Cancer-related fatigue stratification system based on patient-reported outcomes and objective outcomes: A cancer-related fatigue ambulatory index

Mobility Assessment Instruments

OBJECTIVES

Review commonly used mobility assessment instruments and discuss their use in multidisciplinary research and clinical practice.

METHODS

Data sources include peer-reviewed articles sourced in electronic databases (PubMed, CINAHL), government websites, national, and international best practice guidelines to describe frequently used mobility assessment instruments.

RESULTS

Numerous clinician-, observer-, patient-reported, and performance outcome instruments and evidence-based implementation program resources exist, though these vary in their intended purpose and setting. Wearable and ambient sensors provide new opportunities to collect passive, objective physical activity data and observe changes in mobility across settings.

CONCLUSIONS

Selection among multiple assessment tools requires consideration of the available evidence for use in the desired population, the outcomes of interest, whether use is feasible for the setting, and the strength of validity and reliability data for the tool.

IMPLICATIONS FOR NURSING PRACTICE

Nurses, especially in the inpatient setting, are typically in most frequent contact with patients and are well-positioned to assess mobility and ensure that safe, progressive mobility care plans are in place. Development of an organization-wide mobility culture requires a systematic, multidisciplinary approach and long-term commitment.

Patient Reported Fatigue Among Adolescent and Young Adult Cancer Patients Compared to Non-Cancer Patients: A Systematic Review and Meta-Analysis

Adolescent and young adult (AYA) cancer patients and survivors are a growing population due to more frequent diagnoses and improved survival. Fatigue is a common symptom experienced by cancer patients and it is often missed by health care professionals. Patient reported outcome measures (PROMs) can assist in evaluating patient reported fatigue. This systematic review aims to determine if AYA cancer patients report more fatigue than AYAs who have not been diagnosed with cancer. We used a subset of articles from a larger review that searched PubMed, EMBASE, CINAHL, and PsycINFO to determine which PROMs and domains are currently being used to evaluate AYA cancer. This study identified 175 articles related to PROMs in the AYA cancer population. Articles with PROMs reporting on fatigue/vitality were used in this review. From the original 175 articles, we identified 8 fatigue/vitality articles for this review. All eight articles found an increase in fatigue/decrease in vitality in the AYA cancer population compared to healthy controls. A meta-analysis was performed on four articles that used the same PROM tool (EORTC QLQ-C30). This found a statistically significant and clinically meaningful increase in mean fatigue of 12.5 95% confidence interval: 3.3-21.8 points (scale 0-100, higher number indicates more fatigue) in the AYA cancer group compared to healthy noncancer controls. Fatigue in the AYA cancer population is a significant issue, it is often undetected and underreported, and early interventions are needed to prevent the negative subsequent sequelae.

Unraveling the "golden ratio": a pilot study investigating acute-to-chronic workload ratio in breast cancer patients undergoing active treatment

Training load monitoring is a common practice in sports medicine for supporting athletes' health and performance. Despite progress in exercise oncology research for breast cancer patients, training load monitoring is underutilized. This study retrospectively investigated the relationship between maintained training load within a defined range and physical and health outcomes of ten breast cancer patients during active anticancer treatment who underwent a 12-week exercise program. Intervention consisted of endurance and resistance training, three times a week, with each session lasting 30-45 min. Assessments were conducted at baseline, 6 and 12 weeks after enrollment, evaluating physical function (6-min walk test-6MWT, and sit-to-stand), muscle strength, body composition, sleep quality (Pittsburgh Sleep Quality Index-Pittsburgh Sleep Quality Index), quality of life (EORTC-QLQ-C30), heart rate variability and physical activity levels (International Physical Activity Questionnaire-International Physical Activity Questionnaire). The Physiological Cost Index/Energy Expenditure Index (PCI/EEI) was estimated using the 6MWT and Heart rate. Training load monitoring was performed by session rating of perceived exertion (sRPE, relative intensity multiplying with session duration). Acute-to-Chronic Workload Ratio (ACWR) (7:28, rolling average) was calculated accordingly. Analyses were performed within-subjects across time points and between-subjects, comparing those who maintained from weeks 6-12 an ACWR of 0.8-1.3 with those who did not. Adherence rates were similar between groups. Physical function improved in the total sample with large effect sizes (Δ6MWT = 56.5 m [95%CI: 6-100 m], effect size [w] = 0.52, p = 0.006; ΔSit-to-Stand = 1.5 [95%CI: 1-5], effect size [w] = 0.681, p < 0.001), demonstrating greater changes in patients with higher ACWR. Sleep quality improvements were higher in the appropriate ACWR group (p = 0.016). A positive correlation was demonstrated between global health status and 6MWT change from baseline to 12 weeks (ρ = 0.689, p = 0.04). Despite a small sample size, patients maintaining sufficient relative training load presented greater physical fitness and sleep quality improvements. Thus, training load monitoring may enhance exercise program benefits in breast cancer patients under active treatment.

Cancer-related fatigue classification based on heart rate variability signals from wearables

Background

Cancer-related fatigue (CRF) is the most distressing side effect in cancer patients and affects the survival rate. However, most patients do not report their fatigue level. This study is aimed to develop an objective CRF assessment method based on heart rate variability (HRV).

Methods

In this study, patients with lung cancer who received chemotherapy or target therapy were enrolled. Patients wore wearable devices with photoplethysmography that regularly recorded HRV parameters for seven consecutive days and completed the Brief Fatigue Inventory (BFI) questionnaire. The collected parameters were divided into the active and sleep phase parameters to allow tracking of fatigue variation. Statistical analysis was used to identify correlations between fatigue scores and HRV parameters.

Findings

In this study, 60 patients with lung cancer were enrolled. The HRV parameters including the low-frequency/high-frequency (LF/HF) ratio and the LF/HF disorder ratio in the active phase and the sleep phase were extracted. A linear classifier with HRV-based cutoff points achieved correct classification rates of 73 and 88% for mild and moderate fatigue levels, respectively.

Conclusion

Fatigue was effectively identified, and the data were effectively classified using a 24-h HRV device. This objective fatigue monitoring method may enable clinicians to effectively handle fatigue problems.

Effects of Preceding Transcranial Direct Current Stimulation on Movement Velocity and EMG Signal during the Back Squat Exercise

This study aimed to evaluate the effects of preceding anodal transcranial direct stimulation (a-tDCS) over the dorsolateral prefrontal cortex (DLPFC) during the back squat exercise on movement velocity and surface electromyographic (sEMG) activity. Thirteen healthy, well-trained, male firefighters (34.72 ± 3.33 years; 178 ± 7.61 cm; 76.85 ± 11.21 kg; 26.8 ± 4.2 kg·m−2; back squat 1-repetition maximum 141.5 ± 16.3 kg) completed this randomised double-blinded sham-controlled crossover study. After familiarisation and basal measurements, participants attended the laboratory on two occasions separated by 72 h to receive either Sham or a-tDCS (current intensity of 2 mA for 20 min). Immediately after stimulation, participants completed three sets of 12 repetitions (70% of 1-RM) with three minutes of recovery between sets monitored with a linear position transducer. The sEMG of the rectus femoris (RF) and vastus lateralis (VL) of both legs were recorded. No significant differences were observed between a-tDCS and Sham interventions on mean concentric velocity at any set (p > 0.05). Velocity loss and effort index were significantly higher (p < 0.05) in set 3 compared to set 1 only in the a-tDCS group. The right-leg RM and right-leg VL elicited the greatest muscle activation during set 1 after a-tDCS and Sham, respectively (p < 0.05). Our results revealed that a-tDCS over the DLPFC might impact movement velocity or fatigue tolerance in well-trained individuals. Notwithstanding, significant differences in dominant-leg muscle activity were found both in a-tDCS and Sham.

Thirty-second sit-to-stand test as an alternative for estimating peak oxygen uptake and 6-min walking distance in women with breast cancer: a cross-sectional study

Purpose

To determine whether the 30-s sit-to-stand (30STS) test can be a valid tool for estimating and stratifying peak oxygen uptake (VO2peak) and 6-min walking distance (6MWD) in women with breast cancer.

Methods

This cross-sectional study uses data from the ONCORE randomized controlled trial, including 120 women aged 18–70 years with early-stage breast cancer under treatment with anthracycline and/or anti-HER2 antibodies. Participant characteristics were collected at baseline and pooled data from functional assessment (30STS test, relative and absolute VO2peak, and 6MWD) were collected at baseline and post-intervention (comprehensive cardio-oncology rehabilitation program vs. usual care). Bivariate correlations and multivariate linear regression analyses were performed to study the relationship between functional test variables.

Results

The number of repetitions in the 30STS test showed (i) a moderate correlation with relative VO2peak (ml/kg/min) (r = 0.419; p < 0.001; n = 126), (ii) a weak correlation with absolute VO2peak (ml/min) (r = 0.241; p = 0.008; n = 120), and (iii) a moderate correlation with the 6MWD (r = 0.440; p < 0.001; n = 85). The ONCORE equations obtained from the multivariate regression models allowed the estimation of VO2peak and 6MWD (r² = 0.390; r² = 0.261, respectively) based on the 30STS test, and its stratification into tertiles (low, moderate, and high).

Conclusion

The 30STS test was found to be a useful tool to estimate VO2peak and/or 6MWD in women with early-stage breast cancer. Its use may facilitate the assessment and stratification of functional capacity in this population for the implementation of therapeutic exercise programs if cardiopulmonary exercise testing (CPET) or 6MWT are not available.

Trial registration

ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142

Development of a functional assessment task in metastatic breast cancer patients: the 30-second lie-to-sit test

PURPOSE

To develop a physical function test based on lie-to-sit transition and to study its feasibility in patients suffering from metastatic breast cancer (MBC).

MATERIALS AND METHODS

This cross-sectional study recruited 90 women diagnosed with MBC. Patients were asked to transfer from lying to sitting position as fast as possible during 30 s, performing the 30-second lie-to-sit test (30-LTS). Heart rate (HR), rate of perceived exertion (RPE) and number of repetitions were measured. An assessment included the 30-second sit-to-stand test (30-STS), handgrip strength, Upper Limb Functional Index (ULFI) and Lower Limb Functional Index (LLFI). Pearson correlation was calculated between 30-LTS and independent outcomes. A linear regression model explaining the 30-LTS results was further constructed with variables that had a significant correlation.

RESULTS

About 72 patients were measured, of which 65 were able to perform 30-LTS. Subjects performed 8.13 repetitions on average, with a mean RPE of 4.78 (0-10), reaching 63.08% of maximal HR. 30-LTS was significantly correlated with 30-STS (r = 0.567), handgrip (p = 0.26) and LLFI (r = 0.348). The regression model was significant (F = 4.742; p = 0.00), and these variables explained 32% of the variance of the 30-LTS.

CONCLUSION

The 30-LTS showed to be a feasible functional and submaximal test in a sample of MBC. IMPLICATIONS FOR REHABILITATIONThe 30-second lie-to-sit (30-LTS) developed does not require the patient to acquire a standing position and therefore it is an alternative to other more biomechanically demanding tests such as a 30 second sit-to-stand test or Timed up-and-go.30-LTS involves both a functional and energy system assessment tool that can be implemented by allied health professionals in oncology rehabilitation to individualize exercise prescription, as well as for functional screening purposes.The present study adds value to current research focused on individualizing exercise prescription in the oncology field and provides reference values of function in metastatic breast cancer patients.

Inertial Sensors Embedded in Smartphones as a Tool for Fatigue Assessment Based on Acceleration in Survivors of Breast Cancer

BACKGROUND

Cancer-related fatigue is a symptom commonly reported in survivors of breast cancer and is the most variable symptom. Besides questionnaires like PIPER to assess cancer-related fatigue, there is a need to objectively measure fatigue.

OBJECTIVE

The aim of this study was to assess the physiological dimension of fatigue based on acceleration during a 30-second maximal sit-to-stand test.

DESIGN

This was a cross-sectional study.

METHODS

Linear acceleration from a smartphone placed on the sternum was recorded in 70 survivors of breast cancer. Fourth-degree polynomial adjustment from the acceleration signal to the vertical and anterior-posterior axis was calculated. The fatigue temporal cut-off point was detected as a change in the curve slope of the first maximum point of acceleration.

RESULTS

Women were aged 51.8 (8.9) years with a body mass index of 25.4 (5.1) Kg/m2. They performed 23.6 (6.57) number of repetitions. The mean fatigue cut-off point from the total sample was 10.2 (3.1) seconds.

LIMITATIONS

Further research should employ time-prolonged tests to study acceleration behavior beyond 30 seconds as well as include a physiological criterion that justifies the nonlinear saturation of the acceleration-based criterion.

CONCLUSIONS

This study assessed fatigue through a low-cost and easy-to-use methodology during a functional and widely used test such as 30-second maximal sit-to-stand. This would allow clinicians to assess fatigue in a short-effort exercise to individualize exercise prescription dose, measure changes during intervention, and track fatigue objectively throughout survivorship.

Energy System Assessment in Survivors of Breast Cancer

BACKGROUND

Survivors of breast cancer commonly report functional limitations, including cancer-related fatigue (CRF) and decreased aerobic capacity. One key gap is addressing the 3 energy systems (aerobic, anaerobic lactic, and alactic), requiring assessment to establish a baseline exercise intensity and duration.

OBJECTIVE

This study examined the feasibility of energy system-based assessment, also providing descriptive values for assessment performance in this population.

DESIGN

This was a cross-sectional study.

METHODS

Seventy-two posttreatment survivors of breast cancer were recruited. Following a baseline musculoskeletal assessment, women attempted 3 energy system assessments: submaximal aerobic (multistage treadmill), anaerobic alactic (30-second sit-to-stand [30-STS]), and anaerobic lactic (adapted burpees). Heart rate (HR) and rating of perceived exertion (RPE) were recorded. Secondary outcomes included body composition, CRF, and upper- and lower-limb functionality.

RESULTS

Seventy of 72 participants performed the 30-STS and 30 completed the adapted burpees task. HR and RPE specific to each task were correlated, reflecting increased intensity. Women reported low-moderate levels of CRF scores (3% [2.1]) and moderate-high functionality levels (upper-limb: 65.8% [23.3]; lower-limb: 63.7% [34.7]).

LIMITATIONS

All survivors of breast cancer had relatively low levels of CRF and moderate functioning. Additionally, on average, participants were classified as "overweight" based on BMI.

CONCLUSION

This study is the first to our knowledge to demonstrate feasibility of energy system assessment in survivors of breast cancer. Using a combination of HR and RPE, as well as baseline assessment of each energy system, clinicians may improve ability to prescribe personalized exercise and give patients greater ability to self-monitor intensity and progress.

Fatigue Detection during Sit-To-Stand Test Based on Surface Electromyography and Acceleration: A Case Study

The latest studies of the 30-second sit-to-stand (30-STS) test aim to describe it by employing kinematic variables, muscular activity, or fatigue through electromyography (EMG) instead of a number of repetitions. The aim of the present study was to develop a detection system based on acceleration measured using a smartphone to analyze fatigue during the 30-STS test with surface electromyography as the criterion. This case study was carried out on one woman, who performed eight trials. EMG data from the lower limbs and trunk muscles, as well as trunk acceleration were recorded. Both signals from eight trials were preprocessed, being averaged and temporarily aligned. The EMG signal was processed, calculating the spectral centroid (SC) by Discrete Fourier Transform, while the acceleration signal was processed by Discrete Wavelet Transform to calculate its energy percentage. Regarding EMG, fatigue in the vastus medialis of the quadriceps appeared as a decrease in SC, with a descending slope of 12% at second 12, indicating fatigue. However, acceleration analysis showed an increase in the percentage of relative energy, acting like fatigue firing at second 19. This assessed fatigue according to two variables of a different nature. The results will help clinicians to obtain information about fatigue using an accessible and inexpensive device, i.e., as a smartphone.