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Context Cancer patients often experience cancer-related fatigue (CRF) and sleep disturbances due to cancer and cancer treatment, and symptoms can persist long after treatment. Despite these common occurrences, few studies simultaneously characterize CRF and sleep architecture among cancer patients. Objectives The objective was to characterize CRF and the sleep architecture of patients seen in a CRF clinic and sleep clinic at the University of Texas MD Anderson Cancer Center. Methods CRF Clinic medical records were retrospectively reviewed from September 1, 2006, to September 30, 2010, for self-reported performance status, fatigue, pain, sleep disturbance, depression, anxiety, and sleepiness (n = 219). Polysomnography results were recorded for those referred for additional sleep consultation (n = 39). Results Notably, patients often reported fatigue, sleep disturbance, excessive daytime sleepiness, and a majority of patients referred for a sleep consultation were diagnosed with obstructive sleep apnea (n = 33). Conclusion The results highlight the promise of an interdisciplinary collaboration between dedicated a CRF clinic and sleep clinic to conduct effective assessments to identify treatable CRF and sleep disorders.

Objective Anthroposophic painting therapy (APT) is a specific form of art therapy that aims to activate self-healing capacities through painting aquarelles. Methods The Anthroposophic Art Therapy Assessment-Paint’ (AART-ASSESS-P) was developed to measure pictorial expression and validated in the framework of a comprehensive cohort design study. The validation study examined 68 breast cancer patients with fatigue. Art therapists made pre- and post-assessments of spontaneously drawn water-color paintings with a preliminary version of the AART-ASSESS-P (58 items). Inter-rater reliability (IRR) for the items was examined with Cohen's weighted Kappa (κw). Additionally, a reliability- and factor analysis (FA) were conducted. Convergence criteria were patients’ self-report measures: the Satisfaction with Painting Therapy, Inner Correspondence with Painting Therapy and the Self-Regulation Questionnaire. Results IRR for the items was heterogeneous (κw= 0.09-0.89, Mean κw= 0.40, SD = 0.17). Thirty-six items were excluded due to insufficient IRR and item-total correlation (κw= Conclusion The AART-ASSESS-P is the first reliable instrument to measure pictorial expression during APT.

Contains fulltext : 248803.pdf (Publisher’s version ) (Open Access) BACKGROUND: Cancer-related fatigue is a debilitating late effect after treatment for childhood cancer. The prevalence of fatigue in childhood cancer survivors (CCSs) and associated factors for fatigue has varied widely in previous studies. Two important aspects of cancer-related fatigue, its severity and chronicity, are often not assessed. This study investigated the prevalence of, and risk factors for, severe chronic fatigue (CF) in a national cohort of Dutch CCSs. METHODS: In this study, 2810 CCSs (5-year survivors of all childhood malignancies diagnosed between 1963 and 2001 with a current age of 12-65 years) and 1040 sibling controls were included. CF was assessed with the Short Fatigue Questionnaire and was defined as a score ≥ 18 and persistence of fatigue for ≥6 months. Cancer- and treatment-related characteristics, current health problems, and demographic and lifestyle variables were assessed as potential risk factors for CF via multivariable logistic regression analyses. RESULTS: In adult CCSs and sibling controls (≥18 years old), the prevalence of CF was 26.1% and 14.1%, respectively (P < .001). In adolescent CCSs and sibling controls (2, 2.20; 95% CI, 1.50-3.21), and a central nervous system diagnosis (OR, 1.74; 95% CI, 1.17-2.60) were significantly associated with CF in adult CCSs. CONCLUSIONS: This study shows that CCSs, regardless of their cancer diagnosis, report CF more often than sibling controls. This study provides new evidence for the prevalence of fatigue in CCSs.

Aim To assess the effect of different non‐pharmacological interventions on cancer‐related fatigue (CRF) in breast cancer (BC) patients and identify the most effective method for improving CRF. Design A systematic review and network meta‐analysis. Methods Literature will be searched in the ongoing trail in the Clinical Trials.gov, World Health Organization, the International Clinical Trials Registry Platform, Cochrane Library, PubMed, EMBASE, Web of Science and CINAHL, from the inception until December 31, 2020. Two independent researchers will rigorously screen the literature according to the inclusion and exclusion criteria and assess the risk of bias based on the Cochrane Collaboration's Tool of RCTs. Stata 13.0 and Aggregate Data Drug Information System will be used for data analysis. Results This protocol has been registered on the PROSPERO website (registration number is CRD42020222093). This study will provide the reliable evidence of the most effective non‐pharmacological intervention to improving CRF.

Cancer-related fatigue, which is a common symptom among colorectal cancer patients, has a high incidence and it affects the quality of life of these patients. Western medicine still lacks effective treatment means. However, with various methods of intervention and treatment, Chinese medicine has made certain progress in this area, where it has good curative effect in improving fatigue and the quality of life of patients. This article briefly summarizes the main TCM treatment methods for cancer-related fatigue in patients with colorectal cancer in order to provide reference and suggestions for clinical practice.

BACKGROUND: Despite the questionable effectiveness of oral complementary and alternative medicine (OCAM) in relieving cancer-related symptoms, including fatigue (CRF), many patients use it aiming to improve their quality of life. We assessed factors associated with OCAM use, focusing on CRF. METHODS: Women with stage I-III breast cancer (BC) were included from CANTO (NCT01993498). OCAM use was defined as taking homeopathy, vitamins/minerals, or herbal/dietary supplements. Multivariable multinomial logistic regressions evaluated associations of CRF (EORTC QLQ-C30), patient, and treatment characteristics with OCAM use. RESULTS: Among 5237 women, 23.0% reported OCAM use overall (49.3% at diagnosis, 50.7% starting post-diagnosis), mostly homeopathy (65.4%). Mean (SD) CRF score was 27.6 (24.0) at diagnosis and 35.1 (25.3) at post-diagnosis. More intense CRF was consistently associated with OCAM use at diagnosis and post-diagnosis [adjusted odds ratio (aOR) for 10-point increase 1.05 (95% Confidence interval 1.01-1.09) and 1.04 (1.01-1.09) vs. never use, respectively]. Odds of using OCAM at diagnosis were higher among older [for 5-year increase, 1.09 (1.04-1.14)] and more educated patients [college vs. primary 1.80 (1.27-2.55)]. Women with income > 3000 [vs.

Fatigue after treatment for breast cancer has an impact on quality of life. Dragon boating is known to be beneficial. A multiple-point cohort panel design was used. Data was collected from breast cancer survivors to measure fatigue, quality of life, and upper arm functioning at 3 time points. Fatigue levels fell significantly between T1 and T2 and from T2 to T3. Similarly, upper limb functioning improved from T1 to T2 but showed no significant change between T2 and T3. The findings suggest that dragon boating, as a form of exercise, has a role in reducing fatigue.

Fatigue is the most common side effect of cancer and cancer treatment and is often called cancer fatigue or cancer-related fatigue. For cancer patients, cancer-related fatigue has a negative impact on participation in work and social activities, mood, and daily activities, significantly impairing quality of life. Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) sometimes cause fatigue, and early detection and appropriate management of fatigue in cancer patients treated with a VEGFR-TKI prevent fatigue from becoming more severe, thus maximizing the benefits of the treatment.This paper focuses on fatigue and discusses its frequency, assessment, risk factors, and management methods.The drugs currently available for treating cancer-related fatigue are not effective enough, and their mechanisms of action are not fully understood. Some agents have demonstrated efficacy as treatments for fatigue due to pharmacotherapy, and further elucidation of their mechanisms is expected, together with the development of new drugs. Since fatigue has a range of causes, its treatment requires not only medication, but also exercise, nutrition, and other therapeutic approaches. The successful treatment of fatigue will therefore need multidisciplinary therapy involving the establishment of systems of cooperation across various specialties.

Introduction: Sleep problems and fatigue are common symptoms reported by cancer patients. In this study, the researchers used a specialized tool to measure fatigue in cancer patients and its relationship with sleep quality in Yazd, Iran. Methods: This descriptive correlational study included 149 cancer patients (age range: over 18 years) referred to Shahid Sadoughi Hospital in Yazd, Iran. Data were collected by the Pittsburgh Sleep Quality Index (PSQI) and Cancer-Related Fatigue Questionnaire. A PSQI score of ≥5 indicated a poor sleep. Data were analyzed using SPSS Statistics for Windows, version 13.0 (SPSS Inc., Chicago, IL, USA), Pearson’s correlation, t test, analysis of variance (ANOVA), and linear regression. Results: The mean (SD) PSQI score of patients was 13 (4.85) out of 21. About 69.3% of patients had a poor sleep quality. While the mean (SD) of sleep duration was 5.57 (0.54) hours, it was 69.44 (46.58) minutes for sleep latency. Also, with increasing the mean of sleep quality, the mean of fatigue significantly increased (P

Background Cancer-related fatigue is one of the most prevalent and distressing symptoms among cancer patients, resulting in a great cancer research challenge. Numerous systematic reviews of physical training interventions have been conducted to find the most effective approach. However, evidence remains fragmented, and in which cancer population physical training is more effective than other populations is still unclear. Thus, this study critically appraised systematic reviews and meta-analyses on physical training to reduce adults' cancer-related fatigue. Methods A systematic review of systematic reviews and meta-analysis (PROSPERO: CRD42020189049), assessing the efficacy of exercise training for reducing cancer-related fatigue in adults, was conducted in PubMed, CINAHL, Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects, and Pedro. The selected studies (standardized mean difference, SMD; 95%CI), was quantitatively pooled using a random-effects model. Heterogeneity was tested using chi-squared (Q) and I-square statistics (I2). Results Of 1438 identified articles, 11 met the inclusion criteria, and ten were meta-analyzed. The results yielded a positive effect of physical training on fatigue in all cancer populations, SMD = -0.33 (-0.43, -0.23). Subgroup analysis based on tumor localization showed a slightly higher physical training effect on fatigue in adults with breast cancer, SMD = -0.36 (-0.57, -0.15), and prostate cancer SMD = -0.34 (-0.45, -.0.22). Conclusions Our analysis demonstrated some potential improvement in cancer-related fatigue in adult patients undergoing physical training during and after cancer treatments, particularly in patients with breast or prostate cancer.

Exercise is known to improve fatigue among adult cancer patients however there is limited understanding of this relationship in children, adolescents, and young adults (AYA) with cancer. The aim is to evaluate the effect of exercise on fatigue outcomes among children and AYA with cancer and to identify important parameters of exercise (frequency, intensity, time, type, and setting), which may be relevant for future intervention design. A systematic search of PubMed, MedLine, CENTRAL, Embase, and Web of Science databases was conducted in December 2019, for studies within the last decade, reporting the effect of exercise on fatigue among cancer patients and survivors 0-24 years of age. Quality assessment was conducted using the Physiotherapy Evidence Database (PEDro) and "Before/After Studies with No Control Group" scales. Seventeen studies (

Cancer-related fatigue (CRF) is the most frequent and debilitating symptom in patients with advanced cancer. There are limited effective treatments for CRF. The objective of this prospective longitudinal study was to evaluate the change in CRF at Day 43 after treatment with combination therapy of oral Anamorelin 100 mg daily with physical activity and nutrition counseling. In this study, patients with CRF [≤ 34 Functional Assessment of Chronic Illness Therapy-Fatigue subscales(FACIT-F)] received Anamorelin 100 mg orally daily with standardized physical activity and nutrition counseling for 43 days. Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Anorexia Cachexia(FAACT-ACS), Multidimensional Fatigue Symptom Inventory-Short Form(MFSI-SF), Patient-Reported Outcomes Measurement Information System(PROMIS-Fatigue), body composition, and physical performance tests were assessed at baseline, Day 15, 29, and 43. Frequency and type of side effects were determined by NCI CTAE 4.0.(NCT03035409). 28/45 (62%) of patients dosed were evaluable at Day 43. The mean, SD for FACIT-F subscale improvement from baseline was 4.89 (± 13.07), P = .058, MFSI-SF (G) − 3.46 (± 6.86), P = 0.013, PROMIS-fatigue − 4.14 (± 7.88), P = 0.010, FAACT ACS 3.48 (± 8.13), P = 0.035. Godin Liesure-Time physical activity questionnaire 7.41 (± 16.50), P = 0.038. Weight (kg) 1.81 (± 2.63), P = 0.005, and Lean Body Mass 1.54 (± 1.85), P = 0.001, IGF-1 36.50 (± 48.76), P = 0.015. There was no significant improvement in physical performance outcomes. No adverse events > grade 3 related to the study drug were reported. The use of the combination therapy was associated with improvement of CRF (FACIT-F fatigue, PROMIS-fatigue, MFSI-SF-general), activity (Godin-leisure time), anorexia (FAACT), body composition, and IGF-1 levels. Further studies using combination therapy for CRF are justified.

Increased cancer survivorship means more people are living with cancer-related fatigue (CRF), which is associated with activity performance limitations, restricted participation in meaningful life roles, and reduced quality of life. To identify whether non-pharmacological interventions that are effective in minimizing CRF also have an impact on everyday activity performance and participation outcomes for adult cancer survivors. This is a systematic review with narrative synthesis. Eight databases were searched (Medline, CINAHL, PsychINFO, EMBASE, Scopus, OT Seeker, CENTRAL, Cochrane SR database), from 2000 to 2020 for randomized controlled trials of effective non-pharmacological CRF interventions in adult cancer survivors with fatigue. A total of 5,762 studies were identified of which 29 studies were reviewed. In 28 studies, quality of life was investigated as a primary or secondary outcome, where concepts of participation or activity performance were used. Review findings indicate there is insufficient evidence to determine whether activity performance and participation is affected by CRF interventions.

Objective. This paper aims to systematically evaluate the intervention effect of mind-body exercise on cancer-related fatigue in breast cancer patients. Methods. Databases including PubMed, the Cochrane Library, Embase, Web of Science, CNKI, Wanfang Data, and SINOMED were retrieved to collect randomized controlled trials on the effects of mind-body exercise on relieving cancer-related fatigue in breast cancer patients. The retrieval period started from the founding date of each database to January 6, 2021. Cochrane bias risk assessment tools were used to evaluate the methodological quality assessment of the included literature, and RevMan 5.3 software was used for meta-analyses. Results. 17 pieces of researches in 16 papers were included with a total of 1133 patients. Compared with the control group, mind-body exercise can improve cancer-related fatigue in breast cancer patients. The combined effect size SMD = 0.59, 95% CI was [0.27, 0.92], p < 0.00001 . Doing Tai Chi for over 40 minutes each time with an exercise cycle of ≤6 weeks can improve cancer-related fatigue in breast cancer patients more significantly. Sensitivity analysis shows that the combined effect results of the meta-analysis were relatively stable. Conclusion. Mind-body exercise can effectively improve cancer-related fatigue in breast cancer patients.

ObjectiveFatigue is having high prevalence and increased acknowledgment of negative effect on the patient's well-being which has resulted in fatigue being important research variable in breast cancer patients. The recent development shows greater receptivity of health professionals to assessing cancer-related fatigue (CRF). In this review, an attempt has been made to identify CRF instruments which have been used in breast cancer patients with the detailed description about the instruments and their psychometric properties.MethodA search was conducted from January 2000 to April 2020 from electronic databases such as PubMed, Cochrane, Embase, and Google Scholar. The studies were included if the instrument was used to measure fatigue in breast cancer patients and its description and psychometric properties reported in breast cancer patients. The search was limited to studies in the English language and use of English version of instruments.ResultsAmong 34 CRF instruments, 9 instruments were included according to inclusion and exclusion criteria. From nine instruments, six were multidimensional, two were unidimensional, and one instrument was quality-of-life (QOL) subscale. All the scales have showed accepted reliability and validity in breast cancer patients. A minimal clinically important difference was available for Multidimensional Fatigue Symptom Inventory — Short Form, Brief Fatigue Inventory, Piper Fatigue Scale — Revised, FACIT Fatigue scale, and Fatigue symptom inventory instruments.Significance of resultsThis review will help healthcare providers who are dealing with breast cancer patients to acknowledge and better understand what their patients are experiencing. The most appropriate tool will allow healthcare providers to use for holistic assessment of CRF. The instrument will help them to monitor their patient's condition or treatment progress, so it can be incorporated into treatment decisions for better management of fatigue.

OBJECTIVE: Fatigue is a common symptom among cancer survivors that can be successfully treated with cognitive-behavioral therapy (CBT). Insights into the working mechanisms of CBT are currently limited. The aim of this study was to investigate whether improvements in targeted cognitive-behavioral variables and reduced depressive symptoms mediate the fatigue-reducing effect of CBT.METHODS: We pooled data from three randomized controlled trials that tested the efficacy of CBT to reduce severe fatigue. In all three trials, fatigue severity (checklist individual strength) decreased significantly following CBT. Assessments were conducted pre-treatment and 6 months later. Classical mediation analysis testing a pre-specified model was conducted and its results compared to those of causal discovery, an explorative data-driven approach testing all possible causal associations and retaining the most likely model.RESULTS: Data from 250 cancer survivors (n=129 CBT, n=121 waitlist) were analyzed. Classical mediation analysis suggests that increased self-efficacy and decreased fatigue catastrophizing, focusing on symptoms, perceived problems with activity and depressive symptoms mediate the reduction of fatigue brought by CBT. Conversely, causal discovery and post-hoc analyses indicate that fatigue acts as mediator, not outcome, of changes in cognitions, sleep disturbance and depressive symptoms.CONCLUSIONS: Cognitions, sleep disturbance and depressive symptoms improve during CBT. When assessed pre- and post-treatment, fatigue acts as a mediator, not outcome, of these improvements. It seems likely that the working mechanism of CBT is not a one-way causal effect but a dynamic reciprocal process. Trials integrating intermittent assessments are needed to shed light on these mechanisms and inform optimization of CBT. This article is protected by copyright. All rights reserved.

Purpose To identify potential correlates of CRF after curative breast cancer (BC) treatment. The hypothesis was that fatigue would be more severe among women treated with cardiotoxic drugs, with poor physical condition and those who exercised less.Methods Prospective observational cross-sectional design. Fatigue was evaluated through Perform Questionnaire (multi-item, multi-dimensional). Patient-reported assessments and objective information regarding clinical data, physical activity (PA) and physical condition were analysed as potential correlates of CRF.Results 180 women who remained free of disease were recruited. Prevalence of fatigue interfering with quality of life was 43%. Weight, BMI, treatment with trastuzumab and time spent walking one mile were positively associated with fatigue. Age, time from diagnosis, self-reported walking time, basal and recovery heart rate were negatively associated. Previous chemo, radio or hormonal therapy, objectively assessed weekly PA, cardio-respiratory condition, muscular strength and adherence to Mediterranean diet were not associated with CRF. However, an interesting unexpected negative association with nut intake was found.Conclusions CRF is a prevalent problem after BC treatment. Objectively assessed PA, cardiorespiratory fitness and muscular strength did not predict CRF. The association of CRF with trastuzumab and low intake of nuts should be confirmed in further studies. A deeper insight in heart rate variability is warranted. Future research should include longitudinal studies and determination of biomarkers. Implications for Cancer Survivors BC survivors, especially younger and overweight women, should be informed about fatigue as a potential persistent symptom through all stages of the cancer trajectory and into survivorship. They also should be routinely screened for CRF.

Cancer-related fatigue can continue long after curative cancer treatment. The aim of this study was to investigate sleep and rest–activity cycles in fatigued and non-fatigued cancer survivors. We hypothesized that sleep and rest–activity cycles would be more disturbed in people experiencing clinically-relevant fatigue, and that objective measures of sleep would be associated with the severity of fatigue in cancer survivors. Cancer survivors (n = 87) completed a 14-day wrist actigraphy measurement to estimate their sleep and rest–activity cycles. Fatigue was measured using the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-F). Participants were dichotomised into two groups using a previously validated score (fatigued n = 51 and non-fatigued n = 36). The participant’s perception of sleep was measured using the Insomnia Severity Index (ISI). FACIT-F score was correlated with wake after sleep onset (r = −0.28, p = 0.010), sleep efficiency (r = 0.26, p = 0.016), sleep onset latency (r = −0.31, p = 0.044) and Insomnia Severity Index (ISI) score (r = −0.56, p &lt, 0.001). The relative amplitude of the rest–activity cycles was lower in the fatigued vs. the non-fatigued group (p = 0.017, d = 0.58). After treatment for cancer, the severity of cancer-related fatigue is correlated with specific objective measures of sleep, and there is evidence of rest–activity cycle disruption in people experiencing clinically-relevant fatigue.

The objective of this no interventional, 7 months observational study was to analyze the prevalence of cancer-related fatigue (CRF) in cancer patient populations who were receiving chemotherapy and those who were not receiving chemotherapy. This was an observational study. Based on the inclusion and exclusion criteria, 60 subjects (24 male and 36 females) diagnosed with cancer enrolled for the study, which was further allotted into group A (n=30) which was receiving chemotherapy and group B (n=30) which was not receiving chemotherapy. The data collection was performed by administering the validated Fatigue symptoms Inventory (FSI) scale after obtaining the informed consent. The mean age of Group A and B is 49 years and Group B 51 years, respectively. The mean FSI score of the group receiving chemotherapy was 35.70±17.14, whereas the mean FSI score of a group not receiving chemotherapy was 19.50±16.05. An Independent t-test was applied and the independent t value came out to be 2.18. An equal variance t-test reveals, statistically indicating a significant difference in FSI scores in groups receiving chemotherapy and not receiving chemotherapy (p=0.042). From the results, we concluded that Cancer-related fatigue is highly prevalent in patients who are receiving chemotherapy than those who are not receiving chemotherapy. The underlying causes of CRF are poorly understood and further research is warranted in order to assess CRF before and after treatment and develop effective, patient-centred management strategies and to improve quality of life.

International guidelines recommend specific interventions to reduce cancer-related fatigue (CRF). Evidence suggests underutilization of these interventions among breast cancer survivors. The QualFatigue study aimed to explore the potential factors influencing the use of specific interventions, for relief, in patients with CRF through qualitative analyses. Patients with stage I–III breast cancer, and CRF ≥4 on a 10-point numerical scale were recruited within 6–24 months at the end of their primary treatment. Semi-structured interviews were performed. Emergent themes were identified using a stepped content analysis (QDA Miner software). Data saturation was achieved with 15 interviews. Four main themes emerged as potential sources of influence in the participants’ use of specific interventions: (1) expectations regarding the management of CRF, (2) representations of the benefits provided by the interventions, (3) individual physical and psychological conditions, and (4) social and environmental situations. Six key levers came out transversally to optimize the use of specific interventions to relieve CRF: (1) listening and recognition of the individual difficulties and needs; (2) individual and global health assessments; (3) information and advice on how to manage CRF; (4) discussion groups focused on the management of CRF; (5) group activities; and (6) professional and personalized guidance. This study calls for multi-level action to address many persistent barriers and exploit levers in the management of CRF.

Background Metabolomics is the newest ‐omics methodology and allows for a functional snapshot of the biochemical activity and cellular state. The goal of this study is to characterize metabolomic profiles associated with cancer‐related fatigue, a debilitating symptom commonly reported by oncology patients. Methods Untargeted ultrahigh performance liquid chromatography/mass spectrometry metabolomics approach was used to identify metabolites in plasma samples collected from a total of 197 participants with or without cancer. Partial least squares‐discriminant analysis (PLS‐DA) was used to identify discriminant metabolite features, and diagnostic performance of selected classifiers was quantified using area under the receiver operating characteristics (AUROC) curve analysis. Pathway enrichment analysis was performed using Fisher's exact test and the Kyoto Encyclopedia of Genes and Genomes (KEGG) metabolic pathway database. Findings The global metabolomics approach yielded a total of 1120 compounds of known identity. Significant metabolic pathways unique to fatigued cancer versus control groups included sphingolipid metabolism, histidine metabolism, and cysteine and methionine metabolism. Significant pathways unique to non‐fatigued cancer versus control groups included inositol phosphate metabolism, primary bile acid biosynthesis, ascorbate and aldarate metabolism, starch and sucrose metabolism, and pentose and glucuronate interconversions. Pathways shared between the two comparisons included caffeine metabolism, tyrosine metabolism, steroid hormone biosynthesis, sulfur metabolism, and phenylalanine metabolism. Conclusions We found significant metabolomic profile differences associated with cancer‐related fatigue. By comparing metabolic signatures unique to fatigued cancer patients with metabolites associated with, but not unique to, fatigued cancer individuals (overlap pathways) and metabolites associated with cancer but not fatigue, we provided a broad view of the metabolic phenotype of cancer‐related fatigue., We found significant metabolomic profile differences associated with cancer‐related fatigue. Potentially impactful metabolic pathways associated specifically with fatigued cancer patients include changes in metabolites associated with sphingolipid metabolism, histidine metabolism, and cysteine and methionine metabolism.

This study was designed to critically evaluate the effect of music interventions on cancer-related fatigue (CRF) in cancer patients. Seven databases (Cochrane Library, PubMed, Embace, CBM, Wanfang, VIP, and CNKI) were systematically reviewed from inception to June 2020 for randomized controlled trials (RCTs). Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. All analyses were performed with Review Manager 5.3. A total of 8 qualified studies that included 467 patients (music interventions: 235, control: 232) were included. Cancer patients who completed adjuvant therapy in the music intervention group, especially those with malignant hematological diseases, reported reduced CRF levels compared with patients undergoing routine care. Regardless of the frequencies, music interventions can relieve fatigue in cancer patients. Providing prerecorded music and participating in live music both can mitigate CRF. Music interventions can be considered as an alternative therapy for relieving fatigue in cancer patients who are undergoing active treatment or have completed treatment.

Summary Background & aims Cancer-related fatigue (CRF) is a prevalent and persistent symptom from androgen deprivation therapy (ADT) in prostate cancer. The Mediterranean-style dietary pattern (MED-diet) offers a plausible mechanism to mitigate CRF through reducing inflammation and improving body composition. This study aimed to evaluate the effects of a 12-week MED-diet, compared to usual care, on CRF and quality of life in men with prostate cancer treated with ADT. Methods Twenty-three men (65.9 ± 7.8 years; body mass index: 29.6 ± 2.7 kg/m2; ADT duration: 33.8 ± 35.6 months) receiving ADT for ≥3 months were randomly assigned (1:1) to 12-weeks of usual care or the MED-diet involving six individualised nutrition consults. Primary outcomes included CRF [Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale (FACIT-F) and quality of life [FACIT-General (FACIT-G)], secondary outcomes included body mass/composition and interleukin (IL)-6 and IL-8 concentrations measured at baseline, 8-weeks and 12 weeks. Intervention feasibility was measured by intervention safety, study completion rate, consult attendance, and adherence to the MED-diet through the Mediterranean-diet adherence screener (MEDAS). Intention to treat linear mixed models were used to determine changes in outcomes between the MED-diet and usual care at baseline, 8-weeks and 12-weeks. Results The MED-diet improved CRF (FACIT-F) at 8-weeks [+4.8 (0.0, 9.8); P = 0.05] and 12-weeks [+7.2 (2.2, 12.0); P = 0.005], quality of life (FACIT-G) at 12-weeks [+9.2 (2.7, 15.8); P = 0.006], reduced total body mass at 8-weeks [−2.51 kg (−4.25, −0.78); P = 0.005] and 12-weeks [-2.97 kg (−4.71, −1.25); P = 0.001], lean mass at 8-weeks [−1.50 kg (−2.91, −0.10); P = 0.036], and IL-8 at 8-weeks [-0.18 ng/ml (−0.34, −0.02); P = 0.029] compared to usual care. The MED-diet demonstrated zero adverse events, 91% study completion, 100% attendance, and 81% adherence to the MEDAS. Conclusion The MED-diet is safe and feasible, and has the potential to improve CRF and quality of life in overweight men treated with ADT compared to usual care. Further exploration of the MED-diet is warranted in a larger powered sample size to consolidate these findings.

Background: Cancer-related fatigue (CRF) has a high prevalence in individuals with cancer, especially in those with central nervous system (CNS) tumors, and impacts the quality of life (QOL). However, there are limited data on CRF in Indian patients with CNS tumors. Objective: We aimed to estimate the CRF scores in patients with CNS tumors. Materials and Methods: This cross-sectional study was conducted in the Department of Medical Oncology of the Tata Memorial Hospital in Mumbai, India, between May 2019 and August 2019. Patients with CNS tumors aged ≥18 years, who presented to the Neuro-Oncology Disease Management Group, were enrolled in the study. The Functional Assessment of Chronic Illness Therapy Fatigue Scale was used to collect data related to well-being and fatigue. Data were captured in a single visit. Descriptive statistics and multiple regression analyses were performed to identify the factors associated with a high fatigue score. Results: There were 100 patients in our cohort with a median age of 40 (range, 18–64) years. The median fatigue score was 36. The median physical well-being, social well-being, emotional well-being, functional well-being, and Functional Assessment of Cancer Therapy-General (FACT-G) scores were 19, 19.9, 18, 17, and 72, respectively. There was a significant correlation between the fatigue score and the various subscales of FACT-G (P < 0.0001). The associated risk factors for CRF were age (P = 0.021), poor Eastern Cooperative Oncology Group-Performance Status (ECOG PS) (2–3) (P < 0.0001), general category based on the payment ability of the patient (P = 0.004), ongoing treatment status (P = 0.0003), and the presence of recurrent disease (P = 0.001). Conclusion: CRF is common in patients with CNS tumors and impacts all aspect of the QOL. It is affected by age, ECOG PS, payment ability, treatment status, and disease recurrence status.

Background Cancer-related fatigue (CRF) is a common psychosomatic problem in breast cancer patients. Traditional Chinese medicine (TCM) has been used to address symptoms in patients with CRF. Identification of the specific constitution in TCM is essential for personalized care. Aim To explore the relationship between fatigue and specific constitutions in breast cancer. Experimental procedure We conducted a cross-sectional study in all breast cancer patients at Kaohsiung Chang Gung Memorial Hospital in Taiwan. The severity of fatigue was determined using the Brief Fatigue Inventory-Taiwanese (BFI-T) form. TCM patterns were determined using the Body Constitution Questionnaire (BCQ). The relationship between constitution and fatigue was analyzed using logistic regression. Results We recruited 110 breast cancer patients with fatigue (mean age: 55 ± 11 years). The mean duration of breast cancer was 17.4 months. The major constitution among these patients with fatigue was Yang-Qi deficiency (50%). Phlegm-Stasis syndrome was correlated with a duration of breast cancer of more than 18 months (p = 0.02). Out of all participants, 42.7% (n = 47) reported clinically significant fatigue (BFI-T score ≥4). According to logistic regression, the score of Yang-Qi deficiency [odds ratio (OR): 3.5, 95% confidence interval (CI): 1.49–8.21, p, Graphical abstract Image 1, Highlights of the findings and novelties • Cancer-related fatigue is a common distressing symptom in patients with breast cancer. • Accurate Traditional Chinese medicine pattern diagnosis would provide objective and precise medical interventions. • The Yang-Qi deficiency constitution was associated with significant fatigue in breast cancer patients. • Phlegm-Stasis syndrome was correlated with a longer duration of breast cancer.

BACKGROUND As one of the important treatments for lung cancer, chemotherapy not only brings hope for the survival of patients, but also influences their body and mind. Most patients have different degrees of fatigue during chemotherapy and after chemotherapy, and the occurrence and aggravation of fatigue do not necessarily occur during hospitalization, there is a lag, mostly occurs in the interval after chemotherapy, therefore, continuous nursing care is very important for patients with lung cancer undergoing chemotherapy. The purpose of this study was to explore the effect of continuous nursing, based on Omaha System theory, on cancer-related fatigue in patients with lung cancer receiving chemotherapy. METHODS From April 2018 to May 2019, a total of 102 inpatients with lung cancer at a cancer hospital in Hangzhou, China were selected for chemotherapy. A total of 7patients were lost to follow-up during the intervention, leaving 46 and 49 patients randomly assigned to the experimental and control groups, respectively. Participants in the control group received routine nursing after discharge, while those in the experimental group were nursed according to the Omaha System model. RESULTS After 4 cycles of chemotherapy, scores for total, physical, cognitive, and emotional fatigue were significantly lower in the intervention group than those in the control group (P

Cancer-related fatigue is one of the most prominent problems in cancer patients, which often remains inadequately treated, because the etiology of this syndrome is still relatively unknown. This study aimed to examine demographic, clinical, and psycho-social determinants of physical and mental aspects of cancer-related fatigue. The study was conducted on 64 women with a breast cancer diagnosis, aged between 33 and 79 years (M=58.36, SD=11.30) while undergoing radiation therapy. For the assessment of physical and mental fatigue, the Fatigue Assessment Scale (FAS Serbian) was used. Demographic and clinical data, symptoms of anxiety and depression (DASS-21), neuroticism (BFI), and functional and structural social support (Serbian translation MOS-SSS) were examined as well. The results showed that depression, anxiety, and neuroticism correlated positively with both physical and mental fatigue, while structural and functional social support correlated negatively only with the physical dimension. Participants who have a partner reported significantly lower levels of physical fatigue compared to those who are not in a relationship, while such a difference was not detected in the case of mental fatigue. Neuroticism and relationship status were the most important predictors of physical fatigue, while neuroticism alone was the most significant predictor of mental fatigue. The results showed that physical and mental fatigue have different correlates, and that personality traits and social support might be of greater relevance for understanding fatigue, than clinical and demographic factors. These findings may be of importance when assessing the risk factors for fatigue and planning psycho-social interventions to empower breast cancer patients.

Cancer-related fatigue is a common symptom that occurs in patients with cancer. This symptom is also experienced by cancer patients who receive chemotherapy, radiation therapy, bone marrow transplantation, or other cancer treatments. A survey conducted on 1569 cancer patients found that fatigue was experienced by 80% of cancer patients who received chemotherapy and/or radiotherapy. In patients with cancer that has metastasized, the prevalence of fatigue exceeds 75%. Patients who have healed from cancer report that fatigue is a symptom that is experienced for months or even years after the cancer treatment is over. Continued fatigue in cancer patients can interfere with their quality of life so that good assessment and management of this condition are needed. The purpose of this study is to identify the assessment and treatment of cancer-related fatigue currently conducted by health care providers in Indonesia. The study was conducted by requesting the participation of health care providers in an electronic survey carried out according to their respective roles. One hundred and twelve health care providers working with cancer patients consisting of nurses, doctors, nutritionists, and physiotherapists participated in this electronic survey. Overall, there is a perception that cancer-related fatigue is only assessed by less than one-third of health care providers, treatment is carried out only by a quarter of health care providers, and there are no clinical guidelines regarding the management of this condition. Awareness of interventions for fatigue varies among health care providers. There is no definitive clinical service for or management of cancer-related fatigue. The respondents identified the need for clinical guidelines both for the assessment and management of cancer-related fatigue, training and better expertise, and access to provide services to cancer patients who are experiencing fatigue.

Background Cancer-related fatigue (CRF) is a severe symptom in breast cancer survivors. We aimed to explore the effects of the solution-focused brief therapy (SFBT) on CRF in breast cancer patients after lumpectomy or mastectomy under adjuvant chemotherapy. Methods First, 196 patients with primarily diagnosed breast cancer were recruited, screened, and the qualified 160 patients were randomly assigned into the control (routine nursing interventions), and intervention (routine nursing interventions and SFBT) groups. CRF was evaluated using the Chinese version of revised Piper Fatigue Scale. Data were collected at baseline (T1), post-intervention (T2), and post-follow-up (T3). Results Mild to severe fatigue existed in all qualified participants at T1 and the fatigue symptom went worse with the chemotherapy in control group. In intervention group, the fatigue level decreased at T2 (P

Background and objective: Cancer-related fatigue is greatest frequent upsetting sense of tiredness or exhaustion can happen regardless of cancer type and could be experienced physically or emotionally, and or cognitively, that is associated with the tumor or its treat-ment. The current study aimed at assessing prevalence of cancer related fatigue among women with breast cancer. Method: A descriptive cross- sectional study design was conducted from 8th of October 2018 to 8th October 2019. To find out the prevalence of cancer-related fatigue among fe-male breast cancer patients at Nankali Hospital in Erbil city. A sample of 60 breast cancer patient was obtained through non-probability purposive convenience sampling tech-niques. Data were analyzed using Statistical Package for the Social Sciences version 23 for windows. Results: The results showed that the highest percentage of participants (45%) were from age group between 39-54, most of them were from urban area, graduated from primary school, married, however; 53.3% of breast cancer women they had family history of breast cancer. Regarding breast cancer stages, 40% of participants were in third stage. Most of the breast cancer patients were receiving chemotherapy treatment and they had surgery (81.7% and 71.7% respectively). Concerning cancer related fatigue 75% of participants suffered from fatigue, nonetheless; fatigue severity among participants range from severe 53.3% to moderate 48.3%. Also, physical fatigue was a common type of fatigue among women with breast cancer. Conclusion: One of the most common complains symptom of patient with cancer is fa-tigue. Cancer related fatigue impact physical, emotional, cognitive domains of patients’. Moreover, cancer-related fatigue has undesirable effect on patients, mood, daily task per-formance, and the patient’s life.

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. So patient's condition affects their metabolism, muscle mass, body fat and the level of their energy. As a presumption cachexia, sarcopenia and fatigue affect the diagnosis and treatment process. In this study, cancer diagnosed patients, seen in out-patient (OP) department, admitted at day care for short treatment were invited to participate. The nutritional status was assessed using Karada Scanner, simple bioelectric impedance instrument. A standardized functional assessment of chronic illness therapy fatigue scale (FACT-G, version 4), 27-point scale questionnaire was administered to assess Cancer Related Fatigue (CRF). This pilot study provided a fresh positive correlation between the nutritional status of cancer patients and cancer related fatigue. BMI has significant positive correlation with total body fat % (P

Cancer-related fatigue (CRF) is a common side effect of cancer treatment, particularly in breast cancer patients. Over the past decade, the multimodal management of breast cancer has undergone several changes, such as the establishment of postoperative hypofractionated radiotherapy (RT) as a new standard protocol and the reduced use of chemotherapy. The aim of the current study was to investigate the impact of these changes on quality of life (QoL) and CRF. A total of 66 patients was assessed for QoL and CRF using the FACIT‑F questionnaire. Patients were asked to complete the paper-based questionnaire before (TP1) and at the end of radiotherapy (TP2) as well as at follow-up (TP3). Subgroups were compared based on fractionation and previous application of chemotherapy. For the entire cohort, no significant changes in the severity of fatigue were seen. A mild decrease of physical wellbeing (PWB) from TP1 to TP2 was observed (22.2 vs. 20.7, p = 0.007). Fatigue at TP1 was more severe in patients receiving chemotherapy before RT (37.9 vs. 30.5, p = 0.041). Only patients without preceding chemotherapy showed a significant worsening of fatigue from TP1 to TP2 (37.9 vs 34.8, p = 0.005). The same is true for physical wellbeing (PWB), with a decrease from TP1 to TP2 in chemotherapy-naive patients only (23.5 vs. 21.4, p = 0.002). Fractionation did not impact any of the investigated endpoints. Patients undergoing postoperative RT for breast cancer constitute a heterogeneous patient population with varying risks of developing CRF influenced by previous treatments. Therefore, patient selection seems to be critical when interventional studies addressing CRF during radiotherapy are designed.

Background Fatigue prevalence and severity have been assessed in a variety of studies, yet, not in a standardized way, and predominantly in breast cancer patients. Systematic, comparative investigations across a broad range of cancer entities are lacking. Methods The FiX study systematically enrolled 2244 cancer patients across 15 entities approximately 2 years after diagnosis. Fatigue was assessed with the multidimensional EORTC QLQ‐FA12 questionnaire. Physical, emotional, cognitive, and total fatigue were compared across entities and with normative values of the general population. Differences in patients' characteristics and cancer therapy between entities were taken into account using analyses of covariance models. Results Across all entities, mean physical fatigue levels were significantly higher than age‐ and sex‐matched means of the general population for all cancer entities (all Bonferroni‐Holm adjusted P, The FiX study compared fatigue in 2244 cancer patients across 15 tumor entities. Fatigue was prevalent even 2 years after diagnosis across all entities, but with different manifestation. We identified entity‐specific issues to be considered in the treatment of fatigue.

OBJECTIVE: This waiting-list randomized controlled trial examined the effectiveness of a self-management mHealth app in improving fatigue and quality of life (QoL) in cancer patients and survivors.METHODS: Persons with cancer-related fatigue (CRF) were recruited across four English speaking countries, via social media, and randomized into intervention (n = 519) and control (n = 280) groups. Whereas the intervention group received immediate access to the Untire app, the control group received access only after 12-weeks. Primary outcomes fatigue severity and interference, and secondary outcome QoL were assessed at baseline, 4, 8, and 12-weeks. We ran generalized linear mixed models for all outcomes to determine the effects of app access (yes/no), over 12-weeks, following the intention-to-treat principle.RESULTS: Compared with the control group, the intervention group showed significantly larger improvements in fatigue severity (d = 0.40), fatigue interference (d = 0.35), and overall QoL on average (d = 0.32) (P's 56). Effects did not depend on education and cancer status. Reliable change analyses indicated that significantly more people showed full recovery for fatigue in the intervention vs the control group (P's = .02).CONCLUSIONS: The Untire app can be an effective mHealth solution for cancer patients and survivors with moderate to severe CRF.

This randomized, double-blinded, placebo-controlled study aimed to investigate the effect of strength training (ST) combined with vitamin C and E supplementation on perceived and performance fatigability in breast cancer survivors (BCS). Twenty-five BCS were randomly assigned to 1 of 2 groups: vitamins (VIT; n = 12; 51.0 ± 9.0 years) or placebo (PLA; n = 13; 48.2 ± 8.3 years). Both groups performed a 10-week ST protocol, twice a week. The VIT group was supplemented with vitamins C (500 mg/day) and E (180 mg/day) and the PLA group with polydextrose (1 g/day), once a day after breakfast. At the beginning and at the end of the training period, perceived fatigability was assessed using Multidimensional Fatigue Inventory (MFI)-20 (general fatigue and physical fatigue). Performance fatigability was assessed during 30 maximal isokinetic knee extensions at 120°/s. General fatigue decreased similarly in the VIT (p = 0.004) and PLA (p = 0.011) groups. Physical fatigue decreased similarly in the VIT (p = 0.011) and PLA (p = 0.001) groups. Performance fatigability also decreased similarly in the VIT (p = 0.026) and PLA (p < 0.001) groups. There was no difference between groups at any moment (p > 0.05). In summary, antioxidant supplementation does not add any positive synergistic effect to ST in terms of improving perceived or performance fatigability in BCS. This clinical trial is registered in the Brazilian Clinical Trials Registry, number RBR-843pth (UTN no.: U1111-1222-6511). Novelty ST with maximal repetitions reduces perceived and performance fatigability of BCS. Vitamins C and E supplementation does not add any positive synergistic effect to ST in terms of reducing fatigability in BCS.

Introduction Cancer-related fatigue is one of the most prevalent symptoms reported by breast cancer survivors. Despite a corpus of literature dedicated to understanding and identifying evidence-based treatments for cancer-related fatigue, gaps in the literature remain, particularly for breast cancer survivors during their primary treatment. Exercise training may represent an efficacious behavioral modality for mitigating fatigue symptoms in cancer survivors; yet, the effects of exercise during adjuvant therapy is an understudied area. Areas covered In this review, we synthesize the most recent evidence of exercise's effects on cancer-related fatigue during active treatment for breast cancer. We summarize the overall effects of exercise, moderators of these effects, and areas requiring further research. Expert opinion Strong evidence supports at least modest effects of exercise on cancer-related fatigue during breast cancer treatment. However, several knowledge gaps persist, including the need to: risk stratify patients to tailor exercise promotion strategies; implement higher-quality studies and translate this evidence to clinical practice; adopt biobehavioral models to better understand exercise's effects on cancer-related fatigue; evaluate the effects of exercise modes besides aerobic and combined training; and integrate technology to better understand and promote fatigue-reducing behaviors, such as exercise, across cancer care.

Yu-Hung Fang,1 Meng-Jer Hsieh,2,3 Ming-Szu Hung,1,4,5 Yu-Ching Lin,1,3– 5 Liang-Tseng Kuo,5,6 Mong-Liang Lu,7 Bor-Show Tzang,8– 10 Vincent Chin-Hung Chen5,11 1Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; 2Department of Respiratory Therapy, College of Medicine, Chang Gung University, Chiayi, Taiwan; 3Division of Pulmonary Infection and Critical Care Medicine, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan; 4Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; 5Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 6Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; 7Department of Psychiatry, Wan Fang Hospital, and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 8Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan; 9Clinical Laboratory, Chung Shan Medical University Hospital, Taichung, Taiwan; 10Department of Biochemistry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 11Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, TaiwanCorrespondence: Vincent Chin-Hung ChenDepartment of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, No. 6, W. Sec., Jiapu Road, Puzi City, Chiayi County 61363, Taiwan, Republic of ChinaTel +886-5-3621000 ext. 2315Email cch1966@gmail.comBackground: Dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS) concentrations were reported to decrease in patients with advanced cancer. However, the clinical significance of DHEA and DHEAS concentrations in patients with NSCLC receiving chemotherapy (CT) has not been sufficiently documented.Objective: To evaluate the correlation between mental health and hormone concentrations on patients with advanced non-small-cell lung cancer (NSCLC).Materials and Methods: The present study was a cross-sectional analysis based on a self-reported psychological investigation. Salivary samples were collected from 22 patients with advanced NSCLC after CT and 17 healthy controls. The concentrations of DHEA, DHEAS, and cortisol were analyzed to investigate their associations with the results of self-reported questionnaires on psychological health.Results: Patients with advanced NSCLC exhibited significantly higher Patient Health Questionnaire (PHQ-9) and Startle, Physiological arousal, Anger, and Numbness-Chinese version (SPAN-C) scores, poorer health conditions, lower sleep quality, and more severe fatigue after CT than did healthy controls, and salivary concentrations of DHEA and DHEAS were significantly lower among patients after CT than among controls. DHEAS concentrations were negatively associated with depression scores (PHQ-9, r = − 0.496, P = 0.019) and fatigue scores (Brief Fatigue Inventory-Taiwan, r = − 0.562, P = 0.006).Conclusion: Patients with advanced NSCLC after CT had lower DHEA and DHEAS concentrations than did controls. Lower DHEAS concentrations were associated with higher fatigue and depression scores.Keywords: cancer-related fatigue, chemotherapy, DHEA, DHEAS, lung cancer

Background Colon cancer is the most common malignant tumor of the gastrointestinal tract. This cancer and the related treatments bring a raft of lasting physiological and psychological impacts to patients. This study explored the effects of attention and interpretation therapy (AIT) on improving psychological resilience, cancer-related fatigue (CRF), and negative emotions in patients after colon cancer surgery. Methods Patients who had undergone colon cancer surgery in the Affiliated Hospital of Jiangnan University were selected and randomly allocated into an experimental group and a control group, each with 100 cases. Patients in the control group received routine intervention measures, while the experimental group received an extra 10 weeks of AIT. Before and after 10 weeks of intervention, the effects of intervention were evaluated using the Connor-Davidson Resilience Scale (CD-RISC), Self-Rating Anxiety Scale (SAS), Selfrating Depression Scale (SDS) and the Revised Piper Fatigue Scale (PFS-R). Results Before the intervention, there was no statistical difference between the scores of psychological resilience, CRF, and negative emotions between the two groups (P>0.05). We compared the scores before and after the 10 weeks of intervention and found that the scores of psychological resilience of the experimental group were higher than before, and the scores of CRF and negative emotion were lower than before. After the intervention, the psychological resilience score of the experimental group was higher than that of the control group, the CRF and negative emotions scores were lower than those of the control group, and the differences were statistically significant (P Conclusions AIT can effectively strengthen the psychological resilience of patients after colon cancer surgery to a certain extent, reduce anxiety and depression, reduce the degree of CRF, and thus improve the patients' quality of life postoperatively.

Objective Cancer-related fatigue (CRF) affects a substantial number of cancer patients and survivors. Recommendations for CRF treatments are largely based on results of randomized controlled trials. The interpretability of such results is limited to patients eligible and willing to participate in these trials. We aimed to address this limitation in a retrospective study of patients seen at a CRF clinic in a comprehensive cancer center. The objectives were to (a) determine the effectiveness of clinician-initiated interventions for CRF and identify their mediators and (b) describe the frequency and effectiveness of patient-initiated physical activity (PA) behavior for alleviating CRF and identify determinants of this PA. Methods Data (patient-reported somatic and mood symptoms; clinical data; clinician-documented changes in medication and behavior) from n = 213 patients collected as part of the clinic's standard of care at initial clinical consult and follow-up 4 to 11 weeks later were included. Effects of clinician-initiated interventions and patient-initiated PA on change in fatigue were analyzed using linear models. Results Of all clinician-initiated interventions, only psychostimulant start was recorded frequent enough for further investigation and was associated with reduced fatigue; this association was mediated by a reduction in apathy. PA was also associated with reduced fatigue severity. PA initiation/increase after consult was associated with lower apathy at consult. Conclusions These results demonstrate a major role for patient apathy in the effectiveness and initiation of CRF-targeting interventions. Behavioral therapies focusing on reduction in apathy should be considered as initial treatment of CRF in those with substantial apathy.

Introduction Cancer-related fatigue (CRF) is the most commonly reported treatment-related side effect of prostate cancer (PCa). Recognition of financial hardship among cancer survivors is growing. We investigated, for the first time, associations between levels of financial stress and CRF among PCa survivors. Methods We used data from PCa survivors who had been identified through two population-based cancer registries covering the Republic of Ireland and Northern Ireland and had completed a postal questionnaire. CRF was measured by the fatigue subscale of the EORTC QLQ-C30. Financial stress was assessed as household ability to make ends meet (i) pre-diagnosis and (ii) at questionnaire completion (post-diagnosis). Multivariable logistic regression was used to relate financial stress to clinically important CRF (fatigue subscale score ≥ 39 of a possible 100). Results Two thousand four hundred fifty-eight PCa survivors were included. Of these, 268 (10.9%) reported pre-diagnosis financial stress only, 317 (12.9%) post-diagnosis stress only and 270 (11.0%) both pre- and post-diagnosis stress (cumulative stress); 470 (19.1%) reported clinically important CRF. After controlling for confounders, survivors with cumulative financial stress exposure were significantly more likely to have CRF (OR = 4.58, 95% CI 3.30–6.35, p p = 0.001 for pre-diagnosis financial stress only; and OR = 4.11, 95% CI 3.01–5.61, p Conclusions Financial stress may be an independent risk factor for CRF. Implications for Cancer Survivors There may be benefits in targeting interventions for reducing CRF towards survivors with financial stress, or developing strategies to reduce financial stress.

Although patient-preferred live music (PPLM) can be an effective music therapy intervention for addressing cancer-related fatigue (CRF) in adult oncology patients, there is a gap in the literature specific to patients’ experiences of how PPLM impacts CRF. The primary purpose of this interpretivist study was to understand the mechanisms by which PPLM impacts CRF from the patients’ perspectives. The secondary purpose was to gain insight into patients’ song choice rationales and their ensuing function within PPLM. We provided PPLM and conducted semi-structured interviews with adult oncology patients ( N = 5) on a blood and marrow transplant unit. We used an inductive approach to thematic analysis to analyze interview transcripts and achieved trustworthiness through independent analyses of transcripts as well as peer review of codes and themes. Participants described how PPLM provided CRF symptomatic relief by facilitating emotional release and being an aesthetically pleasing distraction. Participants noted they chose songs because of memorable experiences and for musical elements and components, while explaining that PPLM facilitated reminiscence, promoted relaxation and restful states, and encouraged reflection through the lyrics. Results provide an initial patient-centric understanding of how and why PPLM might impact CRF. Implications for clinical practice, limitations, and suggestions for future research are provided.

Prostate cancer, a disease of aging, is the most common cancer for men living in the developed world. Androgen Deprivation Therapy is effective at slowing the progression of prostate cancer cell gr...

Introduction Cancer-related fatigue negatively impacts 50–90% of cancer survivors. In North America, approximately 50% of return-to-work interventions initially fail for survivors, with cancer-related fatigue often cited as a barrier to workability. Occupational therapy-driven cancer-related fatigue work-related programming for survivors is sparse, despite many published reviews calling for interdisciplinary interventions; to address work-related performance, specific functional interventions are likely to be needed. Further exploration and a broader understanding of survivors’ cancer-related fatigue management, participation in rehabilitative programmes, and plans for return to work are necessary to target survivor needs better. Method Drawing on social theory, this exploratory descriptive study utilised content and thematic analysis of interviews from 12 survivors to explore and describe the perspectives of survivors experiencing cancer-related fatigue yet desiring to work. Results Content analysis reflected distinct differences in fatigue-related terminology. Thematic analysis identified three themes specific to cancer-related fatigue and workability: valuing physical wellness, perceived cognitive impacts of cancer-related fatigue on function and workability, and the lack of transition from physical exercise to functional work-related activities. Conclusion Survivors identified gaps in care related to managing cognitive symptoms and the need for functional, work-related interventions to manage cancer-related fatigue. With their expertise in function, occupational therapists are well positioned to facilitate work-specific interventions, within cancer-specific exercise programming.

Fatigue is a distressing symptom in head & neck cancer patients before during and at the end of curative therapy. Pharmacologic and not pharmacologic treatments have been proposed with scarce or no evidence of efficacy. The aim of the study is to evaluate the efficacy of American ginseng in respect to placebo in reducing fatigue in patients treated for head and neck cancer with curative intent. Thirty-two patients who had completed oncological treatment for a primary Head & neck tumor for at least 1 year and had a global fatigue score > 4 by means of Brief Fatigue Inventory (BFI) were randomized to receive 1000 mg of American ginseng or placebo per day for 8 weeks with the aim to assess their efficacy. Changes in fatigue scores in the 2 subgroups of patients before and after the treatment with American ginseng or placebo, were assessed by the BFI at baseline and at the end of week 8. The mean of the mean values of the BFI measured at 8 weeks (end of treatment) was 4.6 in the Ginseng arm and 3.4 in the Placebo arm (p = ns). Mean comparison showed a tendency to statistical significance only for the single item on interference with general activity (p = 0.06), with better performance for placebo. The mean of the differences between baseline values and 8 weeks values was not significantly different between treatment arms considering the entire questionnaire. The present data shows that American ginseng has insufficient evidence to be recommended for Cancer Related Fatigue (CRF) in post treatment HNC survivors.

Objective: The purpose of this study was to examine the factors associated with the occurrence of cancer-related fatigue (CRF) one month after surgery in patients with gastrointestinal cancer. Method: The study included 96 patients with gastrointestinal cancer (50 males and 46 females, mean age 62.7 ± 11.4 years). Data of the Cancer Fatigue Scale (CFS), 6-minute walk distance (6MWD), and hospital anxiety and depression scale (HADS) were obtained before surgery and one month after surgery. The subjects were divided into the following two groups: severe CRF group (CFS score of ≥19 points) and mild CRF group (CFS score of

The pathobiology of cancer-related fatigue (CRF) remains elusive, hindering the development of targeted treatments. Radiation therapy (RT), a common treatment for men with prostate cancer, induces cell damage through the generation of free radicals and oxidative stress. We hypothesized that disruption in cellular responses to this surge of nonphysiological oxidative stress might contribute to CRF in men with prostate cancer treated with RT. We evaluated the potential role of three cell damage pathways (apoptosis, autophagy, necrosis) and oxidative stress in CRF in men with prostate cancer receiving RT. Fatigue was measured by the Functional Assessment of Cancer Therapy-Fatigue (FACT-F) questionnaire. Gene expression was measured in whole blood using RT2 profiler™ PCR arrays. Data were collected at two time points: either baseline or Day 1 of treatment (T1) and completion of treatment (T2). Participants were grouped into either the fatigued or nonfatigued phenotype at T2 using the recommended FACT-F cut-off score for clinical significance. We observed significant upregulation of seven genes related to three cell damage pathways in the fatigued group from T1 to T2 and no significant changes in the nonfatigued group. We also observed significant downregulation of two genes related to oxidative stress in the fatigued group compared to the nonfatigued group at T2. These collective results provide preliminary evidence that cell damage might be upregulated in the CRF phenotype. Validation of these findings using a larger and more diverse sample is warranted.

Background: Fatigue is a common and distressing symptom for patients with gynecologic cancers. Few studies have empirically examined whether it spontaneously resolves. This study was aimed at identifying longitudinal patterns of fatigue and predictors of clinically significant fatigue 1 year after treatment completion.Methods: This was a prospective cohort study of women with newly diagnosed ovarian (n = 81) or endometrial cancer (n = 181) that did not progress or recur within 1 year of treatment completion. Symptoms of fatigue, depression, and anxiety were assessed after surgery and 6 and 12 months after treatment completion with the Fatigue Assessment Scale and the Hospital Anxiety and Depression Scale. Patients' fatigue scores over time were classified (scores of 22-50, clinically significant; scores of 10-21, not clinically significant). Logistic regression models were fit to examine associations between fatigue and patient characteristics.Results: Among 262 participants, 48% reported clinically significant fatigue after surgery. One year later, 39% reported fatigue. There were 6 patterns over time: always low (37%), always high (25%), high then resolves (18%), new onset (10%), fluctuating (6%), and incidental (5%). Patients with fatigue after surgery were more likely to report fatigue at 12 months in comparison with others (odds ratio [OR], 6.08; 95% confidence interval [CI], 2.82-13.11; P < .001). Patients with depressive symptoms also had higher odds of fatigue (OR, 3.36; 95% CI, 1.08-10.65; P = .039), although only one-third of fatigued patients reported depressive symptoms.Conclusion: Nearly half of women with gynecologic cancers had clinically significant fatigue after surgery, whereas 44% and 39% had fatigue 6 months and 1 year later; this suggests that spontaneous regression of symptoms is relatively rare. Women who reported fatigue, depressive symptoms, or 2 or more medical comorbidities had higher odds of reporting fatigue 1 year later. Future studies should test scalable interventions to improve fatigue in women with gynecologic cancers.

Background Cancer-related fatigue (CRF) is a common symptom and has a negative impact on prognosis in cancer patients. CRF could be improved by Korean red ginseng (KRG). Patients and methods For this randomised and double-blinded trial, colorectal cancer patients who received mFOLFOX-6 were randomly assigned to either KRG 2000 mg/day (n = 219) or placebo (n = 219) for 16 weeks. CRF was evaluated using the mean area under the curve (AUC) change from baseline of brief fatigue inventory (BFI) as the primary endpoint. Fatigue-related quality of life, stress, and adverse events were evaluated as secondary endpoints. Results In the full analysis group, KRG up to 16 weeks improved CRF by the mean AUC change from baseline of BFI compared to placebo, particularly in “Mood” and “Walking ability” (P = 0.038, P = 0.023, respectively). In the per-protocol group, KRG led to improved CRF in the global BFI score compared with the placebo (P = 0.019). Specifically, there were improvements in “Fatigue right now,” “Mood,” “Relations with others,” “Walking ability,” and “Enjoyment of life” at 16 weeks (P = 0.045, P = 0.006, P = 0.028, P = 0.003, P = 0.036, respectively). In subgroups of female patients, ≥60 years old, with high compliance (≥80%) or more baseline fatigue, the beneficial effects of KRG were more enhanced than that of placebo. Although neutropenia was more frequent in KRG than placebo, the incidence of all adverse events was similar. Conclusions KRG could be safely combined with mFOLFOX-6 chemotherapy in colorectal cancer patients, and reduced CRF compared with placebo.

While several studies have documented fatigue during and after cancer treatment, long-term cancer survivor fatigue is underreported. In this study, we compare fatigue, quality of life (QoL), and anxiety between relapse-free cancer survivors 15 years after diagnosis and healthy controls. Cancer survivors (CS) were randomly selected from three large population-based cancer registries (Bas-Rhin, Calvados, and Doubs, France). Cancer-free controls were randomly selected from electoral lists with stratification on age group, residence area, and gender. All participants completed self-reported fatigue (MFI), QoL (EORTC QLQ-C30), and anxiety (STAI) questionnaires. Univariable and multivariable logistic regression were used to study the association between fatigue and cancer status, in three cancer subgroups: breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC). Two hundred sixty-three CS and 688 controls (125/275, 45/153, 93/260 CS/controls for BC, CC, and CRC respectively) were included. The mean age was 66 years. In multivariable analyses, CS had higher general and mental fatigue than controls p = 0.04 and p = 0.02, respectively. No difference in QoL was observed between CS and controls. CS were more anxious than controls (p