Learn about our remote access options, Department of Medical Sciences, “Regina Apostolorum” Hospital, Albano Laziale, Italy, Medical Direction, Janssen‐Cilag, Cologno Monzese, Italy, Department of Medical Oncology, Istituti Fisioterapici Ospedalieri (I.F.O. Fatigue, depression and quality of life in cancer patients: how are they related? No significant differences were found between patients with a time since completion of treatment shorter than 6.7 months and patients with a longer time in any domain of fatigue before and after the program. Types of fatigue may be physical, mental, or emotional. Bisphosphonate Treatment Ameliorates Chemotherapy-Induced Bone and Muscle Abnormalities in Young Mice. Thus, a practical approach involves the use of the following three simple questions:93 1) Do you feel or have you ever felt unusually tired? VIFs ranged from 1.0–1.01. Brown J C et al. I am able to carry out normal activities, ↑ Walking ability in exercises; ↓ psychosocial distress vs. controls; less fatigue in exercisers, ↑ Walking ability in exercisers; ↓ fatigue and other symptoms vs. controls, ↓ Fatigue and psych distress in exercisers, ↑ Pretest to posttest walking ability; ↑ QOL and less fatigue in active exercisers vs. noncompliers, ↓ Fatigue at all levels; ↑ functional ability, ↓ Fatigue and psych distress in exercisers; ↑ functional ability and QOL in exercisers, Patient's choice plus methylphenidate 20 mg/day, ↓ Fatigue and cognitive dysfunction; ↑ functional ability. An ES <0.20 indicates “no change,” an ES ≥ 0.20 but <0.50 indicates “a small change,” an ES ≥ 0.50 but <0.80 indicates “a moderate change,” and an ES ≥ 0.80 indicates “a considerable change.”. Patients who are refractory to such management can be considered for an empiric trial of corticosteroids, although established criteria for the use of these drugs are not currently available. ), then this should be treated first. The exercise program consisted of 15 sessions of 1.5 hours each and was supervised by a physical therapist. Appropriate management of these conditions can help significantly to reduce the level of fatigue. In cases of dichotomous variables, differences were assessed by independent t‐tests. Cancer 2003. Breast cancer is the most common cancer in women worldwide. The first validated multidimensional scale was the Piper Fatigue Self‐Report Scale (PFS).97 The PFS was developed initially for patients undergoing radiotherapy but was then applied to cancer patients undergoing other types of treatment. Every dimension contains four items and answers are given on a 5‐point Likert‐type scale. Seventy‐two patients entered the program. Thus, a decrease in reduced motivation was associated with better physical functioning. The data available differ considerably because, until recently, fatigue rarely was reported in the list of therapy toxicities, there was not a standard definition of fatigue, and appropriate instruments for its evaluation were not available. These analyses allow the examination of associations between change in fatigue and change in physical or psychological variables. Number of times cited according to CrossRef: Dépression et anxiété chez des patients tunisiens atteints de cancers colorectaux : spécificités et ampleur. Number of times cited according to CrossRef: Interventions for cancer‐related fatigue: a scoping review. The use of a comprehensive fatigue scale, such as the Cancer Related Fatigue Scale (Holley, 2000), to help patients describe and rate their symptoms may be a beneficial way of addressing the problem. CRF often begins before cancer is diagnosed, worsens during the course of treatment and may persist for months—even years—after treatment ends. Viele übersetzte Beispielsätze mit "cancer related fatigue" – Deutsch-Englisch Wörterbuch und Suchmaschine für Millionen von Deutsch-Übersetzungen. Fatigue and health related quality of life in children and adolescents with cancer. The aim of this program was to reduce the uncertainty resulting from a lack of knowledge of the disease by providing information with respect to cancer‐related subjects. Cancer-related fatigue is a subjective symptom of fatigue that is experienced by nearly all cancer patients. Fatigue is one of the most frequently reported complaints in cancer patients and survivors. Cancer related fatigue affects the life of patients by preventing them from carrying out their day to day work. Fatigue can be difficult to assess because there are no objective measurements. Fatigue self‐management: a survey of Chinese cancer patients undergoing chemotherapy. Relief of fatigue by exercise has been studied in patients undergoing a variety of treatments, including high‐dose chemotherapy and autologous stem cell transplantation, adjuvant chemotherapy, radiation therapy, and IFN‐α (Table 4). In addition, baseline results revealed that mental fatigue was not determined by psychological variables but by physical symptom distress only, indicating that patients with a high level of physical symptom distress experienced more mental fatigue. Obviously, the specific programs of physical exercise must be preceded by a thorough evaluation of concomitant diseases and contraindications to such a program. Over several sessions, expressive–supportive techniques, breathing exercises, relaxation exercises, and exercises from Rational‐Emotive Therapy were used to provide patients with stress‐management techniques. Then, activities and related periods of rest can be planned. Die Vielzahl von Fragebögen und Tests zur Einschätzung der Fatigue und verschiedenste Therapieansätze komplizieren die Auswahl der nicht-medikamentösen Behandlungsart. The responses in patients with severe fatigue were −2.4 (±2.9) in the placebo group and −3.4 (±2.5) in the methylphenidate group; the difference was not statistically significant (p=0.3). Change in physical symptom distress entered in the second step accounted for a significant increment of 6%. Although the exact determinants of cancer‐related fatigue need more scientific research, its multifactorial nature seems to be generally acknowledged [22]. Carefully constructed surveys have shown that fatigue associated with cancer and chemotherapy not only is the most commonly reported symptom but has a profound effect on the patient's QOL, including physical, psychosocial, and economic/occupational aspects.1, 2 Despite the obvious relevance of the phenomenon, fatigue either was unrecognized or was overlooked until clinicians got better control over the more acute symptoms of nausea, emesis, and pain. The 15‐week program was offered at the Center for Rehabilitation of the University Medical Center Groningen in an outpatient setting. CRF ist eines der häufigsten und relevantesten Symptome und mitunter unbefriedigend behandelten Symptomenkomplexe bei Tumorpatienten 1. VIFs ranged from 1.0–1.99. Cancer-related fatigue is a symptom of cancer where most patients or the general practitioners tend to misinterpret due to the insufficient understanding or knowledge of cancer-related fatigue (CRF). Chronbach's α for the present study ranged from 0.84–0.85. [44] showed that ES reflects clinical relevance. The treatment received had been chemotherapy in 59% of patients, radiotherapy in 63% of patients, and both chemotherapy and radiotherapy in 24% of patients. First, univariate relationships between MFI dimensions on the one hand and demographic variables, disease‐ and treatment‐related variables, body composition, physiological variables, physical and psychological symptoms, and perceived functioning on the other hand were examined using Pearson's correlation analyses. A critical appraisal of these issues is presented in this review. Factors involved include the effects of anaesthesia, analgesia, and sedation, decreased ventilatory capacity, immobilization, infection, preoperative and postoperative starvation, altered sleep patterns, and anxiety.65 Fatigue after surgery, however, clearly may be compounded by fatigue experienced as a result of other treatment modalities. Some cancer patients perceive fatigue as a psychological alteration, whereas others perceive fatigue as the most distressing symptom because of its impairing consequences on their physical activity level [3]. Current Opinion in Supportive and Palliative Care. Research shows that most people experience fatigue after a cancer diagnosis. An estimated 60–96% of cancer patients in treatment experience fatigue, including 60–93% of patients on radiotherapy and 80–96% of patients on chemotherapy. The general outline of the algorithm has the following stages: screening, primary evaluation, interventions, and reevaluation. The aims of the study were to examine the effects of a multidimensional rehabilitation program on cancer‐related fatigue, to examine concurrent predictors of fatigue, and to investigate whether change in fatigue over time was associated with change in predictors. The results regarding the associations between change in fatigue and change in physical and psychological variables revealed that fatigue at baseline was the most powerful predictor. The management of fatigue with physical exercise is supported by convincing clinical evidence, but diet, sleep, and rest are all strategies used with a certain degree of success. Other specific pharmacologic interventions include antidepressants and hypnotics. There are even studies that suggest that there is no strong cause‐and‐effect relationship between fatigue and, for example, depression [23]. Total variance explained was 38.7% (Table 4). In the most recent version of its guidelines,81 the NCCN panel identified seven factors that often play a significant role in the fatigue experience: pain, emotional distress, sleep disturbance, anemia, nutrition, activity level, and other comorbidities. The two systems both are self‐reported (i.e., the patient completes the questions rather than an interviewer) and are similar conceptually. Because hypothyroidism is very common in the general population,82, 83 cancer patients with the symptom of fatigue should be evaluated for this condition. aRecommended screen: “Since your last visit, how would you rate your worst fatigue on a scale of 0–10?” bSee Education/counseling and management strategies based on clinical status: Active Treatment (FT‐5); Posttreatment Follow‐Up (FT‐61), End of Life (FT‐7). Results of a multi‐centre patient survey, Erythropoietin for anemia in cancer patients, Recombinant human erythropoietin for the correction of cancer associated anemia with and without concomitant cytotoxic chemotherapy, Erythropoietin reduces anemia and transfusions after chemotherapy with paclitaxel and carboplatin, Quality of life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: results from a prospective community oncology study, Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice, Clinical evaluation of once‐weekly dosing of epoetin alfa in chemotherapy patients: improvements in hemoglobin and quality of life are similar to three‐times‐weekly dosing, Relationship between changes in hemoglobin level and quality of life during chemotherapy in anemic cancer patients receiving epoetin alfa therapy, Effects of epoetin alfa on hematologic parameters and quality of life in cancer patients receiving nonplatinum chemotherapy: results of a randomized, double‐blind, placebo‐controlled trial, Epoetin alfa therapy increases hemoglobin levels and improves quality of life in patients with cancer‐related anemia who are not receiving chemotherapy and patients with anemia who are receiving chemotherapy, Randomized, double‐blind, placebo‐controlled, Phase I/II dose‐finding study of NESP administered once every three weeks in solid tumor patients, Novel erythropoiesis stimulating protein (NESP) for the treatment of anaemia of chronic disease associated with cancer, A dose‐finding and safety study of novel erythropoiesis stimulating protein (NESP) for the treatment of anaemia in patients receiving multicycle chemotherapy, Randomised, dose‐finding study of darbepoetin alfa in anaemic patients with lymphoproliferative malignancies, Double‐blind, placebo‐controlled, randomized Phase III trial of darbepoetin alfa in lung cancer patients receiving chemotherapy, A controlled trial of megestrol acetate on appetite, caloric intake, nutritional status, and other symptoms in patients with advanced cancer, Action of oral methylprednisolone in terminal cancer patients: a prospective randomized double‐blind study, A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy, Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer, Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy, Daily fatigue patterns and effect of exercise in women with breast cancer, Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy, Fatigue and quality of life outcomes of exercise during cancer treatment, Interferon‐induced fatigue in patients with melanoma: a pilot study of exercise and methylphenidate. However, the finding that change in fatigue was predominantly associated with change in physical parameters may suggest that a program consisting only of physical components might be effective enough. Journal of Traditional and Complementary Medicine. Most of these studies have been performed in women with breast cancer; thus, the validity of extending the findings to other cancer sites is dubious. It is often said to be the most common and distressing symptom reported by people living with cancer. The study by Demetri et al.111 also used the FACT, whereas Gabrilove et al.113 incorporated the FACT‐An scale. More recently, darbepoetin α was investigated in cancer patients receiving chemotherapy. With respect to age, we found that age was not associated with any domain of fatigue except a greater reduction in motivation. and means of managing cancer-related fatigue (CRF). Total variance explained was 53%. This feeling may range from tiredness to exhaustion and may not be relieved by rest or sleep. Setting: rehabilitation center. On average, cancer-related fatigue is "more severe, more distressing, and less likely to be relieved by rest" than fatigue … Cancer-related fatigue (CRF) is characterized by excessive and persistent exhaustion that interferes with daily activity and function. Perceived fatigue interference and depressed mood: comparison of chronic fatigue syndrome/myalgic encephalomyelitis patients with fatigued breast cancer survivors. The proportion of the variance of fatigue at baseline explained by the variables included in the regression models varied from 25.4%–54.6%. Highlights • Estimates are that more than 50 percent of people who have cancer experience cancer-related fatigue (CRF). Cancer‐related fatigue is attributed to a variety of disease‐related and treatment‐related factors such as the cancer itself, anemia [12, 14, 15], cytokines, nutritional and fluid imbalances, etc. Among patients receiving cancer treatment other than surgery, it is essentially universal. Paired t‐tests of mean scores at T0 and T1 showed that patients reported significant improvements in every domain of the MFI after the cancer rehabilitation program (Table 2). Volume 136, Issue 3, Pages 446 - 452. Middel et al. Contractions in which the muscle is stretched (eccentric contractions) cause muscle weakness and damage. Maximal voluntary isometric muscle force of the right and left extremity of the following muscle groups was measured: extension of the knee, flexion of the elbow, and extension of the elbow, using a handheld dynamometer (Force Evaluating & Testing (microFET), Hoggan Health Industries Inc, West Jordan, UT). The first aim of the study was to assess the effects of a multidimensional rehabilitation program on cancer‐related fatigue, a program of which the beneficial effects on quality of life have recently been reported [46]. CRF is an extremely prevalent symptom. Large proportions of patients who are treated with biologic response modifiers and cytokines also experience fatigue. This finding is in line with an earlier study showing that fatigue after radiation was mainly determined by fatigue prior to radiation [10]. The most often reported indication for referral to the rehabilitation program was fatigue. Chemotherapy-induced nausea. A 1995 meta‐analysis of studies documenting rates of depression in cancer patients, without regard to cancer type, gender, or disease state, demonstrated mean prevalence rates of 24%, with a range of 15–42%.73 The association between fatigue and depression remains controversial. On a numeric scale from 0 to 10, a score from 0 to 3 is considered mild fatigue, a score from 4 to 6 is considered moderate fatigue, and a score ≥ 7 is considered severe fatigue. Interventions minimizing fatigue in children/adolescents with cancer: An integrative review. The subscale most widely used in oncology to evaluate fatigue is the FACT anemia part (FACT‐An). If the screening does not identify fatigue or the fatigue is mild, then the patient can be referred for subsequent outpatient reassessments. ), Rome, Italy, Department of Hematology, University of Rome “Tor Vergata,” Rome, Italy. Between 80% and 100% of people with cancer report having fatigue. FACT‐An includes the general part (FACT‐G), a specific questionnaire with 7 questions concerning symptoms linked to anemia (that do not include fatigue), and another fatigue part, FACT‐F, for the specific assessment of fatigue. The present study assessed fatigue multidimensionally in a selected group of cancer patients referred to a rehabilitation program. Methods. Percutaneous nerve electrical stimulation for fatigue caused by chemotherapy for cervical cancer. Correlational analyses between the predictor variables showed low to moderate coefficients ranging from 0.27 (physical functioning and mental functioning) to 0.74 (mental functioning and psychological distress). The load was increased every minute by 10, 15, or 20 Watts, respectively, in such a way that patients could reach their maximal workload within 10 minutes. Understanding and managing interferon-α-related fatigue in patients with melanoma. A cancer patient may describe it as a feeling of being tired, weak, restless, weary, heavy, worn out, drained, exhausted, washed-out, slow, or inability to perform routine activities which they could perform with ease before encountering cancer. The psychosocial dimensions of fatigue in men treated for prostate cancer. However, patients were eligible for the rehabilitation program only when (a) treatment had been completed at least 3 months prior to rehabilitation so that patients had time to naturally recover from cancer‐related treatment effects and (b) the physician had judged that the presence of physical and psychological problems were persisting. To examine the effects of the different predictor variables on fatigue at baseline, the following analyses were performed. The variables entered into the second step accounted for a significant increment of 17%. Conclusion: Cancer-related fatigue is a serious problem that impairs patients physically, mentally, and socially. Attitudes of radiation oncologists toward palliative and supportive care in the United States: Report on national membership survey by the American Society for Radiation Oncology (ASTRO). : Impact of medical Qigong on quality of life, fatigue, …- an RCT. Whatever the percentages are, the problem of fatigue is still underestimated by oncologists [12]. To use this technique, the examiner gradually overcomes the force produced by the patient until the extremity gives way [39]. Early studies with darbepoetin α in cancer patients were aimed at defining the clinically effective doses.117-120 The effectiveness of this growth factor relative to supportive care has been demonstrated in the pivotal Phase III trial performed in Europe.121 In that multicenter, double‐blind, placebo‐controlled study, 320 patients with small cell or nonsmall cell lung cancer with at least 12 more weeks of cisplatin‐containing chemotherapy scheduled were randomized to receive placebo or once‐weekly subcutaneous injections of darbepoetin α 2.25 mg/kg for 12 weeks. In individuals with malignancies like head and neck cancer or Hodgkin disease, when the patient's neck or mediastinum is treated with radiation therapy, hypothyroidism develops frequently without being suspected.84, 85, Anemia deserves a particularly thorough analysis, given the possibilities of therapy with this condition. Nur der Schmerz wird als noch unangenehmer empfunden. The medical term for this is "cancer-related fatigue." Evidence-Based Complementary and Alternative Medicine. Highlights • Estimates are that more than 50 percent of people who have cancer experience cancer-related fatigue (CRF). The only randomized study that has evaluated QOL difference in EPO‐treated and placebo‐treated groups demonstrated a significant improvement in the EPO group and a significant worsening of QOL in the placebo group.115 A very interesting study by a Canadian group has been published recently.116 In that trial of 183 anemic cancer patients, rHuEPO was given for up to 16 weeks both to patients who were and were not receiving chemotherapy. Shenmai injection for the treatment of cancer-related fatigue in advanced non-small cell lung cancer patients undergoing chemotherapy: study protocol for a randomized controlled trial. [3, 5]. A systematic review of research using the diagnostic criteria for cancer‐related fatigue. Multiple stepwise regression analysis showed that role limitation due to physical problems was the strongest predictor, followed by maximal workload. To our knowledge, literature data regarding the prevalence or incidence of fatigue in patients with specific malignancies are scarce. Then, an information session, including a video session, was organized to inform patients about the content of the four components of the multidimensional rehabilitation program. To continue reading this article, you must log in with your personal, hospital, or group practice subscription. The bicycle training was performed at a trainings heart rate (THR) of HRrest + 50%–60% (HRmax ‐HRrest) during weeks 1–3 and at a THR of HRrest + 70%–80% (HRmax‐HRrest) during weeks 4–9 [34]. The “break method” was used for all measurements. Reduced activity at baseline was negatively associated with maximal workload, role limitations, psychological functioning, and self‐efficacy. Fatigue is a subjective condition, commonly defined as a patient's feeling of lack of energy, weariness, or as “a persistent, subjective sense of tiredness related to cancer that interferes with usual functioning” [1]. Managing cancer‐related fatigue in men with prostate cancer: A systematic review of non‐pharmacological interventions. Therefore, we developed a multidimensional rehabilitation program that includes exercise, sports and games, information, and psychoeducation. The effect size (ES) and threshold at the 5% level were calculated as indices measuring the magnitude of a treatment effect [43]. Non‐pharmacological interventions to manage fatigue and psychological stress in children and adolescents with cancer: an integrative review. LBM and BF percentage appeared not to be related to any of the domains of fatigue. Correlation analysis for the two sets of subscales revealed that overall agreement between the two instruments was only moderate. Cancer treatment and survivorship statistics, 2012. Krebserkrankte können unter Fatigue leiden – dann können bereits kleinste Anstrengungen enorm kräftezehrend sein. Fatigue is a condition that causes distress and decreased ability to function due to a lack of energy, and has biological, psychological and behavioral causes. Only those predictor variables that had a significant unique effect on preintervention fatigue were entered into the models. Thus, decreased physical fatigue was associated with fewer role limitations. … “Current treatments for this fatigue have limitations and can carry side effects of their own. The findings that physical and psychological parameters are predictive of fatigue are in agreement with our second hypotheses and are in accordance with earlier studies of cancer patients [50–52]. Although the predictive power of change in physical and psychological variables is relatively small, such change may be clinically important. The Relationship between Qi Deficiency, Cancer-related Fatigue and Quality of Life in Cancer Patients. Effect of therapeutic care for treating fatigue in patients with breast cancer receiving chemotherapy. Reduced activity at baseline accounted for 38% of the variance in fatigue postintervention. Fatigue has been ascribed to the abnormal production of inflammatory cytokines in the setting of cancer, but the specific evidence for the role of cytokines in CFR is fragmentary. A widely used definition of cancer-related fatigue (CRF), is the one proposed by the National Comprehensive Cancer Networks definition (NCCN): ‘CRF is a distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning’1, (FT1). The specific causes of CRF can be tackled individually. I have difficulty in finishing something I have started, 13. IFN‐α causes fatigue in 70% of patients; and hypothyroidism, which can lead to fatigue, is identified in up to 20% of patients.71, 72 Neuroendocrine abnormalities with this class of therapy include HPA axis dysfunction; hypothalamic‐pituitary‐gonadal axis inhibition with decreased levels of estrogen, progesterone, and testosterone; and decreases in growth hormone activity. 1). © 2003 American Cancer Society. Patients were eligible for the study if they met the following criteria: age ≥ 18 years; referred by hospital specialists or general practitioners; last cancer‐related treatment >3 months ago; estimated life expectancy ≥ 1 year, and an indication for rehabilitation. Incidence of Fatigue in Patients of Cancer of Head & Neck Region, Receiving Chemotherapy as well as Radiotherapy, and Its Effect on Quality of Life. Chronbach's α for the present study ranged from 0.67–0.87. A further source of financial stress was created by the need to employ someone to help with daily tasks, such as house cleaning (22%), gardening (18%), and food preparation (5%). These findings are partly in agreement with our second hypothesis. Journal of Strength and Conditioning Research. According to the session leaders, absence was negligible. Fifteen percent of the participants were male. RESULTS. The prevalence of diagnosable CRF in the individuals in this sample, most of whom had completed treatment more than 1 year before the survey, was 17%, a much lower figure than expected based on previous reports that used less stringent criteria. Application interest in cancer patients the five regression models of fatigue. of assessment instruments information program consisted of sessions... Of chronic fatigue experienced by the inactivity resulting from the studies by Demetri et.!, the CBR was 61 % and 100 % of the consequences has been an increasing subject research. 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