Impact of fatigue on quality of life among breast cancer patients receiving chemotherapy

Specification of self-reported late-term impairments 3-7 years after primary breast cancer treatment: a nationwide cross-sectional study among Danish breast cancer survivors

PURPOSE

To describe the characteristics of Danish women treated for primary breast cancer, the prevalence and severity of self-reported late-term impairments, and the registration of these impairments in the Danish National Patient Registry.

METHODS

This is a nationwide cross-sectional survey study. A nationwide sample of 9927 women were invited to complete a questionnaire on late-term impairments, including shoulder impairment, lymphedema, fatigue, and chemotherapy-induced neuropathy. Severity was scored on validated patient-reported scales. Clinical characteristics of women and diagnostic codes for "late-term effects" were extracted from the Danish National Patient Registry.

RESULTS

The response rate was 60.9%. The 6046 responders were on average 57 years old at surgery, and 53.5% had a lower education level, 62.7% were married, 56.7% had a body mass index ≥ 25, and 54.4% had one or more co-morbidities. Overall, 60.7% reported having late-term impairments from their breast cancer treatment. The most common impairments were shoulder impairment (75.3%), fatigue (56.9%), chemotherapy-induced neuropathy (49.6%), and lymphedema (26.3%). On average, 58.0% women reporting impairments scored moderate to severe disturbances on validated patient-reported scales. Despite the high self-reported rates, impairments were rarely recorded in the Danish National Patient Registry (lymphedema, 1.3%; fatigue, 0.2%; shoulder impairment, 0.1%; and chemotherapy-induced neuropathy, 0.1%).

CONCLUSION

More than 60% of Danish breast cancer survivors reported moderate to severe late-term impairments 3-7 years post-treatment, yet these impairments were rarely recorded in the Danish National Patient Registry.

IMPLICATIONS FOR CANCER SURVIVORS

Future research should focus on organizational structures in the Danish secondary healthcare, in relation to facilitating screening and timely detection of late-term impairments.

Factors affecting quality of life in women post mastectomy for breast cancer in Baheya Foundation (Egypt): 'A retrospective cohort study'

BACKGROUND

Breast cancer treatment has many strategies, each with its own effects on survivors' quality of life (QoL). The current study evaluated factors influencing QoL in women who have undergone mastectomy and compared different treatments based on sociodemographic and clinical factors.

METHODS

A retrospective cohort study was conducted utilizing the EORTC Quality of Life breast cancer specific tool and the FACT-B and FBSI questionnaires to measure functional and symptom scales impacting QoL. The questionnaire was administered to 318 Egyptian women post-mastectomy and at 6-month follow-up. Results were reported as median and interquartile range (IQR) or frequency and percentage. Fisher's exact and Kruskal-Wallis tests were used for statistical inferences. Generalized linear models were used to predict QoL measures (outcome) by sociodemographic and clinical variables (independent) with adjusting for potential confounders. Independent variables were selected by elastic net regression.

RESULTS

The Global QoL score for this cohort was 42.0 (IQR 25.0-67.0). The functional scale most affected was role (62%), with the cognition having the lowest effect. The most distressing symptoms on the symptom scale were fatigue (65%), insomnia (61%), and pain (60%). FACT-B had a median score of 79.0 (IQR 63.0-95.0). Generalized linear regression indicated that higher cognitive functioning (22.45; p < 0.050) and BCS (6.026, p < 0.010) was positively correlated with women > 60 years old. Urban women correlated with a lower SWB (-2.679, p < 0.05) and higher degree of insomnia. A BMI > 30 correlated negatively with many of the QoL domains. SM or MRM with reconstruction correlated positively with TQOL (8.109 < p < 0.050). Women who received chemotherapy had lower social functioning (-12.41, p < 0.050), BCS (-3.473, p < 0.010), greater association with diarrhoea (8.865, p < 0.010) and financial difficulties (15.23, p < 0.050). In contrast, women who received hormonal therapy had higher role functioning (17.64, p < 0.010), with less complaints of diarrhoea (-10.38, p < 0.010), nausea (-8.668, p < 0.010) and pain (-8.265, p < 0.050).

CONCLUSION

These results indicate that sociodemographic and clinical factors affect QoL in Egyptian women post-mastectomy. The worst functioning was the role and emotional scales, and the most distressing on the symptom scale were fatigue, insomnia, and pain making an imperative case for a more multidisciplinary team approach to treatment.

Effectiveness of Therapeutic Exercise Models on Cancer-Related Fatigue in Patients With Cancer Undergoing Chemotherapy: A Systematic Review and Network Meta-analysis

OBJECTIVE

To assess and compare the effectiveness of different exercise modalities in reducing cancer-related fatigue (CRF) in patients with cancer undergoing chemotherapy. Exercise intensities for selected exercise types were also compared.

DATA SOURCES

We conducted a search in MEDLINE, Embase, CINAHL, Scopus, SPORTDiscus, and Web of Science from inception to October 15, 2021.

STUDY SELECTION

Randomized controlled trials concerning the effectiveness of exercise modalities on CRF in patients with cancer undergoing chemotherapy were included.

DATA EXTRACTION

Study characteristics were extracted using a structured protocol. Methodological quality was assessed employing the PEDro scale and risk of bias was assessed using the Revised Cochrane Risk of Bias Tool for Randomized Trials. The certainty of evidence was assessed based on Grading of Recommendations, Assessment, Development and Evaluation. The measure of effect used was the adjusted standardized mean difference (SMD) or Hedge's g, together with the corresponding 95% confidence intervals (CI).

DATA SYNTHESIS

Forty-seven studies were included. Data were pooled employing a random-effects model. There was a trend that adding low-intensity aerobic and resistance exercise (SMD=1.28, 95% CI -0.18; 2.75, P=.086), or moderate-intensity aerobic and resistance exercise (SMD=0.85; 95% CI -0.12; 1.82, P=.087), was more effective than adding flexibility training to usual care (UC). There was also a trend that UC alone was less effective than adding moderate-intensity aerobic and resistance exercise (SMD=-0.47, 95% CI -0.96, 0.02, P=.060) to UC.

CONCLUSIONS

The addition of low- to moderate-intensity aerobic and/or resistance exercise demonstrated a positive trend for improvement in CRF in patients with cancer undergoing chemotherapy, when compared with UC alone or UC with flexibility training.

Post stroke intervention trial in fatigue (POSITIF): Randomised multicentre feasibility trial

OBJECTIVE

To test the feasibility of a telephone delivered intervention, informed by cognitive behavioural principles, for post-stroke fatigue, and estimated its effect on fatigue and other outcomes.

DESIGN

Randomised controlled parallel group trial.

SETTING

Three Scottish stroke services.

SUBJECTS

Stroke survivors with fatigue three months to two years post-stroke onset.

INTERVENTIONS

Seven telephone calls (fortnightly then a 'booster session' at 16 weeks) of a manualised intervention, plus information about fatigue, versus information only.

MAIN MEASURES

Feasibility of trial methods, and collected outcome measures (fatigue, mood, anxiety, social participation, quality of life, return to work) just before randomisation, at the end of treatment (four months after randomisation) and at six months after randomisation.

RESULTS

Between October 2018 and January 2020, we invited 886 stroke survivors to participate in postal screening: 188/886 (21%) returned questionnaires and consented, of whom 76/188 (40%) were eligible and returned baseline forms; 64/76 (84%) returned six month follow-up questionnaires. Of the 39 allocated the intervention, 23 (59%) attended at least four sessions. At six months, there were no significant differences between the groups (adjusted mean differences in Fatigue Assessment Scale -0.619 (95% CI -4.9631, 3.694; p = 0.768), the Generalised Anxiety Disorder 7 -0.178 (95% CI -3.823, 3.467, p = 0.92), and the Patient Health Questionnaire -0.247 (95% CI -2.935, 2.442, p = 0.851). There were no between-group differences in quality of life, social participation or return to work.

CONCLUSION

Patients can be recruited to a trial of this design. These data will inform the design of further trials in post-stroke fatigue.

Quality of Life and Its Associated Factors Among Cancer Patients Receiving Chemotherapy at Oncology Hospitals in Vietnam After the Third Wave of the COVID-19 Pandemic

Purpose

This study aimed to evaluate the health-related quality of life (HRQOL) of cancer patients receiving chemotherapy and identify associated factors affecting the HRQOL after the third wave of the COVID-19 pandemic in Vietnam.

Patients and Methods

Patients with solid cancers receiving chemotherapy at two oncology hospitals in Vietnam during April and May 2021 were included. The European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire version 3 was used to measure the HRQOL. Three questions were asked to explore patients’ concern levels about contracting COVID-19, delaying chemotherapy, or not controlling cancer well. One question was used to explore whether patients were concerned about cancer progression or COVID-19 infection more, or equally, or had no concern about both. Multiple regression models were conducted to examine factors associated with the global health status (GHS) score.

Results

Of 270 included patients, mean (Standard deviation [SD]) GHS was 56.7 (20.8). Among the functional statuses, social functioning (SF) had the lowest score of 63.6 (29.2). The symptoms with the highest means were insomnia and fatigue, obtaining the score of 38.5 (31.7) and 37.3 (29.2), respectively. The mean of financial difficulties was 54.1 (32.2). In univariate analysis, high concerns about contracting COVID-19, delaying chemotherapy, not controlling cancer well, or more concern about either cancer or COVID-19 over the other were associated with worse GHS, physical functioning, emotional functioning, and SF. In multivariate analysis, those concerns and no income were significantly related to lower GHS scores besides the non-modifiable factors, such as female gender and some cancer types.

Conclusion

Patients at the high concern levels, or with more concern about either cancer or COVID-19 over the other had poorer HRQOL. Interventions to address the concerns are required to improve their HRQOL, particularly for women, those without income, or with some specific cancers.

Effects of traditional Chinese medicine exercise therapy on cancer-related fatigue, anxiety and sleep quality in cancer patients: A protocol for systematic review and network meta-analysis

BACKGROUND

Cancer-related fatigue (CRF) is one of the most common adverse events of anticancer therapies, with an incidence of up to 90%, which seriously affects the quality of life in cancer patients. Complementary and alternative therapies for CRF include acupuncture, Chinese herbal medicine, Tai Chi, Qigong, and massage therapy. Several studies have shown that traditional Chinese medicine (TCM) exercise therapies, such as Tai Chi, Ba Duan Jin, the classics of tendon changing, Six Healing Sounds, and Wu Qin Xi, can improve CRF, anxiety symptoms, and sleep quality in cancer patients. However, their specific efficacy and which TCM exercise therapy is the best remain controversial. In this study, we assess and compare the effects of different TCM exercise therapies on CRF, anxiety, and sleep quality in cancer patients by network meta-analysis (NMA).

METHODS

Randomized controlled trials reporting TCM exercise therapies for CRF, anxiety and sleep quality in cancer patients published before October 2021 will be searched in the PubMed, Web of Science, Scopus, Cochrane Library, Embase, China Scientific Journal Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and Wanfang Data. Two researchers will be independently responsible for literature screening, data extraction and assessment of their quality. Standard pair-wise and NMA will be performed to compare the efficacy of different TCM exercise therapies on CRF, anxiety and sleep quality in cancer patients using Stata 14.0 software.

RESULTS

The results of this meta-analysis will be submitted to a peer-reviewed journal for publication.

CONCLUSIONS

This NMA will contribute to identify the optimal TCM exercise therapy for CRF and provide evidence-based bias for clinical decision-making.

ETHICS AND DISSEMINATION

Ethical approval was not required for this study. The systematic review will be published in a peer-reviewed journal, presented at conferences, and shared on social media platforms.

OSF REGISTRATION NUMBER

DOI 10.17605/OSF.IO/MJ8DA.