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Clinical Case Report: Yoga for Fatigue in Five Young Adult Survivors of Childhood Cancer
Abstract
Purpose:
Cancer-related fatigue (CRF) is a distressing consequence of cancer and its treatment. CRF impacts many young adult (YA) survivors of childhood cancer, compromising work, social relationships, and daily activities. No satisfactory treatment exists. This pilot study aimed to assess the feasibility, safety, and preliminary efficacy of an 8-week twice/week Iyengar yoga (IY) intervention for treating persistent fatigue in YA survivors of childhood cancer.
Methods:
Using a single-arm mixed-methods design, adult childhood cancer survivors aged between 18 and 39 years were recruited from a survivorship clinic at a single institution. Quantitative: The primary outcome was fatigue as measured by the Functional Assessment of Chronic Illness Therapy-Fatigue. Secondary outcomes included vitality, social functioning, multidimensional fatigue, mood, and sleep. Weekly self-report monitoring data were collected. Qualitative: Participants also completed a post-intervention interview, major themes evaluated.
Results:
Five participants enrolled into the study and four completed the intervention. Attendance was 92% and there were no adverse events. Baseline mobility was highly varied, with one YA having had a hemipelvectomy. Quantitative data revealed significantly improved fatigue, social functioning, somatization, and general and emotional manifestations of fatigue following yoga. Qualitative data cross validated, clarified, and expanded upon the quantitative findings.
Conclusions:
The study suggests that a brief IY intervention is safe for YA survivors of childhood cancer, even for those with physical disabilities. Preliminary efficacy was demonstrated for the primary outcome of fatigue. Qualitative data elucidated additional improvements, such as work-related social functioning, and a sense of calm and relaxation.
... Among women diagnosed with cancer, several systematic reviews [22][23][24][25] and meta-analyses [29][30][31][32] have summarized the results of studies exploring yoga's positive effects on outcomes such as health-related QoL, depression, anxiety, fatigue, and sleep disturbances. Notably, women diagnosed with cancer have also reported that yoga may help with self-management of symptoms and treatment effects by improving their capacity to cope with these [33][34][35] and reducing adverse physical effects (e.g., pain, numbness [36,37]). While research on the underlying psychosocial mechanisms that may explain these positive effects is underdeveloped in the oncology field, research in the fields of body image and eating disorder suggest that the focus on moving, stretching, and balancing through a series of poses, awareness of breath, and cultivating the connection between mind and body may address both physical and psychological concerns. ...
... Participants also discussed improved physical fitness and body alignment as yoga helped them feel more physically fit. Indeed, participants described improvements in flexibility [33,34,60,61,66,67,70,74,75,77], mobility [33,70], balance [33,66,77], stamina [35,61,67], strength [33,61,63,67,70,72,75,77], fitness [63,66,77], weight loss and toning [76], and posture [37,70,77] and stated that it counteracted physical deterioration [34] and helped them move their muscles [74]. In terms of improved execution of tasks or activities, participants described how yoga improved their ability to carry out day-to-day activities [70,73,74,77], engage in other forms of physical activity [35,61], and return to normal more quickly [65]. ...
... Indeed, participants described improvements in flexibility [33,34,60,61,66,67,70,74,75,77], mobility [33,70], balance [33,66,77], stamina [35,61,67], strength [33,61,63,67,70,72,75,77], fitness [63,66,77], weight loss and toning [76], and posture [37,70,77] and stated that it counteracted physical deterioration [34] and helped them move their muscles [74]. In terms of improved execution of tasks or activities, participants described how yoga improved their ability to carry out day-to-day activities [70,73,74,77], engage in other forms of physical activity [35,61], and return to normal more quickly [65]. Improvements in fatigue and energy were reported; participants felt that yoga reduced fatigue [65,67,68], increased energy [33, 35, 61, 66, 67, 70, 71, ...
Background
Qualitative research on women’s experiences participating in yoga after a cancer diagnosis is growing; systematic synthesis and integration of results are necessary to facilitate the transfer and implementation of knowledge among researchers and end-users. Thus, the purpose of this meta-synthesis was to: (1) integrate findings from qualitative studies, (2) compare and contrast findings to elucidate patterns or contradictions in conclusions, and (3) develop an overarching interpretation of women’s experiences participating in yoga after a cancer diagnosis.
Methods
Using meta-study methodology, six electronic databases were searched using a sensitive search strategy in November 2020, a supplemental scan of reference lists was conducted in August 2021, and the database search was replicated in October 2021. Two reviewers independently screened titles/abstracts and full-texts to determine eligibility.
Results
The searches yielded 6804 citations after de-duplication. Data from 24 articles meeting the eligibility criteria were extracted, and the results, methods, and theoretical approach(es) were analyzed. The analysis revealed that there was a predominant focus on two focal points in the primary articles: (1) women’s well-being and quality of life (QoL; part I) and (2) intervention preferences (part II). Five overarching categories emerged related to well-being and QoL: (1) yoga can support improvements in multiple dimensions of QoL in women diagnosed with cancer, (2) women diagnosed with cancer experience an interaction between QoL dimensions, (3) elements of yoga that support improvements in QoL dimensions, (4) breathwork and meditation are integral elements of yoga, and (5) yoga practice may support lifestyle behavior change. The articles reviewed had notable limitations related to: (1) reporting about instructor(s), content of the intervention, and environmental characteristics of the setting, (2) identifying and incorporating optimal features in the intervention design, (3) incorporating theory and real-world considerations into the study procedures, and (4) including positive and negative conceptualizations of QoL as an interconnected and multidimensional concept.
Conclusion
Moving forward, it remains critical to identify the ideal structure and content of yoga programs for promoting well-being and QoL among women diagnosed with cancer, as well as to explore barriers and facilitators to sustainable program implementation.
Systematic review registration
PROSPERO CRD42021229253.
... Individual authors have suggested definitions of CRF that capture key aspects of the symptom in childhood cancer survivors. For example, Meeske et al. (2007) [22] highlighted the reduced quality of life that accompanies CRF in this population, and Evans et al. (2017) [23] underlined the negative impact of CRF on work, social relationships, and daily functioning. These definitions each inform on specific aspects of CRF in childhood cancer survivors that are not systematically reported in the definitions of CRF in adult oncology. ...
... Individual authors have suggested definitions of CRF that capture key aspects of the symptom in childhood cancer survivors. For example, Meeske et al. (2007) [22] highlighted the reduced quality of life that accompanies CRF in this population, and Evans et al. (2017) [23] underlined the negative impact of CRF on work, social relationships, and daily functioning. These definitions each inform on specific aspects of CRF in childhood cancer survivors that are not systematically reported in the definitions of CRF in adult oncology. ...
... The number of participants per study ranged from 4 [23] to 1,897 [27] (median = 83.5, IQR = 190), for a total of 6,248 participants. ...
Context
There is no universal definition of cancer-related fatigue (CRF) specific to childhood cancer survivors, despite this population facing unique long-term side effects from their cancer. We aimed to synthesize and combine existing definitions of CRF specific to this context to inform on the necessity of a panel of experts to formulate a new definition of CRF for childhood cancer survivors.
Methods
The literature search was performed in various databases. Titles, abstracts, and keywords were screened by two researchers to confirm eligibility. The data extraction process was performed by two researchers. Our search was conducted in various databases.
Results
Thirty articles were included in the qualitative analysis. Two coders reached consensus on 14 codes. The thematization process produced 4 themes: frequency, context, attributes, and consequences of CRF. These themes were used to synthesize a definition of CRF, as follows: “In childhood cancer survivors, cancer-related fatigue is a common late effect of cancer and cancer treatments. It is characterized by a subjective, persistent, and multidimensional experience that differs from normal fatigue in the physical, emotional, and/or cognitive spheres. Cancer-related fatigue may have a variety of negative consequences including a reduced quality of life and level of functioning, a lack of vigor, work difficulties, relationship issues, and emotional distress.”
Conclusion
A definition of CRF applicable to childhood cancer survivors is timely to organize research efforts and design appropriate interventions. The proposed definition is a first step towards the formulation of a new definition of CRF specific to childhood cancer survivors by experts.
... Reasons for exclusion of 39 articles are detailed in Fig. 1. The nine articles that met eligibility criteria and were included for the systematic review are summarized in Tables 1 and 2. The articles were split into two groups based on the presence of a physical activity intervention (Table 1, n = 4) [15][16][17][18] or a physical activity assessment ( Table 2, n = 5) [6,[19][20][21][22]. Of the nine studies included, two were randomized-controlled trials [15,17]. ...
... All types of cancer diagnoses (leukemia/lymphoma, solid tumors, and CNS tumors) were represented in the included studies, as were multiple types of cancer treatments (surgery, chemotherapy, and radiation). In two out of four of the intervention studies, there was a female predominance (75% in [16] and 65% in [18]). ...
... Withycombe et al. monitored physical activity through a wristband for participants attending summer camp with structured physical activity [18]. Evans et al. studied the effects of an 8-week Iyengar yoga program in which participants attended sessions twice per week [16]. ...
Purpose
Many children, adolescents, and young adult survivors of childhood cancer experience fatigue following cancer treatment. Physical activity has been shown to be effective in improving cancer-related fatigue in adult survivors, but there is a lack of evidence on its effect in childhood cancer survivors. In addition, there are no guidelines for treatment of fatigue in childhood cancer survivors. The purpose of this study was to examine the existing literature on the effect of physical activity on fatigue in children, adolescents, and young adult survivors of childhood cancer.
Methods
We conducted a systematic review to examine the effect of physical activity on fatigue in children, adolescents, and young adult survivors of childhood cancer.
Results
Nine studies were included. Most of the studies included reported an increase in physical activity and a decline in fatigue in the target patient population. Interpretation of these findings is limited due to small sample sizes, inadequate length of follow-up, and variability among reviewed studies. Quantitative analysis was not conducted due to significant variability in both the type of physical activity implemented and in the measurement of fatigue.
Conclusions
Further research, with a larger sample size and consistency in both physical activity interventions and measurement of fatigue, is needed to add greater precision and confidence in the effect of physical activity on fatigue in childhood cancer survivors. Results of this research will help guide future recommendations on physical activity for the treatment of cancer-related fatigue in children, adolescents, and young adult survivors of childhood cancer.
... Vitality among patients with cancer was reported in 38 (13.8%) of included studies, most often as a component of overall quality of life or well-being. Few factors were reported that increased vitality, including marriage, 116 yoga, 117 and stronger overall mental or physical health. 118,119 There were conflicting results for whether time since diagnosis improves vitality. ...
... 54,103 Mind-body exercises, like yoga and tai-chi, improved self-acceptance, and, according to patients, this occurred by demonstrating their body's physical capabilities were intact. 33,117 Happiness was studied by 14 (5.1%) included articles. The factors most commonly attributed to increased happiness was the cancer experience and the suffering it caused, 94 the relief of completing treatment, 160 and gratitude for suffering less than expected. ...
Introduction:
Children and adolescents/young adults (AYAs) with cancer are a vulnerable population susceptible to numerous late effects, such as fatigue and depression, which may diminish their long-term psychological, physical, spiritual, and emotional health. A well-rounded understanding of how positive psychological constructs affect the quality of care and treatment outcomes is therefore warranted.
Methods:
We conducted a scoping review of 15 positive psychological constructs in children and AYAs with cancer. The primary research questions were (1) what is known about positive psychological constructs in children and AYAs with cancer; (2) what value is ascribed to these constructs by patients?.
Results:
Two hundred seventy-six articles were included after database search and screening. These studies were mostly observational or qualitative and conducted in North America. Constructs were often poorly defined, and measurement tools used to gather data were wide ranging. Numerous factors were correlated with increased or decreased expression of certain constructs, but overall themes were difficult to identify. Similarly, patients often spoke of what increased or decreased expression of a construct, with less emphasis on what they implicitly value.
Discussion:
This scoping review found ample evidence for what increases or decreases expression of positive psychological constructs, but this evidence was observational and often conflicting. In the future, we recommend the development of a core set of psychological outcomes, with definitions and corresponding measurement tools. We further recommend an emphasis on randomized trials to more rigorously study how expression of constructs can be improved and what effect this has on the quality of life.
... The symptoms and side-effects of cancer decrease patients' physical well-being and quality of life (QOL). [4,5] Fatigue is a common distressing symptom in patients with cancer, [6] and its prevalence ranged from 50% to 90% in a study reported by Donovan et al. [7] This symptom causes limitation in physical activity [8,9] and interferes with professional, family, and social roles. [10,11] The underlying mechanisms of fatigue are not clear, but its multidimensional and different factors such as psychological, environmental, and physical factors contribute to its occurrence; [12] however, no particular therapies have been found to address it. ...
Background
Fatigue is one of the most common issues related to cancer. Social support has direct effects on health status and coping with illness. This study investigated the relationship between the perception of social support and fatigue in patients with cancer.
Materials and Methods
This descriptive/correlational study was conducted in Omid Hospital in Isfahan, Iran in 2014. One hundred and twenty-five cancer patients receiving chemotherapy were included in the study. Study participants were selected using consecutive sampling. Data were collected using the Cancer Fatigue Scale (CFS), Perceived Social Support Scale, and a demographic characteristics questionnaire. The collected data were analyzed using descriptive and analytical statistical tests in SPSS software.
Results
Mean (SD) of patients’ fatigue and perceived social support scores were 40.63 (11.59) out of 100 and 49.33 (7.85) out of 100, respectively. The Pearson correlation coefficient showed an inverse relationship between fatigue and social support, however, this relationship was not significant. Multiple regression test was used to detect which dimension of perceived social support was a better predictor of the reduction in fatigue score. This test showed that the best predictor was informational support (B = −0.35, p = 0.004).
Conclusions
Results showed a negative relationship between fatigue and perceived social support in cancer patients undergoing chemotherapy. Therefore, social support interventions can help reduce fatigue.
... Nonpharmacological techniques such as guided imagery, mindfulness, relaxation, hypnosis, and cognitive behavioral therapy are effective in alleviating chronic pain in SCD (4,11,28). Activation of the descending neuromodulatory pathway by nonpharmacologic interventions (e.g., acupuncture, meditation, and yoga) has been shown to reduce peripheral and central sensitization. In a pilot study of patients with SCD and healthy controls, a single 30-min hypnosis session decreased pain intensity by a moderate amount in patients with SCD (11). ...
Sickle cell disease (SCD) is a genetic disorder associated with hemolytic anemia, end-organ damage, reduced survival and pain. One of the unique features of SCD is, recurrent and unpredictable episodes of acute pain due to vaso-occlusive crisis, requiring hospitalization. Additionally, SCD patients often develop chronic persistent pain. Currently, sickle pain is treated with opioids, an approach limited by adverse effects. Because pain can start at infancy and continue throughout life, preventing the genesis of pain may be relatively better than treating the pain once it has been evoked. Therefore, we provide insights into the cellular and molecular mechanisms of sickle pain that contribute to the activation of the somatosensory system in the peripheral- and central- nervous systems. These mechanisms include mast cell activation and neurogenic inflammation, peripheral nociceptor sensitization, maladaptation of spinal signals, central sensitization and modulation of neural circuits in the brain. In this review, we describe potential preventive/therapeutic targets and their targeting with novel pharmacologic and/or integrative approaches to ameliorate sickle pain.
... Recently, attention has been focused on perception-based components of pain because of their ability to reduce pain via nonpharmacologic behavioral techniques, such as guided imagery, mindfulness and relaxation training, hypnosis, and cognitive behavioral therapy. [35][36][37] Chronic pain and central sensitization in SCD Chronic pain occurs in a significant proportion of patients with SCD and increases with age. 19,38 If pain lasts for .3 ...
Patients with sickle cell disease (SCD) suffer from intense pain that can start during infancy and increase in severity throughout life, leading to hospitalization and poor quality of life. A unique feature of SCD is vaso-occlusive crises (VOCs) characterized by episodic, recurrent, and unpredictable episodes of acute pain. Microvascular obstruction during a VOC leads to impaired oxygen supply to the periphery and ischemia reperfusion injury, inflammation, oxidative stress, and endothelial dysfunction, all of which may perpetuate a noxious microenvironment leading to pain. In addition to episodic acute pain, patients with SCD also report chronic pain. Current treatment of moderate to severe pain in SCD is mostly reliant upon opioids; however, long-term use of opioids is associated with multiple side effects. This review presents upto- date developments in our understanding of the pathobiology of pain in SCD. To help focus future research efforts, major gaps in knowledge are identified regarding how sickle pathobiology evokes pain, pathways specific to chronic and acute sickle pain, perception-based targets of "top-down" mechanisms originating from the brain and neuromodulation, and how pain affects the sickle microenvironment and pathophysiology. This review also describes mechanism-based targets that may help develop novel therapeutic and/or preventive strategies to ameliorate pain in SCD.
... Recently, attention has been focused on perception-based components of pain because of their ability to reduce pain via nonpharmacologic behavioral techniques, such as guided imagery, mindfulness and relaxation training, hypnosis, and cognitive behavioral therapy. [35][36][37] Chronic pain and central sensitization in SCD Chronic pain occurs in a significant proportion of patients with SCD and increases with age. 19,38 If pain lasts for .3 ...
Patients with sickle cell disease (SCD) suffer from intense pain that can start during infancy and increase in severity throughout life, leading to hospitalization and poor quality of life. A unique feature of SCD is vasoocclusive crises (VOC) characterized by episodic, recurrent and unpredictable episodes of acute pain. Microvascular obstruction during VOC leads to impaired oxygen supply to the periphery and ischemia reperfusion injury, inflammation, oxidative stress and endothelial dysfunction, all of which may perpetuate a noxious microenvironment leading to pain. In addition to episodic acute pain, patients with SCD also report chronic pain. Current treatment of moderate to severe pain in SCD is mostly reliant upon opioids; however, long-term use of opioids is associated with multiple side effects. This review presents up-to-date developments in our understanding of the pathobiology of pain in SCD. To help focus future research efforts, major gaps in knowledge are identified regarding how sickle pathobiology evokes pain, pathways specific to chronic and acute sickle pain, perception-based targets of 'top-down' mechanisms originating from the brain and neuromodulation, and how pain affects the sickle microenvironment and pathophysiology. This review also describes mechanism-based targets that may help develop novel therapeutic and/or preventive strategies to ameliorate pain in SCD.
Introducción: La Fatiga Relacionada al Cáncer (FRC) es identificada por los pacientes como uno de los síntomas más angustiantes y persistentes de agotamiento físico, emocional y/o cognitivo, relacionado al cáncer y/o su tratamiento, impactando negativamente en las actividades de la vida diaria de Niños, Niñas y Adolescentes (NNA) como también Sobrevivientes de Cáncer Infantil (SCI). Aún existe escasa evidencia asociada al tratamiento e intervención oportuna. El objetivo de este estudio es informar acerca de la actual evidencia en relación con la FRC, su prevalencia y el impacto de la rehabilitación física y cognitiva en NNA y SCI. Material o Pacientes y Métodos: Revisión sistemática confeccionada en base a la declaración “Preferred Reporting Items for Systematic Review and Meta-Analyses” (PRISMA), durante un período de un año, en las siguientes bases de datos científicas: EBSCO, Pubmed, Scielo y LILACS. Resultados: Se analizaron de forma descriptiva un total de 48 artículos en esta revisión, siendo divididos entre prevalencia (58,3%) e intervención (41,7%). Los resultados del primero no fueron concluyentes. En cuanto a las intervenciones físicas y cognitivas, el total de los estudios analizados presentaron evidencia respecto de ellas, estos tuvieron impacto significativo en la reducción de la FRC y calidad de vida. Conclusión: Se requiere estandarizar el uso de escalas para la medición de la FRC, además de educar en su uso al personal sanitario como a los pacientes y sus familias, junto con aumentar el financiamiento para la rehabilitación e investigación en el área dentro de la población de NNA y SCI.
Background
Reporting of yoga research often lacks the detail required for clinical application, study replication, summary research and comparative effectiveness studies.
Methods
To improve the transparency of reporting yoga interventions, and building on the development of previous reporting guidelines, a group of international yoga research stakeholders developed the consensus-based CheckList stAndardising the Reporting of Interventions For Yoga (CLARIFY) guidelines.
Results
The 21-item CLARIFY checklist outlines the minimum details considered necessary for high-quality reporting of yoga research. This paper provides a detailed explanation of each of the 21 items of the CLARIFY checklist, together with model examples of how to integrate each item into publications of yoga research. The CLARIFY guideline serves as an extension for existing research reporting guidelines, and is flexible for use across all study designs.
Conclusion
We strongly encourage the uptake of these reporting guidelines by researchers and journals, to facilitate improvements in the transparency and utility of yoga research.
Objective:
This scoping review will aim to identify the domains contributing to cancer-related fatigue in childhood cancer survivors and will explore whether non-pharmacological interventions have addressed these domains. This information will help to better define cancer-related fatigue, identify knowledge gaps in the literature, and direct future research efforts.
Introduction:
Cancer-related fatigue is a commonly reported symptom in aftercare following childhood cancer treatments. However, its operational definition and contributors are unclear, which makes it difficult to select targets and design adequate interventions. In this scoping review, we will identify contributing domains to help clarify their role as key characteristics of cancer-related fatigue. We will then review the evidence as to whether these contributing domains have been addressed by non-pharmacological interventions aiming at fatigue.
Inclusion criteria:
We will include articles on cancer-related fatigue following childhood cancer treatments (age at diagnosis ≤21 years) and non-pharmacological interventions aiming to reduce fatigue. We will retain qualitative and quantitative studies written in English or French.
Methods:
In accordance with the JBI methodological framework for conducting scoping reviews, we will perform a search in PubMed, PsycINFO, CINAHL, Embase, Cochrane Library, Grey Matters, OAlster, and OpenGrey. We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. The data collection and analysis of eligible articles will be performed by two independent reviewers and will be classified in summary tables. The findings on contributors will be synthesized in a cross table linking contributor domains with intervention type.
Objectives
We aimed to identify contributors to cancer-related fatigue (CRF), explore non-pharmacological interventions addressing CRF, and highlight which contributors were targeted by these interventions in childhood cancer survivors.
Methods
We performed a search in various databases and used the PRISMA-ScR checklist. Findings were synthesized in various different tables and figures in accordance with our objectives.
Results
We included 49 articles in this systematic scoping review. We identified 59 significant contributors. Depression and physical activity level were some of the most studied significant contributors. Ten interventional studies were identified (e.g., yoga, physical activity intervention) that addressed 6 contributors (e.g., physical activity level).
Discussion
This review is the first to describe and relate contributors and non-pharmacological interventions targeting CRF in childhood cancer survivors. Important clinical implications could be derived from the variety of factors explaining CRF and how it is currently addressed.
Aim
To examine the association between symptoms severity and treatment burden in people living with HIV.
Design
Correlational, secondary analysis of data from participants diagnosed with HIV enrolled in a descriptive, cross‐sectional study examining physical activity patterns.
Methods
We analysed data from 103 men and women using self‐report data collected between March 2016 ‐ February 2017. Our primary statistical analyses consisted of explanatory multivariate modelling with individual PROMIS‐29 scores representing symptom severity and treatment burden measured using the Treatment Burden Questionnaire‐13.
Results
Greater symptom severity was associated with higher levels of cumulative treatment burden as well as higher levels of task‐specific medication and physical activity burden. Multivariate regression analyses revealed that fatigue was a risk factor of cumulative treatment burden as well as task‐specific medication and physical activity treatment burden. Effect sizes of multivariate models ranged from small (0.11) to medium (0.16). Additionally, post hoc analyses showed strong correlations between fatigue and other measured symptoms.
Conclusion
Findings support extant treatment burden literature, including the importance of addressing symptom severity in conjunction with treatment burden screening in the clinical setting. Results also suggest clinical interventions focused on the reduction of fatigue could reduce treatment burden in people living with HIV. Strong correlations between fatigue and other symptoms indicate the potential for reducing fatigue by addressing other highly clustered symptoms, such as depression.
Impact
People living with HIV exhibiting higher levels of fatigue are at high risk for treatment burden and poorer self‐management adherence. Clinicians should consider incorporating symptom and treatment burden assessments when developing, tailoring and modifying interventions to improve self‐management of HIV and other co‐morbid conditions.
Background
The practice of yoga has been shown to improve disease- and treatment-related side effects in the noncurative cancer patient.
Objective
This user experience study aimed to examine the feasibility and usefulness of a DVD-based yoga program for young adult cancer patients with a noncurative diagnosis.
Methods
Participants were asked to partake in a 7-week DVD-based yoga program and complete measures of program use and usefulness.
Results
Nine patients expressed study interest and 5 consented to participate. Four completed the full study protocol. Participants reported being satisfied with the program and described that it provided an opportunity for self-care. Improvements in functional, physical, and spiritual well-being and overall quality of life were found. Barriers included competing time demands and feeling unwell. No adverse events were reported.
Conclusion
The program was viewed as an accessible and useful activity option; however, a desire for greater social support from relatable others was highlighted.
This study was designed to determine whether yoga might alleviate symptoms of pain, sleep disturbance, anxiety, and depression in children with cystic fibrosis (CF). CF is the most common genetic, life-limiting chronic disease among Caucasian populations. It primarily affects the lungs but also many other secretory organs and consequently leads to significant morbidities. Research has shown that children with CF have significantly increased depression, anxiety, and pain compared to their healthy counterparts. Subjects participated in six one-on-one sessions over a 10-week period with a certified instructor who designed each yoga practice based on a preestablished list of 30 yoga asanas. Questionnaires evaluating pain, sleep disturbance, sustained anxiety, immediate anxiety, and depression were administered. Differences between premeasures and postmeasures were evaluated using a two-sided test. Twenty subjects were assessed (12 females/8 males), median age of 11 (7–20) years. Mean immediate anxiety scores decreased (before session to after session 29 to 23.6, respectively, p<0.001 ). Joint pain improved (3.25 to 3.65, p=0.028 ). CFQ-R emotion subscale improved from 79.2 to 85 ( p=0.073 ), and the respiratory subscale improved from 66.7 to 79.2 ( p=0.076 ). Other results were less notable. We conclude that yoga may reduce immediate anxiety and joint pain in patients with CF.
Researchers occasionally have to work with an extremely small sample size, defined herein as N = 5. Some methodologists have cautioned against using the t-test when the sample size is extremely small, whereas others have suggested that using the t-test is feasible in such a case. The present simulation study estimated the Type I error rate and statistical power of the one- and two-sample ttests for normally distributed populations and for various distortions such as unequal sample sizes, unequal variances, the combination of unequal sample sizes and unequal variances, and a lognormal population distribution. Ns per group were varied between 2 and 5. Results show that the t-test provides Type I error rates close to the 5% nominal value in most of the cases, and that acceptable power (i.e., 80%) is reached only if the effect size is very large. This study also investigated the behavior of the Welch test and a rank-transformation prior to conducting the t-test (t-testR). Compared to the regular t-test, the Welch test tends to reduce statistical power and the t-testR yields false positive rates that deviate from 5%. This study further shows that a paired t-test is feasible with extremely small Ns if the within-pair correlation is high. It is concluded that there are no principal objections to using a t-test with Ns as small as 2. A final cautionary note is made on the credibility of research findings when sample sizes are small.
Purpose: Despite the recognition of fatigue as a common and distressing symptom during cancer treatment, there are few evidence-based interventions available to manage such fatigue. The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue, physical functioning, emotional distress, and quality of life (QOL) during breast cancer treatment.
Description of study: Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design. Subjects were randomly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer. Symptoms, physical functioning, and QOL were measured at baseline, midtreatment, and at the end of treatment.
Results: Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment.
Clinical implications: A home-based walking exercise program is a potentially effective, low-cost, and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer. This health-promoting self-care activity needs further testing in large randomized clinical trials.
To estimate the number of individuals in the United States diagnosed with cancer as children (ages 0-19 years) as of 2005, with a focus on those surviving for >30 years.
To estimate the national prevalence of survivors of childhood cancers, we used data from the Surveillance Epidemiology and End Results program from 1975 to 2004. Long-term childhood cancer survivors, diagnosed before 1975, were estimated using incidence and survival models extrapolated into years before 1975.
We estimated that there are a total of 328,652 survivors of childhood cancer in the United States as of January 1, 2005, of these, 24% have survived >30 years since diagnosis. The cancer sites with the largest number of survivors are brain (51,650), acute lymphoblastic leukemia (49,271), germ cell tumors (34,169), and Hodgkin lymphoma (31,598). Sites with higher proportions of survivors diagnosed >30 years ago are germ cell (43%), soft tissue (38%), renal (34%), and bone (26%). Historical trends from Connecticut data show major improvements in survival for all of the childhood cancer sites.
The number of survivors of childhood cancers is expected to increase in the future consequent to the lifesaving advances in treatment introduced after 1970, especially for acute lymphoblastic leukemia. Because this population is at increased risk for illness-related morbidity and mortality, appreciating the number of survivors who were treated as children is important both to determining the national cancer burden and planning for the future health care needs of these individuals.
Although fatigue is one of the most common and debilitating symptoms experienced by cancer patients, it has received little systematic attention. This situation is due in large part to the lack of adequate instruments to measure fatigue. The primary aim of this study was to validate a newly developed measure of fatigue for use with cancer patients: the Fatigue Symptom Inventory (FSI). This 13 item self-report measure was designed to measure the intensity and duration of fatigue and its impact on quality of life. The psychometric properties of the FSI were assessed in women undergoing treatment for breast cancer, women who had completed treatment for breast cancer and women with no history of cancer. A seven-item interference subscale was found to have good internal consistency, with alpha coefficients above 0.90 in all three groups. The complete FSI was found to have rather weak to moderate test-retest reliability among patients in active treatment and healthy comparison subjects assessed on three separate occasions. Convergent validity was demonstrated using comparisons with existing measures of fatigue. Construct validity was demonstrated using comparisons between and within groups as well as comparisons with measures of anxiety and depression. Overall, the FSI was established as a valid and reliable measure of fatigue in cancer patients and healthy individuals. Suggestions are made for the potential application of the measure in clinical research.
Fatigue is the most prevalent cancer-related symptom and has a significant adverse impact on patients' functional ability and quality of life. Hypotheses regarding the aetiology of cancer-related fatigue are discussed, and clinical practice guidelines for the evaluation and management of oncology patients with fatigue are reviewed. Both nonpharmacologic and pharmacologic strategies for the management of fatigue are summarised.
Yoga has been practiced for thousands of years to improve physical and emotional well-being. Empirical research on yoga has been ongoing for several decades, including several recent studies conducted with cancer patients and survivors.
This review provides a general introduction to yoga and a detailed review of yoga research in cancer.
Nine studies conducted with cancer patients and survivors yielded modest improvements in sleep quality, mood, stress, cancer-related distress, cancer-related symptoms, and overall quality of life. Studies conducted in other patient populations and healthy individuals have shown beneficial effects on psychological and somatic symptoms, as well as other aspects of physical function.
Results from the emerging literature on yoga and cancer provide preliminary support for the feasibility and efficacy of yoga interventions for cancer patients, although controlled trials are lacking. Further research is required to determine the reliability of these effects and to identify their underlying mechanisms.
Fatigue is one of the most common and debilitating symptoms experienced by patients with cancer. Cancer-related fatigue (CRF) is characterized by feelings of tiredness, weakness, and lack of energy, and is distinct from the “normal” drowsiness experienced by healthy individuals in that it is not relieved by rest or sleep. It occurs both as a consequence of the cancer itself and as a side effect of cancer treatment, although the precise underlying pathophysiology is largely unknown. CRF may be an early symptom of malignant disease and is reported by as many as 40% of patients at diagnosis. Virtually all patients expect fatigue from cancer therapy. Up to 90% of patients treated with radiation and up to 80% of those treated with chemotherapy experience fatigue. CRF continues for months and even years ollowing completion of treatment in approximately one third of the patients with cancer. The impact of CRF on a patient's quality of life (QoL), particularly in relation to physical functioning and the ability to perform activities of daily living, is both profound and pervasive. In addition, CRF is associated with considerable psychological distress and can impose a significant financial burden by limiting a patient's ability to work. These effects can extend to caregivers and family members, who may also have to reduce their working capacity in order to provide additional care for a patient with CRF. This paper examines the prevalence of CRF and explores the impact of this distressing symptom on patients' functioning and QoL.
Disclosure of potential conflicts of interest is found at the end of this article.
Purpose:
To describe the occurrence of fatigue in a large sample of breast cancer survivors relative to general population norms and to identify demographic, medical, and psychosocial characteristics of fatigued survivors.
Patients and methods:
Breast cancer survivors in two large metropolitan areas completed standardized questionnaires as part of a survey study, including the RAND 36-item Health Survey, Center for Epidemiological Studies-Depression Scale, Breast Cancer Prevention Trial Symptom Checklist, Medical Outcomes Study Sleep Scale, and demographic and treatment-related measures.
Results:
On average, the level of fatigue reported by the breast cancer survivors surveyed (N = 1,957) was comparable to that of age-matched women in the general population, although the breast cancer survivors were somewhat more fatigued than a more demographically similar reference group. Approximately one third of the breast cancer survivors assessed reported more severe fatigue, which was associated with significantly higher levels of depression, pain, and sleep disturbance. In addition, fatigued women were more bothered by menopausal symptoms and were somewhat more likely to have received chemotherapy (with or without radiation therapy) than nonfatigued women. In multivariate analyses, depression and pain emerged as the strongest predictors of fatigue.
Conclusion:
Although the majority of breast cancer survivors in this large and diverse sample did not experience heightened levels of fatigue relative to women in the general population, there was a subgroup of survivors who did report more severe and persistent fatigue. We identified characteristics of these women that may be helpful in elucidating the mechanisms underlying fatigue in this population, as well as directing intervention efforts.
Purpose:
Young adult cancer survivors have a number of increased health and psychosocial risks. To minimize these risks, they must address any modifiable risk factors, for example increase their physical activity (PA) and reduce stress. Unfortunately, more than half of young survivors remain sedentary, and few participate in a structured form of relaxation. This study evaluated the feasibility, acceptability, and effects of a theory-based PA and meditation intervention for young survivors.
Methods:
Young adult cancer survivors (age 18-39 years) were randomized to receive the 12-week "RElaxation aNd Exercise for Wellness" (RENEW) intervention right away (intervention group) or after a 12-week wait (control group). Participants were assessed at baseline, 12 weeks, and 24 weeks.
Results:
Thirty-five survivors were enrolled and randomized. Results indicate that 89% of intervention calls were delivered, and most participants felt that intervention goals and the number and duration of intervention calls were appropriate. Satisfaction ratings indicate that the intervention was acceptable, and 100% of participants would recommend it to others. Comparison of the intervention and control groups at the 12-week assessment (i.e., before controls received the intervention) revealed that the intervention group was performing more minutes of at least moderate intensity PA/week (p = 0.002; M = 113.8, SE = 23.5 vs. M = -8.7, SE = 27.1) and outperformed controls on a test of cardiovascular fitness (p = 0.008; M = -1.76, SE = 0.41 vs. M = -0.03, SE = 0.45). When data from the intervention and control groups were pooled, pre- to post-intervention analyses indicated a trend toward improved mood.
Conclusion:
This theory-based intervention for young adult cancer survivors was feasible and acceptable, and may have helped survivors increase PA, improve fitness, and enhance mood.
PURPOSE: Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy. The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver.
PATIENTS AND METHODS: Four hundred eleven patients about to start chemotherapy were randomly assigned to receive usual psychosocial care only, a professionally administered form of stress management training, or a patient self-administered form of stress management training. Quality-of-life assessments were conducted before randomization and before the second, third, and fourth treatment cycles. Intervention costs were estimated from both payer and societal perspectives.
RESULTS: Compared with patients who received usual care only, patients receiving the self-administered intervention reported significantly (P ≤ .05) better physical functioning, greater vitality, fewer role limitations because of emotional problems, and better mental health. In contrast, patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only. Costs of the self-administered intervention were estimated to be 66% (from a payer perspective) to 68% (from a societal perspective) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy.
CONCLUSION: Evidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment.
Objectives:
Irritable bowel syndrome (IBS) is a chronic, disabling condition that greatly compromises patient functioning. The aim of this study was to assess the impact of a 6-week twice per week Iyengar yoga (IY) program on IBS symptoms in adolescents and young adults (YA) with IBS compared with a usual-care waitlist control group.
Methods:
Assessments of symptoms, global improvement, pain, health-related quality of life, psychological distress, functional disability, fatigue, and sleep were collected pre- and posttreatment. Weekly ratings of pain, IBS symptoms, and global improvement were also recorded until 2-month follow-up. A total of 51 participants completed the intervention (yoga = 29; usual-care waitlist = 22).
Results:
Baseline attrition was 24%. On average, the yoga group attended 75% of classes. Analyses were divided by age group. Relative to controls, adolescents (14-17 years) assigned to yoga reported significantly improved physical functioning, whereas YA (18-26 years) assigned to yoga reported significantly improved IBS symptoms, global improvement, disability, psychological distress, sleep quality, and fatigue. Although abdominal pain intensity was statistically unchanged, 44% of adolescents and 46% of YA reported a minimally clinically significant reduction in pain following yoga, and one-third of YA reported clinically significant levels of global symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects for adolescents revealed global improvement immediately post-yoga that was not maintained at follow-up. For YA, global improvement, worst pain, constipation, and nausea were significantly improved postyoga, but only global improvement, worst pain, and nausea maintained at the 2-month follow-up.
Conclusions:
The findings suggest that a brief IY intervention is a feasible and safe adjunctive treatment for young people with IBS, leading to benefits in a number of IBS-specific and general functioning domains for YA. The age-specific results suggest that yoga interventions may be most fruitful when developmentally tailored.
Thank you for your interest in:
Ware, JE, Jr., Kosinski, M, Bjorner, JB, et al., User’s manual for the SF-36v2® Health Survey (2nd ed.). Lincoln, RI: QualityMetric Incorporated, 2007.
This 309-page manual is available at and for loan from many university research libraries. Because it is the most requested book; Boston University research library has multiple copies for library loan.
Good luck with your research,
John E. Ware, Jr., PhD
This study explored the use of Yoga by using a cross-sectional analysis of 286 young adult cancer survivors. The aim was to explore yoga practice, reasons for using this therapy; predictors of yoga use and any potential relationship between yoga use and well-being. Ninety one participants (32.82%) reported practicing yoga from their initial diagnosis. Practitioners reported a relatively high intensity (mean: 7.46 h/month) and length (25.88 months) of practice. The most common reasons given for undertaking yoga were to maintain flexibility and promote relaxation. Sociodemographic predictors of yoga use included gender, higher education with increased yoga use generally related to enhanced feelings of well-being. Results suggest that yoga use is more commonly used by cancer survivors with greater resources. Understanding more about the use of yoga by cancer survivors may facilitate the development and promotion of yoga-based interventions.
Objective:
Rheumatoid arthritis (RA) is a chronic, disabling disease that can greatly compromise health-related quality of life (HRQoL). The aim of this study was to assess the impact of a 6-week twice/week Iyengar yoga program on HRQoL of young adults with RA compared with a usual-care waitlist control group.
Methods:
The program was designed to improve the primary outcome of HRQoL including pain and disability and psychological functioning in patients. Assessments were collected pretreatment, posttreatment, and at 2 months after treatment. Weekly ratings of anxiety, depression, pain, and sleep were also recorded. A total of 26 participants completed the intervention (yoga=11; usual-care waitlist=15). All participants were female (mean age=28 y).
Results:
Overall attrition was low at 15%. On average, women in the yoga group attended 96% of the yoga classes. No adverse events were reported. Relative to the usual-care waitlist, women assigned to the yoga program showed significantly greater improvement on standardized measures of HRQoL, pain disability, general health, mood, fatigue, acceptance of chronic pain, and self-efficacy regarding pain at posttreatment. Almost half of the yoga group reported clinically meaningful symptom improvement. Analysis of the uncontrolled effects and maintenance of treatment effects showed improvements in HRQoL general health, pain disability, and weekly ratings of pain, anxiety, and depression were maintained at follow-up.
Conclusions:
The findings suggest that a brief Iyengar yoga intervention is a feasible and safe adjunctive treatment for young people with RA, leading to HRQoL, pain disability, fatigue, and mood benefits. Moreover, improvements in quality of life, pain disability, and mood persisted at the 2-month follow-up.
Cancer-related fatigue afflicts up to 33% of breast cancer survivors, yet there are no empirically validated treatments for this symptom.
The authors conducted a 2-group randomized controlled trial to determine the feasibility and efficacy of an Iyengar yoga intervention for breast cancer survivors with persistent post-treatment fatigue. Participants were breast cancer survivors who had completed cancer treatments (other than endocrine therapy) at least 6 months before enrollment, reported significant cancer-related fatigue, and had no other medical conditions that would account for fatigue symptoms or interfere with yoga practice. Block randomization was used to assign participants to a 12-week, Iyengar-based yoga intervention or to 12 weeks of health education (control). The primary outcome was change in fatigue measured at baseline, immediately post-treatment, and 3 months after treatment completion. Additional outcomes included changes in vigor, depressive symptoms, sleep, perceived stress, and physical performance. Intent-to-treat analyses were conducted with all randomized participants using linear mixed models.
Thirty-one women were randomly assigned to yoga (n = 16) or health education (n = 15). Fatigue severity declined significantly from baseline to post-treatment and over a 3-month follow-up in the yoga group relative to controls (P = .032). In addition, the yoga group had significant increases in vigor relative to controls (P = .011). Both groups had positive changes in depressive symptoms and perceived stress (P < .05). No significant changes in sleep or physical performance were observed.
A targeted yoga intervention led to significant improvements in fatigue and vigor among breast cancer survivors with persistent fatigue symptoms.
Despite the prevalence of sleep complaints among psychiatric patients, few questionnaires have been specifically designed to measure sleep quality in clinical populations. The Pittsburgh Sleep Quality Index (PSQI) is a self-rated questionnaire which assesses sleep quality and disturbances over a 1-month time interval. Nineteen individual items generate seven "component" scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of scores for these seven components yields one global score. Clinical and clinimetric properties of the PSQI were assessed over an 18-month period with "good" sleepers (healthy subjects, n = 52) and "poor" sleepers (depressed patients, n = 54; sleep-disorder patients, n = 62). Acceptable measures of internal homogeneity, consistency (test-retest reliability), and validity were obtained. A global PSQI score greater than 5 yielded a diagnostic sensitivity of 89.6% and specificity of 86.5% (kappa = 0.75, p less than 0.001) in distinguishing good and poor sleepers. The clinimetric and clinical properties of the PSQI suggest its utility both in psychiatric clinical practice and research activities.
The effects of weekly supportive group meetings for women with metastatic carcinoma of the breast were systematically evaluated in a one-year, randomized, prospective outcome study. The groups focused on the problems of terminal illness, including improving relationships with family, friends, and physicians and living as fully as possible in the face of death. We hypothesized that this invention would lead to improved mood, coping strategies, and self-esteem among those in the treatment group. Eighty-six patients were tested at four-month intervals. The treatment group had significantly lower mood-disturbance scores on the Profile of Mood States scale, had fewer maladaptive coping responses, and were less phobic than the control group. This study provides objective evidence that a supportive group intervention for patients with metastatic cancer results in psychological benefit. Mechanisms underlying the effectiveness of this group intervention are explored.
This paper reports the development and validation of a questionnaire assessing fatigue and anemia-related concerns in people with cancer. Using the 28-item Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire as a base, 20 additional questions related to the symptoms and concerns of patients with anemia were developed. Thirteen of these 20 questions dealt with fatigue, while the remaining 7 covered other concerns related to anemia. Using semi-structured interviews with 14 anemic oncology patients and 5 oncology experts, two instruments were produced: The FACT-Fatigue (FACT-F), consisting of the FACT-G plus 13 fatigue items, and the FACT-Anemia (FACT-An), consisting of the FACT-F plus 7 nonfatigue items. These measures were, in turn, tested on a second sample of 50 cancer patients with hemoglobin levels ranging from 7 to 15.9 g/dL. The 41-item FACT-F and the 48 item FACT-An scores were found to be stable (test-retest r = 0.87 for both) and internally consistent (coefficient alpha range = 0.95-0.96). The symptom-specific subscales also showed good stability (test-retest r range = 0.84-0.90), and the Fatigue subscale showed strong internal consistency (coefficient alpha range = 0.93-0.95). Internal consistency of the miscellaneous nonfatigue items was lower but acceptable (alpha range = 0.59-0.70), particularly in light of their strong relationship to patient-rated performance status and hemoglobin level. Convergent and discriminant validity testing revealed a significant positive relationship with other known measures of fatigue, a significant negative relationship with vigor, and a predicted lack of relationship with social desirability. The total scores of both scales differentiated patients by hemoglobin level (p < 0.05) and patient-rated performance status (p < 0.0001). The 13-item Fatigue subscale of the FACT-F and the 7 nonfatigue items of the FACT-An also differentiated patients by hemoglobin level (p < 0.05) and patient-rated performance status (p < or = 0.001). The FACT-F and FACT-An are useful measures of quality of life in cancer treatment, adding more focus to the problems of fatigue and anemia. The Fatigue Subscale may also stand alone as a very brief, but reliable and valid measure of fatigue.
Although fatigue is the most common symptom reported by cancer patients and has serious adverse effects on quality of life, it remains poorly understood. A survey was designed to characterize the epidemiology of cancer-related fatigue from the perspectives of the patient, primary caregiver, and oncologist. A telephone survey included 419 cancer patients recruited from 100,000 randomly selected households nationwide. Patients provided access to 200 primary caregivers (usually family members) who were also interviewed by telephone. In a separate mail survey, 197 of 600 randomly sampled oncologists (unrelated to the patients) responded to a questionnaire that assessed perceptions and attitudes concerning fatigue in cancer patients who had received chemotherapy or radiotherapy and their caregivers. The median patient age was 65 years, and the principal cancer diagnoses were breast (females) and genitourinary (males). Fifty-nine percent of the patients had received chemotherapy, 63% radiation therapy, and 24% both; 20% of patients received their last treatment within 6 weeks, 31% within 7 weeks to 1 year, and 49% more than 1 year ago. More than three quarters of patients (78%) experienced fatigue (defined as a general feeling of debilitating tiredness or loss of energy) during the course of their disease and treatment. Thirty-two percent experienced fatigue daily, and 32% reported fatigue significantly affected their daily routines. Caregivers reported observing fatigue in 86% of the index patients, and oncologists perceived that 76% of their patients experienced fatigue. Although oncologists believed that pain adversely affected their patients to a greater degree than fatigue (61% v 37%), patients felt that fatigue adversely affected their daily lives more than pain (61% v 19%). Most oncologists (80%) believed fatigue is overlooked or undertreated, and most patients (74%) considered fatigue a symptom to be endured. Fifty percent of patients did not discuss treatment options with their oncologists, and only 27% reported that their oncologists recommended any treatment for fatigue. When used, treatments for fatigue were generally perceived by patients and caregivers to be successful. These data confirm the high prevalence and adverse impact of cancer-related fatigue, although it is seldom discussed and infrequently treated. For patients and oncologists, improving the quality of life of cancer patients requires a heightened awareness of fatigue, a better understanding of its impact, and improve communication and familiarity with interventions that can reduce its debilitating effects.
The purpose of this study was to develop and validate a multidimensional measure of fatigue for use with cancer patients.
Items for the Multidimensional Fatigue Symptom Inventory (MFSI) were generated through literature review, discussion with healthcare providers, and a survey of currently available measures of fatigue. The 83-item MFSI was designed to assess global, somatic, affective, cognitive, and behavioral symptoms of fatigue. The instrument was administered on three occasions to 275 women who had received or were undergoing treatment for breast cancer and 70 women with no history of cancer. Reliability, validity, and factorial structure of the MFSI were analyzed.
The factor analysis produced five empirically derived scales that correspond generally to the five rationally derived scales. Reliability of the rationally and empirically derived scales was excellent (alpha coefficients .87 to .96). Estimates of test-retest reliability were also favorable. Other results support the validity of both the rationally and empirically derived scales. The MFSI appears to be sensitive to fatigue, accurately discriminating cancer patients from control subjects and between patients with varying levels of performance status.
The MFSI may be useful in identifying patterns of fatigue within individual patients and across treatment modalities. Such specificity may allow the clinician to develop, implement, and evaluate interventions that are targeted for differing patterns of fatigue. Because the measure is keyed to a 1-week time frame, it may be useful during the course of cancer treatment. The MFSI appears to be a valid and reliable tool to assess the full spectrum of symptoms that characterize the construct of fatigue.
Professionally administered psychosocial interventions have been shown to improve the quality of life of cancer patients undergoing chemotherapy. The present study sought to improve access to psychosocial interventions during chemotherapy treatment by evaluating the efficacy and costs of a patient self-administered form of stress management training that requires limited professional time or experience to deliver.
Four hundred eleven patients about to start chemotherapy were randomly assigned to receive usual psychosocial care only, a professionally administered form of stress management training, or a patient self-administered form of stress management training. Quality-of-life assessments were conducted before randomization and before the second, third, and fourth treatment cycles. Intervention costs were estimated from both payer and societal perspectives.
Compared with patients who received usual care only, patients receiving the self-administered intervention reported significantly (P < or = .05) better physical functioning, greater vitality, fewer role limitations because of emotional problems, and better mental health. In contrast, patients who received the professionally administered intervention fared no better in terms of quality of life than patients receiving usual care only. Costs of the self-administered intervention were estimated to be 66% (from a payer perspective) to 68% (from a societal perspective) less than the average costs of professionally administered psychosocial interventions for patients starting chemotherapy.
Evidence regarding the efficacy and favorable costs of self-administered stress management training suggests that this intervention has the potential to greatly improve patient access to psychosocial intervention during chemotherapy treatment.
To examine predictors of adherence in a randomized controlled trial of resistance exercise training (RET) in prostate cancer survivors receiving androgen deprivation therapy.
A randomized controlled trial conducted at fitness centers in Ottawa and Edmonton, Canada. Prostate cancer survivors (n=155) completed measures of social cognitive variables, quality of life (QOL), behavior, and fitness before being randomized to either an exercise (n=82) or control (n=73) group. The exercise group was asked to perform supervised RET three times per week for 12 weeks.
The exercise group attended 28.2 of the 36 (78.3%) RET sessions. Univariate analyses revealed eight different significant (Ps <.05) predictors of exercise adherence including exercise stage of change, intention, age, QOL, fatigue, subjective norm, leg-press test, and perceived behavioral control. A multivariate analysis indicated that there were three independent predictors of adherence that explained 20.4% of the variance: exercise stage of change (beta=0.26; P=.013), age (beta=-0.22; P=.037), and intention (beta=0.19; P=.073).
Exercise adherence in the trial was very good but not optimal. Adherence was predicted by variables from many different categories including social cognitive, QOL, behavioral, fitness, and demographic. These findings may have important implications for maximizing adherence during clinical trials of exercise in prostate cancer survivors.
Despite the high prevalence of cancer-related fatigue and its documented negative effects on patients' quality of life, limited evidence is available to support interventions to prevent or treat cancer-related fatigue. Both pharmacologic and nonpharmacologic interventions have been tested, with aerobic exercise programs and anemia correction by erythropoietin demonstrating greatest effectiveness. This article reviews the available evidence and describes gaps in knowledge. Recommendations for future research on interventions for cancer-related fatigue are presented.
Increased recognition of the problem of fatigue in cancer patients can be attributed, in part, to the development of measures that have provided researchers with the tools necessary for quantifying and characterizing fatigue and exploring its etiology and treatment. Although a consensus regarding the definition of fatigue is lacking, there is general agreement that it is a subjective and multidimensional phenomenon whose assessment requires the use of self-report methods. Consistent with this view, several multidimensional measures of fatigue have been developed and validated for use with cancer patients. These measures differ considerably in their format and content and, as with the definition of fatigue, there is no consensus at the present time regarding the dimensional structure of fatigue. In addition to measuring fatigue on a continuum along one or more dimensions, it may also be possible to assess a clinical syndrome of cancer-related fatigue. Criteria for assessing fatigue in this manner have been proposed and are currently undergoing evaluation. Despite the progress that has been made, there are several important unresolved issues in the assessment of fatigue in cancer patients. These include how to distinguish fatigue from depression, how to use self-reports of fatigue in clinical decision-making, how to capture temporal changes in fatigue, and how best to address the continuing lack of consensus regarding the conceptualization and measurement of fatigue.
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