants) (both moderate-certainty evidence). We are uncertain about the effects on medium-term CRF (MD 2.67, 95% CI -2.58 to 7.92, on FACT-F; MID 3; 1 study, 62 participants), long-term CRF (MD 0.41, 95% CI -2.24 to 3.05, on FACT-F; MID 3; 2 studies, 230 participants), medium-term QoL (MD 6.79, 95% CI -4.39 to 17.97, on EORTC QLQ C-30; MID 10; 1 study, 62 participants), and long-term QoL (MD 1.51, 95% CI -3.40 to 6.42, on EORTC QLQ C-30; MID 10; 2 studies, 230 participants) (all very low-certainty evidence). For adverse events (any grade and follow-up), we did not perform meta-analysis due to heterogeneous definitions, reporting, and measurement (9 RCTs, 955 participants; very low-certainty evidence). Cardiovascular training after anticancer therapy versus no training for people with cancer We included 13 studies (1109 participants); nine studies contributed data to quantitative analyses (756 participants). We are uncertain about the effects of cardiovascular training on short-term CRF (MD 3.62, 95% CI 0 to 7.13, on FACT-F; MID 3; 6 studies, 497 participants), long-term CRF (MD -0.80, 95% CI -1.72 to 0.13, on the Fatigue Symptom Inventory (FSI), scale 1 to 10, higher values mean worse outcome; MID 1; 2 studies, 262 participants), short-term QoL (MD 3.70, 95% CI -0.14 to 7.41, on the Functional Assessment of Cancer Therapy - General (FACT-G), scale 0 to 108, higher values mean better outcome; MID 4; 8 studies, 642 participants), long-term QoL (MD 3.10, 95% CI -1.12 to 7.32, on FACT-G; MID 4; 1 study, 201 participants), and adverse events (risk ratio (RR) 2.71, 95% CI 0.58 to 12.67; 1 study, 50 participants) (all very low-certainty evidence). There were no data for medium-term CRF and QoL.

AUTHORS' CONCLUSIONS

Moderate-certainty evidence shows that cardiovascular training by people with cancer during their anticancer therapy slightly reduces short-term CRF and results in little to no difference in short-term QoL. We do not know whether cardiovascular training increases or decreases medium-term CRF/QoL, and long-term CRF/QoL. There is very low-certainty evidence (due to heterogeneous definitions, reporting and measurement) evaluating whether the training increases or decreases adverse events. In people with cancer who perform cardiovascular training after anticancer therapy, we are uncertain about the effects on short-term CRF/QoL, long-term CRF/QoL, and adverse events. We identified a lack of evidence concerning cardiovascular training before anticancer therapy and on safety outcomes. The 36 ongoing and 12 completed, but unpublished, studies could help close this gap, and could contribute to improving the effect estimates and certainty.

FUNDING

This Cochrane review was funded by the Federal Ministry of Education and Research of Germany, grant number: FKZ 01KG2017.

REGISTRATION

Protocol available via DOI: 10.1002/14651858.CD015211.

Effectiveness of Exercise-Based Interventions on Fatigue among Head and Neck Cancer Patients on Radiotherapy: Systematic Review with Meta-Analysis

OBJECTIVES

Fatigue is a significant challenge among head and neck cancer patients undergoing radiotherapy, impacting their well-being and daily functioning. Exercise-based interventions hold promise in alleviating this fatigue burden. This systematic review aims to evaluate the effectiveness of exercise-based interventions on fatigue among patients with head and neck cancer receiving radiotherapy.

METHODS

We systematically searched for the studies in Cumulative Index to Nursing and Allied Health Literature, PubMed, Cochrane Library Database, MEDLINE, and Google Scholar in the English language from 2000 to 2023. Two reviewers independently identified the articles using key thesaurus and free text terms based on the inclusion criteria. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. Meta-analysis was done by using RevMan 5.3 software.

RESULTS

The systematic review included nine trials encompassing 647 participants, out of which five were randomized control trials and were selected for meta-analysis. Pooled data from randomized control trials showed that exercise-based interventions were effective in reducing few dimensions of fatigue such as general fatigue, physical fatigue, emotional fatigue significantly (P < .001) among Head and Neck Cancer patients receiving radiotherapy.

CONCLUSION

Preliminary evidence from the review suggests that engaging in exercise-based interventions may reduce fatigue among patients with head and neck cancer receiving radiotherapy. However, future research is necessary, as most of the articles in current review were either pilot studies or feasibility trials.

IMPLICATIONS FOR NURSING PRACTICE

This systematic review and meta-analysis protocol was registered in PROSPERO with the register number CRD42023428284.

Effects of an individualised exercise program in hospitalised older adults with cancer: A randomised clinical trial

We aimed to examine the effects of an individualised multicomponent exercise program on functional outcomes in hospitalised older patients with cancer. Patients aged ≥ 65 were recruited upon admission to a Medical Oncology Department and randomly allocated to receive a multicomponent exercise training program twice daily for five days or standard hospital care. The primary outcome measure was the change in functional status using the Short Physical Performance Battery. This study allocated 30 patients in the Control group and 28 in the intervention group. The mean age was 74.4 years. The intervention group (n = 14) showed significant improvements vs the Control group (n = 20) in the Short Physical Performance Battery (SPPB) (between-group difference, 1.92; 95% CI = 0.80,3.07), knee extension strength (between-group difference 7.72; 95% CI = 1.83,13.8), as well as a significant reduction in fatigue (between-group difference -26.5; 95% CI = -38.6,-13.9). This individualised exercise program appears to have contributed to improving functional abilities and reducing fatigue in hospitalised older cancer patients.

Physical activity and exercise health benefits: cancer prevention, interception, and survival

Physical activity (PA) has an established role in the promotion of health and fitness and the prevention of disease. Expected overall benefits include reduction of all-cause morbidity and death, weight control, improved quality of life, improved bone health and decreased falls of elderly subjects, , deeper cognition, and reduced risk of depression, anxiety, and sleeplessness. Currently, PA is a mainstay in the management of cardiovascular diseases, metabolic syndrome, diabetes, and bone health. Recently, the perception of its role in primary and secondary prevention, interception, and treatment of cancer, however, is also gaining importance. Regular walking, the simplest type of PA, is associated with reduced all-cause and cardiovascular disease mortality, and a role in cancer prevention is of increasing interest. Furthermore, PA improves the quality of life of cancer patients, attenuating side effects of chemotherapy, decreasing sarcopenia, increasing fitness, and inhibiting the recurrence and progression of some cancer types. It promotes emotional and psychological benefits in patients, inducing positive changes. While mechanisms, effective levels and useful amount of PA practice are well established in cardiology, they are yet to be fully determined in oncology. Nevertheless, PA is recommended to reduce cancer risk in the general population, and it has been introduced in programs for the prevention of second cancers. In perspective, it will help as integrative therapy in cancer patients and for cancer survivors. The number of beneficial effects in the cancer continuum is highlighted in this review.

Effect of exercise for patients with advanced lung cancer and cancer-related fatigue: A systematic review and meta-analysis

BACKGROUND

Cancer-related fatigue (CRF) is a significant burden for patients with advanced lung cancer. While exercise is recommended for managing CRF during pre- and active treatment phases, evidence supporting its efficacy in advanced stage remains limited. This systematic review and meta-analysis aimed to quantify the effects of exercise on CRF and its common complications in patients with advanced lung cancer.

METHODS

A systematic search of 4 databases (PubMed, Embase, Cochrane, and Web of Science) was conducted up to July 10, 2024 to identify relevant randomized controlled trials (RCTs). Studies were selected based on predefined eligibility criteria, including adult patients with advanced lung cancer reporting fatigue as an outcome. Study selection followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and the risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0). The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Random- or fixed-effects models were used for meta-analyses based on heterogeneity levels.

RESULTS

Eight RCTs involving 749 patients were included. Meta-analysis revealed that exercise significantly improved CRF in patients with advanced lung cancer (standardized mean difference (SMD) = -0.33; 95% confidence interval (95%CI): -0.54 to -0.12); p = 0.00; I2 = 0.00%). Subgroup analysis showed greater efficacy in patients aged ≤60 years (p = 0.028), those engaging in traditional Chinese exercise (p = 0.003), and interventions lasting fewer than 12 weeks (p = 0.017). Exercise also significantly improved quality of life (SMD = 0.29; 95%CI: 0.02-0.55; p = 0.04; I2 = 0.00%) and reduced dyspnea (SMD = -0.43; 95%CI: -0.71 to -0.16; p = 0.00; I2 = 0.00%). No significant effects were observed on sleep quality, anxiety, or depression. The risk of bias across studies was moderate, and the quality of evidence, as evaluated by GRADE, was rated as low due to study limitations. Adverse events were minimal, with only one mild, exercise-related event reported.

CONCLUSION

Exercise significantly alleviates CRF in patients with advanced lung cancer, improves certain complications, and enhances quality of life. The intervention's effectiveness varies by age, type of exercise, and duration. Further high-quality studies are needed to validate these findings.

Effects of exercise interventions on cancer-related fatigue in children with cancer: A meta-analysis

BACKGROUND

Cancer-related fatigue (CRF) emerges as a common symptom in pediatric cancer patients during treatment. Exercise interventions are increasingly being used as CRF interventions to improve CRF in children with cancer.

AIM

The objective of this meta-analysis was to synthesize the best available evidence concerning the effectiveness of exercise interventions for cancer-related fatigue in children with cancer.

METHODS

Six databases were extensively searched from inception to December 2023 to identify relevant randomized controlled trials. The risk of bias and methodological quality were assessed using the Cochrane appraisal tool. Pooled effects were calculated using a random-effects model. Heterogeneity was assessed using the I 2 test.

RESULTS

Eight trials (n = 465) were finally included. Exercise was statistically more effective than conventional care in improving CRF in children with cancer (SMD = -0.62, 95% CI [-1.21, -0.03]) with high statistical heterogeneity (p = .004; I 2  = 86%). The results of the subgroup analysis showed that intervention duration <12 weeks (p < .05), exercise frequency ≥ 3 times/week (p < .05), and exercise duration <45 min/time (p < .05) were more effective in improving CRF in children with cancer.

LINKING EVIDENCE TO ACTION

Our results suggest that exercise interventions are effective in reducing CRF in children with cancer. We recommend exercise frequency ≥ 3 times/week, exercise duration <45 min/time, and intervention duration <12 weeks.

The effect of exergame rehabilitation on the quality of life of cancer patients undergoing abdominal surgery: a randomized controlled trial

PURPOSE

Exergames, which combine digital games and physical exercise, have become increasingly popular for rehabilitation in the health domain. This study aimed to assess the effectiveness of exergame rehabilitation on the quality of life of cancer patients undergoing abdominal surgery.

METHODS

This randomized controlled trial evaluated the effectiveness of exergame rehabilitation on the quality of life of cancer patients who had undergone abdominal surgery. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcome was the quality of life, and data collection occurred at three different time points: upon admission, 48 h postoperatively, and on the 7th day after surgery.

RESULTS

Quality of life was evaluated using the WHOQOL-BREF Scale. At the third assessment, a statistically significant difference was observed between the two groups (p = 0.016), indicating that the intervention group had a higher quality of life than the control group.

CONCLUSIONS

The study showed a positive effect of exergames on the population under investigation. By the 7th day after surgery, the intervention group demonstrated an improvement in their quality of life compared to the control group.

CLINICAL TRIAL REGISTRATION

Center of Open Science OSF https://osf.io/286zb/ , registered in July, 2023.

Effect of Tele-exercise Interventions on Quality of Life in Cancer Patients: A Meta-analysis

PURPOSE

To evaluate the impacts of tele-exercise intervention with cancer patients' quality of life, taking into account the influence of the duration of tele-exercise intervention, type of intervention, and gender of cancer patients on quality of life.

METHODS

The PubMed (MEDLINE), Embase, CINAHL, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and PsycINFO databases were searched from inception to August 21, 2023. The Cochrane Collaboration's risk of bias tool 2 was utilized to estimate the risk of bias, and the Grading of Recommendations, Assessment. For statistical analyses, R Studio was employed.

RESULTS

This meta-analysis contained eight trials. When compared to controls, tele-exercise interventions (SMD = 0.41, 95% CI: 0.12 to 0.70, p < .010; I2 = 54%, p = .030) have a positive influence on boosting the quality of life within cancer patients. Subgroup analyses demonstrated the greater effectiveness of tele-exercise in enhancing the quality of life of cancer patients when the duration was greater than or equal to 10 weeks. Furthermore, tele-exercise was found to have a stronger advantageous effect on quality of life among female cancer. In addition, among the types of interventions for tele-exercise, neither web-based nor telephone-based formats significantly enhanced quality of life among cancer patients.

CONCLUSION

Tele-exercise interventions are a cost-effective and feasible non-pharmacologic complementary way to promote cancer patients' quality of life. Additional large-sample, carefully designed randomized controlled trials are warranted to further validate the impact of tele-exercise concerning cancer patients' quality of life.

REGISTRATION NUMBER

CRD42023477147.

[Enhancing the evidence on the significance of supervised physical exercise in alleviating fatigue among breast cancer patients]

Introduction

Experiences, behaviours, and perspectives of young cancer survivors on physical activity

This narrative review aimed to identify young cancer survivors' behaviours, experiences, and perspectives concerning physical activity, and identify useful strategies for promoting a healthy lifestyle. A manual search on the following databases was conducted: PubMed, Scopus, and Web of Science. The search was conducted between June 1, 2023, and April 12, 2024. Articles published from database inception up to April 12, 2024, were retrieved. Articles published in any language were considered. Perspectives including ideas, perceived barriers, and facilitators have been identified. Young cancer survivors seem to engage in physical activity as a useful coping strategy to regain normality and keep healthy after the cancer diagnosis. Although emotional and social support seems fundamental to increase participation, several other factors, including physical limitations, fatigue, sex, cancer type, and socio-economic status can influence physical activity participation. For those engaged in physical activity, the preferred activities are walking, biking, going to the gym, and exercising at home, while the least preferred are exercising at the hospital or boot camp-based exercises. Yoga is more frequently chosen by those still under treatment. Young cancer survivors appear to have unique needs different from those of adult cancer survivors. Mode of treatment delivery, increased awareness concerning the effects of physical activity, including families and friends, connecting survivors, and providing social support together with increasing motivation are key strategies for the promotion of physical activity in young cancer survivors. Fitness and healthcare professionals should consider these aspects to increase young cancer survivors' involvement in physical activities.

Efficacy of aerobic and resistance exercises on cancer pain: A meta-analysis of randomised controlled trials

Purpose

To evaluate effects of aerobic and resistance exercises for cancer-related pain in adults with and surviving cancer. Secondary objectives were to a) evaluate the effect of exercise on fatigue, psychological function, physical function, b) assess fidelity to exercise.

Design

A systematic search of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Central Register of Controlled Trials was conducted to identify randomised controlled trials (RCTs) comparing aerobic and/or resistance exercise to control groups. The primary endpoint were changes in cancer-related pain intensity from baseline to post intervention. Meta-regression analysis evaluated predictors for heterogeneity between study findings. Tolerability was defined as reporting of exercise-induced adverse events while fidelity evaluated by reported intervention dropout.

Results

Twenty-three RCTs including 1954 patients (age 58 ± 8.5 years; 78 % women); 1087 (56 %) and 867 (44 %) allocated to aerobic/resistance exercise therapy and control group, respectively. Exercise therapy was associated with small to moderate decreases in cancer-related pain compared to controls (SMD = 0.38, 95 % CI: 0.17, 0.58). Although there was significant heterogeneity between individual and pooled study effects (Q = 205.25, p < 0.0001), there was no publication bias. Meta-regression including supervision, age, duration and exercise type as moderators showed no significant differences in reported outcomes. Analysis of secondary outcomes revealed a moderate effect for improvements in physical function, fatigue and psychological symptoms.

Conclusions

Aerobic and resistance exercises are tolerable and effective adjunct therapies to reduce cancer-related pain while also improving physical function, fatigue and mood. Future RCTs of dose, frequency, compliance and exercise type in specific cancer settings are required.

Mediating effect of social support between caregiver burden and quality of life among family caregivers of cancer patients in palliative care units

PURPOSE

To identify factors influencing the quality of life of family caregivers with terminal cancer in Chinese palliative wards and to test whether social support mediates the relationship between caregiver burden and caregiver quality of life.

METHODS

A cross-sectional study design was used. Sociodemographic data were collected and the Quality of Life Scale, the Caregiver Burden Scale, and the Social Support Rating Scale were administered to Chinese family caregivers from December 2021 to December 2022. The factors influencing quality of life and caregiver burden were examined using the Mann‒Whitney U test and the Kruskal‒Wallis H test. The mediating role of social support was assessed using the bootstrap method.

RESULTS

Family caregivers' quality of life in Chinese terminal cancer palliative units was related to caregivers' daily care time, the caregiver-patient relationship, and patient age. Caregiver quality of life was negatively associated with caregiver burden and positively associated with social support. In addition, social support mediated the relationship between caregiver burden and caregiver quality of life.

CONCLUSION

Social support mediated the impact of caregiver burden on caregiver quality of life. Family, society, and palliative care institutions should be integrated to take actions to reduce family caregiver burden, increase social support, and transfer the positive aspects of specific cultural contexts to the culture of palliative care in general to collaboratively cope with various problems related to end-stage cancer.

The Effect of Psychoeducational Interventions on Cancer-Related Fatigue: A Systematic Review and Meta-analysis of Randomized Controlled Studies

BACKGROUND

Cancer-related fatigue is one of the most common symptoms of cancer patients. Psychoeducation is often used in the management of cancer-related fatigue.

OBJECTIVE

The aim of this study was to synthesize the effects of psychoeducational interventions on cancer-related fatigue.

METHODS

This article is a systematic review and meta-analysis of randomized controlled studies. The 11 electronic databases were searched, and studies using psychoeducational interventions to manage cancer-related fatigue were included. Data synthesis was performed using Comprehensive Meta-Analysis software version 3.0. The random-effects model was used to pool the effect size for intervention. The subgroup analysis was conducted to investigate the effect of the characteristics of psychoeducational interventions. This study was reported according to the Cochrane Handbook for Systematic Reviews of Intervention version 6.3 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

RESULTS

This analysis included 10 studies with a total of 1369 participants. Most of the included studies compared the psychoeducational intervention group with the passive control group. Our meta-analysis revealed that psychoeducational intervention has a positive medium effect on improving cancer-related fatigue with a low quality of evidence. Subgroup analyses indicated no difference between group and individual interventions, between face-to-face and digital interventions, or between ≤3 and >3 sessions.

CONCLUSIONS

Psychoeducational interventions can improve cancer-related fatigue. Additional well-designed randomized controlled studies are needed to upgrade the quality of evidence for psychoeducational interventions on cancer-related fatigue.

IMPLICATIONS FOR PRACTICE

Nurses may practice psychoeducational interventions to manage cancer-related fatigue and may use this study design for randomized controlled studies for psychoeducational interventions on cancer-related fatigue.

Multisymptom Burden in Cancer Survivors: Benefits of Physical Activity

In contrast with other leading causes of mortality, the cancer death rate in the United States continues to decline, reflecting improvements in prevention, screening, and treatment. Despite these advances, there has been limited development of strategies to counter the unwanted and debilitating effects associated with cancer and its treatments. Indeed, syndromes including cachexia, cardiotoxicity, fatigue, and mucositis among others plague cancer survivors, leading to poor life quality and premature mortality. The systemic nature of these impairments creates a strong rationale for treatment strategies to mitigate syndromes affecting cancer survivors. Currently, however, there are limited treatments approved by the US Food and Drug Administration to counter the debilitating side effects of cancer and cancer treatments. In noncancer clinical populations, physical activity is a well-established strategy to increase muscle mass, improve cardiovascular health, enhance energy levels, and promote gut health. Although physical activity programs are widely encouraged for cancer survivors, researchers are just beginning to understand the physiological basis of their positive effects and how they can be maximized for different cancer populations and treatments. This graphical review describes the benefits of physical activity and associated mechanisms for ameliorating select side effects of cancer and its therapeutics.

Symptom clusters and their impact on quality of life among Chinese patients with lung cancer: A cross-sectional study

PURPOSE

To investigate the symptom clusters of Chinese patients with lung cancer, and explore their impact on quality of life (QoL) and each of its functioning.

METHOD

A cross-sectional study was conducted between October 2022 and April 2023 among 219 lung cancer patients at a general hospital in Sichuan Province. Data were collected using a general information questionnaire, the MD Anderson Symptom Inventory, and the EORTC QLQ-C30. R within the RStudio platform was used to conduct descriptive statistics, exploratory factor analysis and multiple regression analysis.

RESULTS

Psychoneurological, respiratory, gastrointestinal and fatigue-related symptom clusters were identified, each of which was significantly negatively correlated with overall QoL, global health status/QoL and each functioning. The respiratory (β = -0.60, P = 0.02) and fatigue-related symptom cluster (β = -0.86, P = 0.02) were predictors of global health status/QoL; the fatigue-related symptom cluster predicted physical (β = -1.68, P < 0.01), role (β = -1.63, P < 0.01) and cognitive functioning (β = -1.45, P < 0.01); the psychoneurological symptom cluster was a predictor of patients' emotional functioning (β = -1.26, P < 0.01); and the psychoneurological (β = -0.81, P < 0.01) and gastrointestinal symptom cluster (β = -0.60, P = 0.05) predicted social functioning.

CONCLUSIONS

Respiratory and fatigue-related symptom clusters were strong predictors of global health status/QoL; fatigue-related, psychoneurological and gastrointestinal symptom clusters had a negative impact on patients' functioning. Nurse practitioners should pay more attention to monitoring respiratory and fatigue-related symptom clusters to identify high-risk populations in time, and tailored interventions based on symptom clusters are needed to synergistically reduce the symptom burden, thereby improving patients' QoL.