Psychological distress among cancer patients is linked to adverse outcomes. The enhanced Distress Thermometer (eDT) allows patients to self-report distress levels on a Likert scale (0-10) and select from a list of physical, emotional, family, and psychological problems contributing to their distress. The physical problem list includes symptoms and functional impairments. Little is known about the predictive validity of the eDT physical problem list. This study aims to evaluate predictors of risk associated with distress scores measured by the eDT among patients with physical problems.

Patient medical records with significant distress were reviewed, defined by eDT scores ≥ 6 with any physical problems or scores < 6 with > 3 problems selected. Patients were categorized into three groups based on eDT score: mild (1-3), moderate (4-6), and severe (7-10). The chi-square test assessed differences in demographic and clinical variables across distress categories. Linear regression evaluated associations between distress scores and significant predictive variables.

Data from 549 patients showed severe distress was common among head and neck, breast, skin, and colorectal cancers. Significant predictors of distress included age, gender, geography, and number of physical problems (NPP) reported. Higher distress was associated with individuals younger, female, urban, and reporting more physical problems. The regression model explained 15% of the variance in distress scores.

Age, geography, gender, and NPP were factors influencing distress in cancer patients. Future research is recommended to develop more comprehensive clinical and demographic profiles to better identify cancer patients at risk for high distress and unmet supportive care needs.

To evaluate incidence of mental health disorder (MHD) diagnosis after orchiectomy in testicular cancer patients and identify factors associated with MHD.

Using claims from the IBM Marketscan database, we identified patients 18 years or older diagnosed with testicular cancer between 2009 and 2021 who underwent orchiectomy, had no prior MHD diagnoses, and maintained insurance coverage spanning 6months before and 12months after diagnosis. Chemotherapy and RPLND were defined as advanced treatments. We identified insurance claims associated with diagnoses of MHD at 12 and 36months after orchiectomy. Factors predicting the cumulative incidence of MHD were analyzed using multivariable regression. Male patients with no lifetime cancer diagnosis and 4years of continuous insurance coverage were identified as controls and matched by demographics.

Of all 5881 patients, 507 (8.6%) and 909 (13.9%) had a new diagnosis of MHD within 12 and 36months of orchiectomy, respectively. The cumulative incidence of MHD was significantly different among cases and controls over 12months (9.2% vs 2.2%, P<.0001) and 36months (14.8% vs 7.3%, P<.0001). In the multivariable regression, factors associated with new diagnosis of MHD were younger age, more recent year of diagnosis, higher CCI, and receipt of advanced treatment.

Testicular cancer patients have a higher incidence of developing MHD compared to age-matched controls. Physicians should counsel patients prior to orchiectomy regarding the risk of developing MHD, understand factors associated with likelihood of MHD incidence, and refer patients to receive appropriate interventions as needed postoperatively.

To explore the potential correlates of cancer-related fatigue (CRF) at the time of diagnosis, with a specific consideration toward aspects related to physical activity and physical condition.

Candidates were patients ≥ 18, diagnosed with colon or rectum cancer (stages I-IV), able to walk a mile or to complete the 6-min walking test. Fatigue was measured through PERFORM which is a multidimensional questionnaire (PQ). Quality of life (EORTC-QLQC30 and EORTC-QLQC29), diet (PREDIMED), and sociodemographic data were also assessed by questionnaires. Physical activity was measured by self-reported questionnaire (IPAQ) and accelerometers, and physical condition through objective tests such as Rockport 1-mile walk, estimated VO2 peak, 6-min walk, sit-to-stand, handgrip and, anthropometric data.

A total of 238 CRC patients (64.8 ± 11.0 mean age, 66.4% men) were recruited. Mean fatigue PQ score was 50.5. Values under 50.2 were associated with reduced QOL. CRF was associated with female sex (p < 0.001), poorer self-reported perceived health (p = 0.008), being retired woman (p = 0.025), poorer QOL (p =  < 0.001), and a previous diagnosis of hypercholesterolemia (p = 0.032). CRF was associated with a number of symptoms such as pain, anxiety, and gastrointestinal symptoms, in addition to dyspnoea, body image, and financial difficulties. CRF was associated to low self-reported PA levels (in women) and more sedentary levels (in men). CRF was not associated with metastatic stage, physical condition, or objectively assessed physical activity.

One out of four patients presents CRF at the time of CRC diagnosis. Women reported to have significantly higher levels of fatigue than men. Its association with other symptoms such as pain, anxiety, gastrointestinal symptoms, and its tremendous impact on the QOL make it necessary to ask the patients about fatigue in the first consultation. Oncologists should be aware of the importance of documenting this symptom in the clinical record to guarantee the follow-up and management.

Fatigue is a significant contributor to the burden experienced by patients with chronic disorders. The development of standardized treatments is challenging due to the lack of consensus concerning the etiology of fatigue. The aim of this systematic review is to provide an overview of non-pharmacological interventions for fatigue. The efficacy and differences in fatigue treatment across conditions will be explored.

A systematic literature search was conducted using the databases PubMed, Web of Science, PsycInfo and CINAHL. Trials were eligible when (1) adult patients (≥ 18 years old) with disorders causing fatigue were included, (2) non-pharmacological interventions performed, (3) treatment was compared to standard care, placebo or active control group, (4) fatigue was the only primary outcome assessed with a multidimensional tool, and (5) a randomized controlled trial (RCT) design was applied.

7592 papers were screened. 91 RCTs were eligible, with data reported in 95 papers. Specific fatigue interventions were present for a broad range of conditions. Findings demonstrated promising evidence for physical activity, CBT, online programs and multidimensional modules. Additional types of interventions were effective, but evidence was limited due to risk of bias and small sample sizes. Due to high heterogeneity concerning methodology, a meta-analysis was not possible.

Several non-pharmacological treatment options for fatigue are promising. No clear evidence was found that fatigue should be treated differently depending on the underlying condition. However, further research is necessary with a focus on a transdiagnostic approach to fatigue, high study quality and long-term follow-ups.

Lighting interventions can mitigate fatigue by promoting circadian rhythmicity. We test whether individualized, wearable-based lighting interventions delivered via a mobile app reduce cancer-related fatigue in a randomized controlled trial with 138 breast cancer, prostate cancer, and hematopoietic stem cell transplant patients. Participants are randomized to tailored lighting intervention or control. The primary endpoint is PROMIS fatigue 4a at trial end, with secondary endpoints including change in daily fatigue, sleep, anxiety, depression, physical function, and overall health. Fatigue T-scores at week 11 do not differ between groups but decrease significantly from week 1 to week 11 (3.07 points, p = 0.001) in the intervention group, with a significant final-week treatment effect (p = 0.014). Daily fatigue, anxiety, sleep disturbance, and physical function improve within intervention. Further studies are needed to see if these results generalize in broader cancer care. The trial is registered at ClinicalTrials.gov (trial registration number: NCT04827446).

BackgroundAs the role of physical activity in breast cancer management gains increasing recognition, understanding the effects of aerobic exercise on patients' quality of life and biological markers has emerged as a critical area of research to inform clinical practices and improve patient outcomes.ObjectiveThis study aims to investigate the impact of low-intensity resistance exercise training on serum tumor biomarkers and quality of life in women with breast cancer, providing evidence for its potential role as an adjunct therapy in improving clinical outcomes and patient well-being.MethodsThis study was carried out on 70 women between the ages of 18 and 65, who were included in the study while receiving chemotherapy treatment. The subject was divided into low-intensity resistance exercise (Group I) and control (Group II). Demographic characteristics, quality of life, and serum tumor biomarkers were evaluated. Participants in group I underwent a 12-week exercise programme of low-intensity resistance exercises three times a week (three metabolic equivalents, approximately 30 min/session).ResultsThe quality of life has been found to be significantly higher in the low-intensity resistance exercise group (p < 0.05). The serum tumor biomarker levels of CEA, CA15-3, and CA19-9 decreased across all participants. However, the reduction in serum tumor biomarker levels was found to be more pronounced in Group 1 (p < 0.05).ConclusionsLow-intensity resistance exercise has demonstrated a positive effect on the quality of life in women with breast cancer. Within the framework of oncological rehabilitation, aerobic exercise regimens may be preferred due to their role in promoting improvements in serum tumor biomarker levels and contributing to enhanced quality of life.

To contribute to the refinement of future physical activity (PA) guidelines, which have remained mostly generic until now, we performed an umbrella review of meta-analyses for PA in cancer survivors.

Medline and Scopus databases were searched in January 2024 for systematic reviews and meta-analyses on the association/effect of any type of PA in every cancer type and for any studied outcome. Statistically significant meta-analyses were categorized into four evidence groups (strong, highly suggestive, suggestive, weak) using pre-established grading criteria.

A total of 102 publications reporting 740 meta-analytic associations were identified, including breast (n = 427), prostate (n = 104), hematological (n = 58), colorectal (n = 79) and lung (n = 54) cancer survivors. Overall, 401 (54 %) associations were nominally statistically significant, of which 16 were categorised as strong, 10 as highly suggestive, and 93 as suggestive evidence. In breast cancer, there was strong or highly suggestive evidence that post-diagnosis PA is associated with lower all-cause mortality, recurrence, cancer-related fatigue, depression, and higher mental health, body strength, aerobic capacity, and weight loss. In prostate cancer, strong evidence was identified for the positive association of PA with cardiovascular fitness, quality of life and fatigue amelioration. In colorectal cancer, strong and highly suggestive evidence supported the association of PA with lower all-cause mortality. In lung cancer, strong evidence supported the association of preoperative combination of breathing exercise and PA with reduced length of hospital stay.

This grading of the entirety of the available evidence can facilitate robust introduction of targeted exercise prescription in oncology care as standard practice.

High-intensity interval training (HIIT) performed before, during, and after cancer treatment can attenuate the adverse effects induced by anti-cancer drugs. A clear presentation and rationale of characteristics of HIIT variables is vital to produce the expected HIIT adaptations in cancer patients. However, there are concerns regarding the HIIT protocols used in the cancer literature.

The aims were to (1) identify the characteristics of HIIT and the formats that have been prescribed, (2) analyze which anchors have been utilized to prescribe effort and pause intensity, (3) examine characteristics of the physical tests used for HIIT prescription, and (4) identify potential adverse events related to HIIT intervention.

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, including PubMed, Scopus, and Web of Science databases.

A total of 51 studies were retrieved, and the following results were found: (1) Only 25 studies reported all four essential variables for HIIT prescription [effort intensity (effort duration): pause intensity (pause duration)]. Of these studies, 23 used active pause and employed the following prescription (on average): [84% (116 s): 39% (118 s)] when percentage of maximal aerobic power (MAP) [maximal/peak oxygen uptake ( V O2max/peak)/MAP] was used; [124% (161 s): 55% (142 s)] when percentage of anaerobic threshold (AT) was used; [83% (230 s): 62% (165 s)] when maximal heart rate percentage (%HRmax) was used. From these 23 studies, 12 used V O2max/peak/MAP (one of the most recommended variables for HIIT prescription). Seven studies adopted the HIIT-long format, and in the remaining five studies, the format was unclear. (2) Twenty-four studies used fractions of V O2max/peak or mechanical variables like MAP as anchors for prescribing effort intensity, two studies used AT, 20 studies used fractions of HRmax/heart rate reserve, two studies used rate of perceived exertion (RPE), while one used RPE and % V O2peak concomitantly, and two studies utilized RPE/%HRmax concomitantly. Two studies utilized passive resting, 12 studies used % V O2peak/%MAP for prescribing pause intensity, four studies used AT, seven studies used %HRmax, one study used %HRmax/% V O2peak, and two studies used absolute loads. (3) Ten studies did not report the characteristics of the physical tests employed, two studies used submaximal tests, and 39 studies utilized graded exercise tests. (4) Ten studies did not report if there were adverse events associated with the exercise program, while 34 studies did not report any adverse events.

Only 50% of the studies provided all the necessary variables for accurate HIIT prescription, raising concerns about the replicability, comprehension, and effective application of HIIT in cancer patients. Most of the studies that reported all variables appeared to have employed the HIIT-long format. Only a few studies used more individualized anchors (e.g., AT) to prescribe HIIT-long format for cancer patients, which is considered a very heterogeneous population.

Patients with leukemia often suffer from the combined effects of cancer-related fatigue (CRF) and subthreshold depression, which mutually exacerbate each other in a vicious cycle. In this editorial, we comment on the article by Liu et al, published in the World Journal of Psychiatry. We further elucidate the profound impact of subthreshold depressive symptoms on the experience of CRF and complications in patients with leukemia. This editorial highlights the importance of early identification and treatment of subclinical depression, and advocates for a multidisciplinary and integrated treatment approach that includes social support, psychological interventions, and individualized treatment plans. Future research needs to explore the biological mechanisms underlying the interaction between the two to develop more effective prevention and treatment strategies.

The APPROACH pilot study explored the feasibility and acceptability of an app (NHS Active 10) with brief, habit-based, behavioral support calls and print materials intended to increase brisk walking in people diagnosed with cancer.

Following UK Medical Research Council guidelines, this study assessed the implementation of the intervention, examined the mechanisms of impact, and identified contextual factors influencing engagement.

Adults (aged ≥18 y) with breast, prostate, or colorectal cancer who reported not meeting the UK guidelines for moderate-to-vigorous physical activity (≥150 min/wk) were recruited from a single hospital site in Yorkshire, United Kingdom. They were randomly assigned to the intervention or control (usual care) arm and assessed via quantitative surveys at baseline (time point 0 [T0]) and 3-month follow-up (time point 1 [T1]) and qualitative exit interviews (36/44, 82%) at T1. The process evaluation included intervention participants only (n=44). Implementation was assessed using data from the T1 questionnaire exploring the use of the intervention components. The perceived usefulness of the app, leaflet, and behavioral support call was rated from 0 to 5. Behavioral support calls were recorded, and the fidelity of delivery of 25 planned behavior change techniques was rated from 0 to 5 using an adapted Dreyfus scale. Mechanisms of impact were identified by examining T0 and T1 scores on the Self-Reported Behavioural Automaticity Index and feedback on the leaflet, app, call, and planner in the T1 questionnaire and qualitative interviews. Contextual factors influencing engagement were identified through qualitative interviews.

The implementation of the intervention was successful: 98% (43/44) of the participants received a behavioral support call, 78% (32/41) reported reading the leaflet, 95% (39/41) reported downloading the app, and 83% (34/41) reported using the planners. The mean perceived usefulness of the app was 4.3 (SD 0.8) in participants still using the app at T1 (n=33). Participants rated the leaflet (mean 3.9, SD 0.6) and the behavioral support call (mean 4.1, SD 1) as useful. The intended behavior change techniques in the behavioral support calls were proficiently delivered (overall mean 4.2, SD 1.2). Mechanisms of impact included habit formation, behavioral monitoring, and support and reassurance from the intervention facilitator. Contextual factors impacting engagement included barriers, such as the impact of cancer and its treatment, and facilitators, such as social support.

The APPROACH intervention was successfully implemented and shows promise for increasing brisk walking, potentially through promoting habit formation and enabling self-monitoring. Contextual factors will be important to consider when interpreting outcomes in the larger APPROACH randomized controlled trial.

RR2-10.1186/s40814-022-01028-w.

The aim of the present study is to describe the course of fatigue syndrome in patients with musculoskeletal tumors starting from chemotherapy and to compare it with that of other cancer populations. The second objective is to identify the risk factors for a higher level of fatigue.

A prospective prognostic observational cohort study was carried out. All patients diagnosed with musculoskeletal tumors who started chemotherapy treatment over 12 years of age were identified and enrolled consecutively from July 2019 to April 2021 in the osteo-oncology department. Patients' fatigue was measured using the Brief Fatigue Inventory at four different time points: at the beginning of treatment and then subsequently at 6, 12 and 24 months from the time of enrollment.

The mean fatigue value was 3.3 (SD = 2.4) at the start of antiblastic treatment, which progressively decreased over time until it reached a mean score of 2.1 (SD = 1.5). At 24 months; 17% of patients had moderate/severe fatigue. Presence of metastases at the onset of the disease, location of the tumor in the upper limb, a shorter oncological treatment-free gap and surgical treatment were independent predictive factors of BFI score.

In patients with musculoskeletal tumors, fatigue is a complication of the disease itself and does not occur only after chemotherapy treatment. In the first two years of treatment, there is a decreasing trend in fatigue syndrome, which remains a significant complication to be monitored over time and to be considered in patient management. Prevention pathways should be implemented.

During chemotherapy treatment of patients with bone and soft tissue sarcomas, a fatigue prevention plan should be implemented. Patients with tumor localisation in the upper limb, metastasis at onset and surgical treatment have a higher risk of developing a higher fatigue score.

Exercise interventions are among the best-known interventions for cancer-related fatigue (CRF). Rural survivors of cancer, however, report specific barriers to engaging in exercise programs and lack overall access to effective programs.

The purpose of this investigation was to assess the feasibility of a novel telehealth exercise program designed specifically for rural survivors of cancer with CRF.

A single-arm clinical trial of the BfitBwell Telehealth Program was performed. Based on an established clinical program, this adapted 12-week program addressed barriers previously reported by rural survivors by providing synchronous videoconference exercise sessions (2 per program), asynchronous exercise sessions using a personal training smartphone or internet app (3-5 per week), and regular symptom (CRF) monitoring using automated emailed surveys (every 2 weeks). Personalized exercise prescriptions containing aerobic and resistance activities were implemented by cancer exercise specialists. Symptom-triggered synchronous sessions were initiated for participants failing to improve in CRF, as identified by a reference chart of CRF improvements observed during a supervised exercise program. Eligible participants were adult survivors of any cancer diagnosis who had completed treatment with curative intent in the past 12 months or had no planned changes in treatment for the duration of the study, lived in a rural area, and were currently experiencing CRF. Feasibility was assessed by objective measures of recruitment, data collection, intervention acceptability and suitability, and preliminary evaluations of participant responses. CRF was the primary clinical outcome (assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue Scale [FACIT-Fatigue]) and was measured before, after, and 6 months after program completion.

In total, 19 participants enrolled in the study, 16 initiated the exercise program, and 15 completed the program. A total of 14 participants were recruited through internet advertisements, and the total recruitment rate peaked at 5 participants per month. Participants completed 100% of initial and final assessments (30 assessments across all participants) and 93% (70/75 possible surveys across all participants) of emailed surveys and attended 97% (29/30 possible sessions across all participants) of synchronous exercise sessions. In total, 6 participants initiated symptom-triggered sessions, with 6 of 7 initiated sessions attended. The mean FACIT-Fatigue scores significantly improved (P=.001) by 11.2 (SD 6.8) points following the completion of the program. A total of 13 participants demonstrated at least a minimal clinically important difference in FACIT-Fatigue scores (≥ +3 points) at this time. FACIT-Fatigue scores did not significantly change from program completion to 6-month follow-up (n=13; mean change -1.1, SD 3.4 points; P=.29).

Results from this investigation support the feasibility of the BfitBwell Telehealth Program and a subsequent efficacy trial. Novel program components also provide potential models for improving exercise program efficacy and efficiency through asynchronous exercise prescription and symptom monitoring.

ClinicalTrials.gov NCT04533165; https://clinicaltrials.gov/study/NCT04533165.

In recent years, cancer survival rates have increased exponentially. However, this rise in survival comes with a significant drawback. As the number of treatment lines has grown, so too have the side effects, which can severely impact patients' functionality and quality of life. One of the most concerning effects is dyspnoea, a serious health issue that imposes substantial limitations on individuals. While traditional clinical approaches, primarily focused on pharmacological interventions, are commonly employed to manage dyspnoea, we argue that these methods may not always provide optimal symptomatic relief. Therefore, we propose a study protocol to implement an interdisciplinary intervention for these patients. This protocol aims to enhance standard clinical practice by introducing a program of functional re-education and environmental adaptation. We believe this intervention is essential for the follow-up care of patients with respiratory conditions after hospital discharge.

A two-arm, randomized, parallel, controlled clinical trial will be conducted by the University of Salamanca, Spain, in collaboration with the Medical Oncology Service of the University Health Care Complex of Salamanca. The trial aims to recruit 80 oncology patients who exhibit symptoms of dyspnoea during hospital admission. Participants will be randomly assigned to one of two groups: the control group, which will receive a health education program, and the experimental group, which will receive both the health education program and a functional re-education and environmental adaptation program. Assessments will be conducted at three time points: baseline (prior to hospital discharge), follow-up (15 days after discharge), and the end of the intervention (1 month after discharge). During these assessments, sociodemographic data will be collected, and the following scales will be administered: Barthel Index, Medical Research Council Dyspnoea Scale (mMRC), EuroQol 5-D questionnaire (EQ-5D), Visual Analogue Scale (VAS), Short Physical Performance Battery (SPPB), Tampa Scale for Kinesiophobia (TSK), and the Zarit Reduced Caregiver Burden Scale.

The findings of this research can be easily implemented in clinical settings by introducing a targeted intervention to improve the quality of life for this patient population. This study aims to advance traditional clinical approaches by facilitating the recovery or adaptation of cancer patients in their daily routines, in relation to the severity of their symptoms. Our primary goal is to enhance independence and functionality, ultimately improving their overall standard of living.

ClinicalTrials.gov; ID: NCT06035263. Registered on: September 19, 2023. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000DM2U&selectaction=Edit&uid=U0004OJ7&ts=6&cx=f7qqxo.

Cancer-related fatigue is one of the most common burdens of cancer patients. To date, most studies focused on fatigue during or after treatment. However, investigation of pretreatment fatigue is crucial to identify causal or risk factors other than cancer therapy and to enable timely fatigue management.

Two hundred and thirty-two breast cancer patients (mean age = 55.6) and 41 healthy participants (mean age = 49.3) were recruited via the National Center for Tumor Diseases (NCT) Heidelberg. Patient-reported outcomes were assessed with the EORTC QLQ-FA12 for fatigue, the EORTC QLQ-C30 for functioning, the STAI for anxiety, the CESD-R for depression and the PSQI for sleep disturbance. Descriptive analyses and logistic regression models were performed using baseline data before start of cancer treatment. The thresholds of clinical importance (TCI) were applied to test for clinically relevant fatigue.

Compared to the healthy participants, patients scored significantly higher in physical, emotional, and total fatigue, in depression, in global health status and in all functioning scales except cognitive function (all p < 0.01). 48.7% of all patients reported clinically relevant fatigue. Being younger, being obese, having low education, or low social support was associated with a higher likelihood of clinically relevant fatigue before treatment. Higher depression and anxiety scores, poorer sleep quality and global health status, and impaired functioning seemed to get along with an increased likelihood of scoring above the TCI of fatigue (all p < 0.001).

Our study results suggest that fatigue screening, patient-centered fatigue education and psychosocial support may be needed already from the time of cancer diagnosis.

Cancer-related fatigue (CRF) is the most prevalent, distressing, and quality of life disturbing symptom during and after cancer treatment for many cancer types including breast cancer. The experience and burden of this symptom can induce a cognitive bias towards fatigue or a fatigue-related self-image, which can further increase the fatigue symptoms and related behaviour. For this, a Cognitive Bias Modification (CBM) eHealth app (IVY) has been developed. The app aims to counter the fatigue-related self-image and to modify it towards vitality, which might translate to less experienced fatigue and more experienced vitality. This study aims to evaluate the feasibility of the IVY CBM training and the research design of a wait-list control trial. If feasibility is judged sufficient, the effectiveness of the CBM app will also be analyzed on (1) underlying mechanisms (cognitive fatigue bias), (2) symptom fatigue (self-reported fatigue and vitality), and (3) related behaviours (avoidance and all-or-nothing behaviour).

This feasibility study addresses individuals being treated for breast cancer receiving (neo)adjuvant treatment or metastatic care. The number of target participants is 120 (60 (neo)adjuvant, and 60 metastatic) patients. Both groups will be randomized with 30 people in the IVY treatment group and 30 people in the delayed treatment control group. All participants will receive the training via the IVY app, in which participants categorize words related to vitality with words related to 'I' and words related to fatigue with words related to 'other'. If feasibility is judged sufficient, the effects of the training will be explored on 3 levels: (1) self-identity bias, which will be measured with a short computer task based on the Implicit Association Test (IAT), (2) avoidance and all-or-nothing behaviour, and (3) fatigue and vitality levels, which will all be measured with questionnaires.

This study aims to evaluate the feasibility of a larger-scale multi-centre Randomized Controlled Trial (RCT) to investigate a novel eHealth application and, if possible, to give indications on the effectiveness of this intervention to counter fatigue in individuals with breast cancer. Using the IVY CBM app requires very little effort, both in time and cognitive load, which could be especially beneficial for fatigue symptoms.

Registered at the Open Science Framework (OSF; https://osf.io/e85g7/ ) on October 20, 2023.

Cancer survivors experience an array of physical, psychological, and social problems after treatment has ended. Perceived social isolation may exacerbate the effects of physical problems on mental health. We examined the association between physical health (cancer-related fatigue and physical function) and mental health (depression and anxiety symptoms) in cancer survivors in the first year of survivorship (i.e., up to one year after the end of treatment with curative intent), as well as the moderating role of perceived social isolation.

Survey data were collected from 118 cancer survivors who completed treatment with curative intent in the last year. We assessed mental and physical health symptoms, as well as perceived social isolation.

In multivariable analyses, fatigue was significantly associated with both depression (β = 0.279, 95% CI: 0.193,0.362) and anxiety symptoms (β = 0.189, 95% CI: 0.106,0.272). Social isolation moderated the effect of fatigue on depression and anxiety such that higher social isolation exacerbated the association of fatigue with mental health.

Cancer survivors who continue to experience fatigue after curative treatment are at risk for mental health problems, including depression and anxiety symptoms. For cancer survivors who feel socially isolated, the association between fatigue and mental health may be stronger. The current standard of care for survivorship does not sufficiently address psychosocial needs. Future research should evaluate the inclusion of social support interventions in early-term survivorship care.

Background: Patients report fatigue as the most distressing symptom associated with cancer and treatment. Baduanjin has beneficial effects on reducing fatigue. However, no relevant randomized controlled trials comparing the effects of Baduanjin exercise with routine exercise in patients with lung cancer and fatigue have been reported. Methods: This blinded trial aimed to compare the effect of Baduanjin versus routine exercise on fatigue for patients with lung cancer. Participants in the intervention group received Baduanjin training and performed Baduanjin every week, while those in the control group performed routine exercise at the same frequency. Results: A total of 73 patients were analyzed. After the intervention, patients in the Baduanjin group experienced significant improvement in fatigue and pain (p < 0.05), while no significant difference in Edmonton Symptom Assessment System items were observed among patients in the exercise group. Conclusion: Our study showed that Baduanjin was a better exercise than routine activity in relieving their fatigue.

Little is known about the impacts of fatigue after cancer treatment, including whether cancer-related fatigue impacts people's use of healthcare. This study sought to examine how cancer-related fatigue impacts healthcare use after completing cancer treatment. A population-based survey was administered in Nova Scotia, Canada, to examine survivors' experiences and needs after completing cancer treatment. Respondents included survivors of breast, melanoma, colorectal, prostate, hematologic, and young adult cancers who were 1-3 years post-treatment. Survey responses were linked to cancer registry, physicians' claims, hospitalization, and ambulatory care data. Data were analyzed descriptively and using regression models. The final study cohort included 823 respondents. Younger respondents reported higher levels of cancer-related fatigue compared to older respondents. More females than males reported cancer-related fatigue. Upon adjusted analyses, those with cancer-related fatigue had lower odds of being discharged to primary care for their cancer-related follow-up (odds ratio = 0.71, p = 0.029). Moreover, those with cancer-related fatigue had 19% higher primary care use (incidence rate ratio = 1.19, p < 0.0001) and 37% higher oncology use (incidence rate ratio = 1.37, p < 0.016) during the follow-up period compared to those without cancer-related fatigue. Providers (oncology and primary care) may require additional support to identify clinically relevant fatigue and refer patients to appropriate resources and services.

Cancer-related fatigue is a pervasive symptom, affecting up to 90% of cancer patients throughout their illness, and can persist well after treatment has ended. Despite its prevalence, no definitive evidence-based treatment exists, leading to an abundance of proposed alternatives, including natural supplements. To further explore the potential effects of guaraná on cancer-related fatigue, a systematic review with meta-analysis was conducted and registered on the International Prospective Register of Systematic Reviews (CRD42023484144).

A thorough search of PubMed/MEDLINE and Cochrane Library was conducted using MeSH terms and related keywords for cancer-related fatigue and guaraná. Eligible studies were selected according to predetermined criteria and assessed for quality in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Data extraction was independently performed by two reviewers, with any discrepancies resolved by a third researcher.

In total, 4 full articles and 1 abstract, encompassing a total of 229 patients from 2009 to 2023, were included in the meta-analysis. Despite high heterogeneity between studies (I2=78%, ꭓ2=18.51, df=4, p=0.0010), the analysis revealed a significant benefit of using guaraná to alleviate cancer-related fatigue, with a standard mean difference of -0.77 (95%CI -1.34, -0.21) and a test for the overall effect of Z=2.68 (p=0.007).

This meta-analysis provides support for the use of guaraná in the treatment of cancer-related fatigue. However, further investigation through larger prospective randomized controlled trials is necessary to validate these findings.

The majority of cancer patients experience fatigue during the course of their illness. Fatigue should not be seen as an inevitable consequence of cancer and its treatment. Cancer-related fatigue (CRF) is a multidimensional symptom complex that is influenced by a variety of factors. Complementary medicine approaches offer potentially promising strategies to address this fatigue and can therefore be a valuable addition to conventional therapies.In this narrative review, complementary medicine treatment approaches for tumor-associated fatigue are presented according to the historical development and current scientific evidence. The focus is on methods with the highest current evidence based on the recommendations of national and international guidelines. Therapeutic approaches from mind-body medicine, such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), yoga, tai chi, and qigong, as well as acupuncture, acupressure, moxibustion, and phytotherapeutic treatment approaches are presented.In Germany, the complementary therapies listed here are not generally covered by health insurances. However, a few clinics have developed comprehensive programs in mind-body medicine, for which cost coverage has already been obtained. As a result, complementary medical treatments for cancer-related fatigue that adhere to national and international guidelines are typically available only as private services or within the framework of study participation.

Older cancer survivors consistently express the need for interventions to reduce cancer-related fatigue (CRF) and maintain quality of life (QOL). Yoga is a promising treatment to address CRF and QOL. However, research comparing the efficacy of yoga for improving fatigue and QOL in older survivors (60+) vs. younger adult survivors (≤59)is limited. Our objective was to examine the effects of yoga on CRF and QOL in older survivors vs. younger survivors.

We conducted a secondary analysis of a nationwide, multicenter, phase 3 randomized controlled trial. For this study, participants who provided evaluable pre- and post-intervention data on the Functional Assessment for Chronic Illness Therapy-Fatigue (FACIT-F) and the Functional Assessment for Cancer Therapy-General (FACT-G) were eligible. The yoga intervention comprises gentle Hatha and Restorative Yoga and includes breathing exercises, physical alignment postures, and mindfulness.

Of the 177 participants included in the study, 30.1 % were aged 60+ and 69.9 % were aged ≤59. More younger participants had breast cancer (82.0 % vs. 59.2 %. p = 0.009), surgery (98.9 % vs. 77.8 %, p < 0.001), and chemotherapy (80.5 % vs. 55.6 %, p = 0.001). There were no differences in the cancer stage (66.1 % stage I or II). There were statistically significant and clinically meaningful within-group improvements from baseline to post-intervention in CRF for participants aged ≤59 and participants aged 60+ (4.0 ± 0.7, p < 0.001 vs. 3.1 ± 1.0, p = 0.003). Both age groups also demonstrated improvements in QOL (3.2 ± 0.8, p < 0.001 vs. 2.1 ± 1.2, p = 0.078), physical (1.6 ± 0.3, p < 0.001 vs. 0.8 ± 0.5, p = 0.084), functional (0.7 ± 0.3, p = 0.048 vs. 1.0 ± 0.5, p = 0.037), and emotional well-being. There were no significant between-group differences between the age groups. Most younger and older participants reported that yoga helped improve their sleep quality (92.8 % vs 88.5 %) and they would recommend it to other survivors (98.2 % vs 90.4 %).

Older cancer survivors who undergo gentle Hatha and restorative yoga performed two to three times per week for four weeks at a low to moderate level of intensity have similar improvements in CRF and QOL compared to participants aged ≤59. For older survivors experiencing these toxicities, it is reasonable for clinicians to prescribe yoga.

govidentifier: NCT00397930.

The study aimed to assess the impact of interactive video games (IVGs) as a form of physical activity (PA) on the quality of life.

The study used a quality-of-life questionnaire (KIDSCREEN-10) and the HBSC questionnaire. In order to determine individual IVGs training parameters, an initial assessment of cardiorespiratory fitness level was performed, using the Cardio Pulmonary Exercise Test-Godfrey's progressive protocol. Children in the intervention group participated in 12 interval training sessions using IVGs (Microsoft's Xbox 360 S console with Kinect,).

The study included 21 patients (7-13 years old; 12 boys and 9 girls) treated for acute lymphoblastic leukemia (n = 13) and acute myeloid leukemia (n = 8). Before the IVGs, all children had insufficient PA levels (90% of children in the intervention group and 90.91% of children in the control group did not engage in any PA during the last 7 days). After the intervention, 80% of the children in the IVGs group undertook PA lasting at least 60 min a day, three times a week. They exhibited better well-being, a subjective feeling of improved physical fitness (p < 0.0001), a greater subjective sense of strength and energy (p < 0.0001), and less feeling of sadness (p = 0.0016) than the children from the control group (p = 0.0205).

The results of our study confirmed that an attractive form of virtual game or sport is willingly undertaken by children undergoing cancer treatment, and has significant benefits in improving the quality-of-life parameters. There is a clear need to create specific recommendations and rehabilitation models for children with cancer.

Individuals diagnosed with cancer experience multiple inter-related short- and long-term side effects. Chief among such symptomology is cancer-related fatigue (CRF), which, if left unmanaged, can become chronic and result in increased disability and healthcare utilization. A growing number of self-report scales have been developed to measure CRF symptoms based on various theoretical conceptualizations with the aim of promoting targeted assessment and intervention efforts. It may be, however, unwise to assume that the various measures are conceptually similar (i.e., that they assess for the same constructs). Accordingly, we aimed to characterize item content among nine self-report scales, using a Jaccard index to quantify content overlap among scales.

We characterized construct assessment among nine self-report scales recommended to assess CRF by a recent clinical practice guideline, and used a Jaccard index to quantify content overlap among scales.

Analysis of 208 items across nine rating scales resulted in 20 distinct symptoms of CRF assessed. The most common symptoms were energy level (captured in all nine scales), cognitive function, impaired task performance (in eight scales), sleepiness, and physical function (in seven scales). Mean overlap among all scales was low (Jaccard index = 0.455). Only one construct (duration of fatigue; 5.0%) was captured by a single scale, and one symptom (energy level; 5.0%) was common across all scales. The PFS, MFSI, and BFI each captured at least one symptom from each of the NCCN domains of CRF.

CRF scales are heterogeneous in the content they measure, critically impairing integration of knowledge across studies using disparate scales. Future work is urgently needed to build more integrated theoretical and/or computational models of CRF based on relevant mechanisms.

Cancer survivors frequently experience prolonged physical and psychological symptoms including cancer-related fatigue (CRF), sleep disturbances, cognitive impairment, and musculoskeletal pain. Conventional treatments for these symptoms have demonstrated limited efficacy, emphasising the need for complementary therapies. The Yoga for Cancer Survivors (YOCAS) program is a structured mind-body intervention designed to address these challenges. This systematic review evaluated the efficacy of YOCAS in managing CRF, sleep quality, cognitive function, and musculoskeletal symptoms in cancer survivors using randomised controlled trials (RCTs). A comprehensive search was conducted across the Google Scholar, Scopus, Cochrane Library, and PubMed databases for RCTs published between January 2000 and September 2024. Eligible studies included adult cancer survivors who had completed primary treatment and compared YOCAS interventions to control groups. The primary outcomes were cancer-related fatigue, sleep quality, cognitive function, and musculoskeletal symptoms. The risk of bias was evaluated using the Cochrane Risk of Bias Tool, and the findings were synthesised. Six RCTs, involving 1,717 participants, met the inclusion criteria. The YOCAS program demonstrated significant improvements in the reduction of cancer-related fatigue and sleep quality. Cognitive function and memory were improved, particularly among breast cancer survivors, with reduced musculoskeletal pain reported in participants undergoing hormonal therapy. Despite variations in study design, the risk of bias was generally low. ​​​​​​​The YOCAS program effectively reduced cancer-related fatigue, improved sleep quality, and addressed the cognitive and musculoskeletal symptoms in cancer survivors. Given its low risk and broad applicability, YOCAS shows promise as a complementary therapy for cancer survivorship care. Future research should focus on the long-term sustainability of these benefits and explore the impact of the program across diverse cancer populations.

Cancer-related fatigue (CRF) is a prevalent adverse effect experienced by cancer patients while receiving and after treatment, impacting as many as 90% of individuals. Although CRF is common, the genetic processes responsible for it and their influence on individual vulnerability are not well understood and are still being investigated.

The primary objective of this scoping review is to identify and assess genes linked to the vulnerability and severity of CRF. This will help us better understand the genetic factors involved and assist in developing targeted nursing treatments in clinical settings.

This review followed the PRISMA guidelines. A comprehensive search was performed in databases, such as PubMed, EMBASE, Web of Science, Cochrane Library, SinoMed, CNKI, and VIP, encompassing genetic association studies on CRF published up to February 25, 2024. The JBI Critical Appraisal Tools were used to assess the quality of observational studies.

This evaluation encompassed a comprehensive analysis of 14 studies that involved 3,254 patients. The results indicate strong connections between CRF and various inflammatory cytokines (IL-4, IL-6, IL-8, IL-10, IL-1β), tumor necrosis factor-alpha (TNF-α), catechol-O-methyltransferase (COMT), and circadian rhythm genes (CLOCK, PER).

This scoping review emphasizes the significant genetic factor in CRF, with multiple genes showing distinct effects on cancer fatigue symptoms. Identifying these genes enhances our comprehension of CRF and unveils novel avenues for cancer treatment approaches. Future research should prioritize conducting cohort studies to monitor alterations in gene expression pre- and post-treatment, hence improving individualized medicinal strategies in oncology.

Cancer-related fatigue (CRF) is common among patients with cancer. Various interventions have been reported to reduce fatigue, and some evidence suggests that nurse-led interventions may be effective in the management of CRF. A systematic review was conducted to assess the effectiveness of nurse-led interventions for CRF in patients with cancer and survivors.

The aim of this study was to review and appraise the evidence for the effectiveness of different types of nurse-led interventions on fatigue in patients with cancer and survivors.

Electronic databases such as PubMed, Scopus, Cochrane Library, Web of Science, and ScienceDirect were searched to identify studies published from January 2013 to October 2023. The studies that described nurse-led interventions in patients with cancer or survivors regardless of treatment duration, modes of intervention delivery, and any based intervention were included. The studies were excluded if no fatigue was an outcome measure.

Twelve studies from 2013 to 2023 were included and eligible for the review. Nine studies obtained a Jadad score of 3 or more, indicating high quality for the quality assessment. Eleven of the included studies reported a significant effect of the nurse-led interventions in reducing fatigue in patients with cancer or survivors.

Nurse-led interventions that focus on multidisciplinary, exercise, psychological, and behavioral approaches appear promising in the management of CRF. More research is needed in order to determine the most acceptable forms of intervention.

The development of evidence-based interventions for managing CRF is significant to nursing practice.

Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate that targets human epidermal growth factor receptor 2 (HER2) and has shown promising results in the treatment of advanced/metastatic breast cancer. The objective of this report is to provide guidance on the prophylaxis, monitoring, and management of adverse events (AEs) in patients with breast cancer treated with T-DXd, and to emphasize that proper management of AEs is needed to optimize the effectiveness of T-DXd treatment and reduce the number of discontinuations. The article covers various aspects of T-DXd treatment, including its clinical efficacy, safety profile, and dosing considerations, and provides practical recommendations for managing AEs, such as nausea/vomiting, interstitial lung disease, and hematologic toxicity. Although there are still many knowledge gaps about the cause and incidence of AEs in real-world patients, this document may serve as a valuable resource for clinicians who are involved in the care of breast cancer patients receiving T-DXd treatment.

To determine if the effects of exercise-based cancer rehabilitation on physical functioning, activity (including physical activity) and participation (including quality of life) are maintained at 6 to 12 months.

Electronic databases CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched from the earliest available time to August 2021. Randomised controlled trials examining the long-term effects (≥ 6 months post-intervention) of exercise-based rehabilitation were eligible for inclusion. Outcome data (e.g. fitness, physical activity, walking capacity, fatigue, depression, quality of life) were extracted and the methodological quality assessed using PEDro. Meta-analyses using standardised mean differences were used to synthesise data and Grades of Recommendation, Assessment, Development and Evaluation criteria were applied.

Nineteen randomised controlled trials including 2974 participants were included. Participants who underwent exercise-based rehabilitation had improved physical activity (SMD 0.30, 95% CI 0.09 to 0.51, I2 = 0%), cardiorespiratory fitness (SMD 2.00 ml/kg/min, 95% CI 0.56 to 3.45, I2 = 0%), walking capacity (SMD 0.62, 95% CI 0.33 to 0.92, I2 = 0%), depression (SMD 0.71, 95% 0.05 to 1.37, I2 = 90%), quality of life (physical functioning component SMD 0.56, 95% CI 0.11 to 1.01, I2 = 62%) and sleep (MD 0.69 points, 95% 0.46 to 0.92, I2 = 0%) at 6 to 12 months follow-up. There was no data available on cancer-related mortality or recurrence.

Health outcomes of cancer survivors after exercise-based rehabilitation can be maintained after rehabilitation completion.

Cancer survivors can maintain health benefits achieved through exercise-based rehabilitation.

Cancer-related fatigue (CRF) is unrelenting. As neither rest nor sleep ameliorates cognitive, emotional, and physical symptoms, quality of life is diminished. This study examines resistance training (RT) effectiveness on CRF in cancer survivors. The secondary aims were to identify the dose-response relationship of RT frequency, intensity, and volume on CRF in different cancer survivor populations.

Systematic searches via numerous databases for RCTs were performed in June 2022. Patient-reported outcome measures (PROM), were analysed, pre-to-post intervention, using a random-effects model. The Physiotherapy Evidence Database (PEDro) scale informed methodological quality assessment.

Eight studies were included (cancer survivors: breast (BCS) = 5; endometrial (ECS) = 1; prostate (PCS) = 2). Overall, RT interventions ≥ 6 weeks elicited large significant reductions in CRF for FACIT-F (SMD = 0.932, p = <0.001) and moderate significant reductions in CRF for PFS-R (SMD = -0.622, p = 0.004).

Main findings indicate that RT ameliorates CRF, especially in BCS; however, individualised approaches should be advocated. Supervised training elicited the greatest positive outcomes, thus should be a pivotal part of the cancer rehabilitation pathway. Future studies should be adequately powered, undertake discrete analyses of different cancer types, and investigate chronic RT effects.

Cancer-related fatigue, pain, gastrointestinal and other symptoms are among the most familiar complaints in practically every type and stage of cancer, especially metastatic cancers. Such symptoms are also related to cancer oxidative stress and the damage instigated by cancer cytotoxic therapies to cellular membranes, especially mitochondrial membranes. Cancer cytotoxic therapies (chemotherapy and radiotherapy) often cause adverse symptoms and induce patients to terminate their anti-neoplastic regimens. Cancer-related fatigue, pain and other symptoms and the adverse effects of cancer cytotoxic therapies can be safely moderated with oral Membrane Lipid Replacement (MLR) glycerolphospholipids and mitochondrial cofactors, such as coenzyme Q10. MLR provides essential membrane lipids and precursors to maintain mitochondrial and other cellular membrane functions and reduces fatigue, pain, gastrointestinal, inflammation and other symptoms. In addition, patients with a variety of chronic symptoms benefit from MLR supplements, and MLR also has the ability to enhance the bioavailability of nutrients and slowly remove toxic, hydrophobic molecules from cells and tissues.

Cancer-related fatigue (CRF) is a common side effect of cancer and cancer treatment that significantly impairs the quality of life and can persist for years after treatment completion. Although fatigue is often associated with cancer treatment, it is also a result of the disease itself, even before intervention. CRF at the time of diagnosis may affect treatment timing or completion and is a consistent predictor of post-treatment fatigue at any time. The mechanisms underlying CRF are multidimensional and not well understood, particularly at the time of diagnosis.

Sixty-five breast cancer patients at the time of diagnosis were included. The participants completed self-assessment questionnaires about CRF, sleep disturbances, and emotional symptoms and wore an accelerometer to assess levels of spontaneous physical activity and sleep quality. During the experimental session, the participants underwent cognitive, neuromuscular, and exercise metabolism evaluations.

Using augmented backward elimination regression, this study found that emotional symptoms and perceived sleep disturbances were the strongest predictors of CRF (adjusted r2 = 0.51). Neuromuscular fatigability and sleep disturbance were also associated with physical dimensions, whereas cognitive performance was associated with cognitive dimensions.

At the time of diagnosis, emotional and cognitive dimensions are over-represented compared to the general population, and specific subdimensions have specific predictors that support the idea of distinct mechanisms. Evaluating CRF subdimensions and their potential mechanisms at the time of diagnosis would be particularly relevant for identifying high-risk patients and offering them appropriate interventions.

This study was registered at ClinicalTrials.gov (NCT04391543) in May, 2020.

Patients with advanced cancer are frequently burdened with a severe sensation of fatigue called cancer-related fatigue (CRF). CRF is induced at various stages and treatments, such as cachexia and chemotherapy, and reduces the overall survival of patients. Objective and quantitative assessment of CRF could contribute to the diagnosis and prediction of treatment efficacy. However, such studies have not been intensively performed, particularly regarding metabolic profiles. Here, we conducted plasma metabolomics of 15 patients with urological cancer. The patients with and without fatigue, including those with cachexia or chemotherapy-induced fatigue, were compared. Significantly lower concentrations of valine and tryptophan were observed in fatigued patients than in non-fatigued patients. In addition, significantly higher concentrations of polyamine pathway metabolites were observed in patients with fatigue and cachexia than in those without cachexia. Patients with exacerbated fatigue due to chemotherapy showed significantly decreased cysteine and methionine metabolism before chemotherapy compared with those without fatigue exacerbation. These findings suggest that plasma metabolic profiles could help improve the diagnosis and monitoring of CRF.

Low skeletal muscle mass index (SMI) has recently emerged as an independent prognostic factor in oncological patients and it is linked with poor survival and higher treatment toxicity. The present study aims to determine the possible impact of low SMI on survival and acute toxicity in oropharyngeal patients.

Seventy-six patients with locally advanced oropharyngeal squamous cell carcinoma (stage III-IVC) were treated in our institution with Helical TomoTherapy® (HT - Accuray, Maddison, WI, USA) between 2005 and 2021. All patients received concomitant platinum-based chemotherapy (CT) (at least 200 mg/m2). The SMI was determined using the calculation of cross-sectional area at C3. Twenty patients (26%) presented pre-treatment low SMI, according to Chargi definitions.

All patients concluded the treatment. Thirteen patients with low SMI (65%) and 22 patients with normal SMI (39%) presented acute toxicity greater than or equal to grade 3, but this difference was not statistically significant (p-value = 0.25). Overall survival was analyzed in 65 patients, excluding those who finished CT-RT less than six months before the analysis. Overall survival was significantly lower in low SMI versus normal SMI patients (p-value = 0.035). Same difference was observed in N0-N2a patients, suggesting an important role of SMI also in lower nodal burden and putatively better prognosis.

Although the results are limited to a small population, our case series has the advantage to be very homogeneous in patients and treatment characteristics. In our setting, SMI demonstrated a crucial impact on overall survival. Further investigation with larger samples is necessary to confirm our results to improve patient outcomes.

Cancer-related fatigue (CRF) is a common distressing complaint of breast cancer (BC) patients treated with chemotherapy. Nutritional quality plays a pivotal role in CRF, while increased interest towards new pharmacological agents has been observed. Melatonin, an endogenous hormone that regulates the human sleep-wake cycle, could alleviate CRF. In the present randomized, placebo-controlled 3-month trial, we investigated the effects of melatonin intake (i.e., 1 mg/day) vs. placebo in BC patients on CRF. In both arms, the Mediterranean diet (MD) was implemented. Medical history, anthropometry and blood withdrawal were performed. CRF was evaluated by the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire and MD adherence by the MedDietScore. In total, 49 BC women (median age 52 years) were recruited, namely N = 23 in the intervention arm and N = 26 in the placebo arm. At baseline, CRF was positively associated with body mass index (BMI), even when adjusted for age, waist circumference and blood indices related to disease prognosis (beta = -0.882, p = 0.003). At 3 months, both groups showed a BMI decrease (p < 0.05), but only the intervention group improved CRF compared to baseline (p = 0.003). No differences in CRF were observed between the groups. In conclusion, melatonin oral supplementation could ameliorate CRF in BC patients.

Perceived deficits in executive functioning are among the many difficulties that women diagnosed with breast cancer experience. This study assessed the presence of perceived deficits in executive functioning among women with breast cancer prior to systemic treatment and radiation and associations between perceived deficits in executive function and comorbid fatigue, sleep, and mood disturbance.

Participants were recruited following their breast cancer diagnosis and assessed using the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A), subjective and objective measures of sleep duration and efficiency, and self-report measures of insomnia severity, sleep quality, fatigue, and mood disturbance. Hierarchical regression was used to examine associations between symptoms, adjusting for age and education.

The final sample included 92 women with a mean age of 60.7 years and 13.5 years of education. Thirteen percent of participants reported global executive dysfunction. After partitioning out variability from other independent variables, fatigue (p = < .001), perceived sleep quality (p = .030), and symptoms of insomnia (p = .008) accounted for 13.3%, 5.7%, and 8.5% of unique variance in perceived executive functioning, respectively. Emotional fatigue was most strongly associated with perceived deficits in executive functioning. Neither subjective or objective sleep duration or efficiency was associated with perceived deficits in executive functioning.

Fatigue, particularly emotional fatigue, insomnia, and poor sleep quality had the strongest associations with perceived deficits in executive functioning. Sleep interventions and fatigue management strategies may prove useful for women who seek to improve their perceived executive functioning.

Cancer-related fatigue (CRF) is a highly prevalent and debilitating symptom reported by breast cancer survivors (BCS). CRF has been associated with the co-occurrence of anxiety, depression, poor sleep quality, cognitive impairment, which are collectively termed as psychoneurophysiological (PNP) symptoms. CRF and these PNP symptoms are often reported during and after treatment with long-lasting distress. It is unclear how CRF and these PNP symptoms influence each other. This study aimed to explore predictive factors (i.e., PNP symptoms and social-demographic factors) of CRF, and test exploratory path models of the relationships of CRF with PNP symptoms (depression, anxiety, sleep disturbance, pain, and cognitive function) in BCS.

This paper is part of a larger descriptive, correlational, and cross-sectional study. Validated and reliable instruments assessed CRF, depression, anxiety, sleep disturbance, pain, and cognitive function. Descriptive statistics, Pearson correlation, multiple linear regression models, and path analysis were employed.

Patients (N = 373) who reported less bodily pain had worst CRF (r = -0.45, p < .01). Significant predictors of CRF included depression, sleep disorder, bodily pain, perceived cognitive ability, and dispositional (state) optimism. Depression alone accounted for 31% of the variance in CRF. An integrative path model with bodily pain, neuropathic pain, CRF, and depression showed a good fit across different indices (CFI = 0.993, RMSEA = 0.047, 90% CI 0-0.12, SRMR = 0.027).

This study identified significant predictors of CRF and revealed a good fit mediation model with significant pathways for CRF, suggesting that a common etiology may underpin the co-occurrence of CRF with PNP symptoms (pain and depression). However, further investigation with longitudinal design is necessary to explore the causal relationships of these symptoms. Evidence-based strategies/interventions are needed to reduce or eliminate the burden of these symptoms on the lives of BCS.

In colorectal cancer (CRC) patients, apart from fatigue, psychological and physical symptoms often converge, affecting their quality of life and ability to work. Our objective was to ascertain symptom clusters within a year following CRC treatment and their longitudinal association with persistent fatigue and reduced work ability at the 3-month follow-up. We used data from MIRANDA, a multicenter cohort study enrolling adult CRC patients who are starting a 3-week in-patient rehabilitation within a year post-curative CRC treatment. Participants completed questionnaires evaluating symptoms at the start of rehabilitation (baseline) and after three months. We performed an exploratory factor analysis to analyze the clustering of symptoms at baseline. Longitudinal analysis was performed using a multivariable linear regression model with dichotomized symptoms at baseline as independent variables, and the change in fatigue and ability to work from baseline to 3-month-follow-up as separate outcomes, adjusted for covariates. We identified six symptom clusters: fatigue, gastrointestinal symptoms, pain, psychosocial symptoms, urinary symptoms, and chemotherapy side effects. At least one symptom from each factor was associated with higher fatigue or reduced ability to work at the 3-month follow-up. This study highlights the interplay of multiple symptoms in influencing fatigue and work ability among CRC patients post-rehabilitation.

This study aimed to examine the effects of an eight-session structured urban forest healing program for cancer survivors with fatigue.

Cancer-related fatigue (CRF) is a complex and multifactorial common symptom among cancer survivors that limits quality of life (QoL). Although health benefits of forest healing on physiological, physical, and psychological aspect as well as on the immune system have been reported in many studies, there is limited evidence on the efficacy of specialized forest program for cancer survivors.

A single-blinded, pre-test and post-test control group clinical trial was conducted with -75 cancer survivors assigned to either the forest healing group or the control group. The intervention was an eight-session structured urban forest program provided at two urban forests with easy accessibility. Each session consists of three or four major activities based on six forest healing elements such as landscape, phytoncides, anions, sounds, sunlight, and oxygen. Complete data of the treatment-adherent sample (≥ 6 sessions) was used to examine whether sociodemographic, clinical, physiological (respiratory function, muscle strength, balance, 6-min walking test) and psychological (distress, mood state, sleep quality, QoL) characteristics at baseline moderated the intervention effect on fatigue severity at 9 weeks.

Significant time-group interactions were observed muscle strength, balance, 6-min walking test, distress, fatigue, moods, and QoL. The mean difference in fatigue between pre- and post-forest healing program was 9.1 (95% CI 6.2 to 11.9), 11.9 (95% CI 7.6 to 16.1) in moods, and -93.9 (95% CI -123.9 to -64.0) in QoL, showing significant improvements in forest healing group, but no significant improvements in the control group.

This study suggests that a forest healing program positively impacts the lives of cancer survivors, by addressing both physical and psychological challenges associated with CRF.

KCT0008447 (Date of registration: May 19, 2023).

To investigate influencing factors of cancer-related fatigue (CRF) in adult patients with acute leukemia (AL).

A total of 288 adult patients diagnosed with acute leukemia in West China Hospital were included in this study. A cross-sectional survey, including the Clinical Information Questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Pittsburgh Sleep Quality Index (PSQI), and Hospital Anxiety and Depression Scale (HAD), was provided to the patients. Hierarchical multiple linear regression analyses were conducted to evaluate the associations of the variable factors and the AL patients' CRF.

The CRF score of AL patients was 33.25 ± 10.35. Gender, age, albumin level, depression, anxiety status of the patients and treatment cycles were identified as influencing factors of CRF in AL patients (P < 0.05). The CRF level of acute leukemia patients in the complete remission group was lower than that of patients who were not achieving complete remission. Depression, anxiety, age, employment, albumin, and sleep disturbance were independent influencing factors for CRF in patients who were not achieving complete remission.

Acute leukemia patients who are female, older, hypoalbuminemia，or in the induction therapy have a higher risk of developing a high degree of CRF. Clinical staff should pay more attention to the CRF of patients who were not achieving complete remission. Early screening and aggressive intervention could be adopted in caring for these patients.

Little is known about the effectiveness of the newly emerging technology of exergaming in reducing Cancer Related Fatigue (CRF).

The study's primary aim was to examine the effectiveness of exergaming in reducing CRF; the secondary aims were to improve functional capacity/endurance and promote physical activity (PA) among children with acute lymphoblastic leukemia (ALL).

In this Randomized Controlled Trial (RCT), 45 children aged 6-14 years were randomly assigned into group-I, n = 22, and group II, n = 23. Group-I played exergaming of moderate intensity for 60 min, twice a week for three weeks. Group II was given an instructional session regarding the benefits of PA with advice to practice PA for 60 min twice a week. CRF, functional capacity/endurance, and PA were measured using the pediatric quality of life multidimensional fatigue scale (Ped-QLMFS), six-minute walk test (6-MWT), and Godin-Shepard Leisure Time Physical Activity Questionnaire (QSLTPAQ) respectively. All measurements were taken thrice; in the first, third, and fifth weeks of intervention.

Group-I demonstrated a significant reduction of CRF, and a significant increase of functional capacity/endurance compared to group-II over the five weeks study period. The effect of time × intervention interaction was significant. Based on Cohen's guidelines, CRF and functional capacity/endurance had large effect sizes (η² = 0.41, p = .00) and (η² = 0.27, p = .00) respectively.

The protocol of exergaming used in this RCT effectively reduces CRF and promotes functional capacity/endurance and PA in children with ALL undergoing chemotherapy. It may provide an alternative treatment modality to decrease the healthcare load.Key messagesCancer-related fatigue (CRF) is described as physical exhaustion, sleep disturbance, emotional distress, and cognitive dysfunction.Exergaming reduces CRF and promotes functional capacity/endurance and physical activity in children with acute lymphoblastic leukemia undergoing chemotherapy.Exergaming may provide an alternative treatment modality to decrease the healthcare load.