Integrative Nonpharmacologic Behavioral Interventions for the Management of Cancer-Related Fatigue

Mustian, Karen M.; Morrow, Gary R.; Carroll, Jennifer K.; Figueroa-Moseley, Colmar; Jean‐Pierre, Pascal; Williams, Geoffrey

doi:10.1634/theoncologist.12-s1-52

Cited by 226 publications

(231 citation statements)

References 159 publications

(200 reference statements)

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“…Patients with low levels of physical activity have higher levels of pro-inflammatory cytokines, whereas exercise has been shown to reduce fatigue in those with nonmalignant disease and in those with cancer [22,23]. The exact mechanisms for this are unclear in patients with cancer, but there is a growing body of work examining possible causal factors [23].…”

Section: Discussionmentioning

confidence: 99%

The Systemic Inflammatory Response and Its Relationship to Pain and Other Symptoms in Advanced Cancer

et al. 2013

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Introduction. Inflammation has been identified as a hallmark of cancer and may be necessary for tumorgenesis and maintenance of the cancer state. Inflammation‐related symptoms are common in those with cancer; however, little is known about the relationship between symptoms and systemic inflammation in cancer. The aim of the present study was to examine the relationship between symptoms and systemic inflammation in a large cohort of patients with advanced cancer. Methods. Data from an international cohort of patients with advanced cancer were analyzed. Symptoms and patient‐related outcomes were recorded using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire—Core Questionnaire. Systemic inflammation was assessed using C‐reactive protein levels. The relationship between these symptoms and systemic inflammation was examined using Spearman rank correlation (ρ) and the Mann‐Whitney U test. Results. Data were available for 1,466 patients across eight European countries; 1,215 patients (83%) had metastatic disease at study entry. The median survival was 3.8 months (interquartile range [IQR] 1.3–12.2 months). The following were associated with increased levels of inflammation: performance status (ρ = .179), survival (ρ = .347), pain (ρ = .154), anorexia (ρ = .206), cognitive dysfunction (ρ = .137), dyspnea (p= .150), fatigue (ρ = .197), physical dysfunction (ρ = .207), role dysfunction (ρ = .176), social dysfunction (ρ = .132), and poor quality of life (ρ = .178). All were statistically significant at p < .001. Conclusion. The results show that the majority of cancer symptoms are associated with inflammation. The strength of the potential relationship between systemic inflammation and common cancer symptoms should be examined further within the context of an anti‐inflammatory intervention trial.

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Section: Discussionmentioning

confidence: 99%

The Systemic Inflammatory Response and Its Relationship to Pain and Other Symptoms in Advanced Cancer

et al. 2013

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“…This view is unfortunate and is contradicted by the available evidence. In this issue, Mustian et al [16] provide an overview of the current NCCN recommendations for assessment and management of CRF. Various integrative nonpharmacologic behavioral interventions are available; physical exercise and psychosocial therapy have the strongest scientific evidence supporting their effectiveness.…”

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confidence: 99%

“…Multidimensional CRF measures may be useful in assessing physical, emotional, and cognitive domains. In a related vein, the articles by Roscoe et al [20], Mustian et al [16], and Ryan et al [21] summarize information showing that fatigue may occur as part of a cluster of symptoms including pain, difficulty sleeping, and perceived muscle weakness. The associations among these symptoms might prompt the development of effective integrated treatment strategies.…”

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confidence: 99%

Cancer-Related Fatigue: Causes, Consequences, and Management

Morrow

2007

The Oncologist

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“…The psychoeducative fatigue group focused on CRF comprehension and management, stress management, including exercises for improving mindfulness, relaxation, and handling of emotions in an interactive manner from a psychotherapeutic and anthroposophical point of view. 10,27 2. Sleep education, apart from a lesson on the basics of chronobiology and sleep medicine (circadian, rest/activity, basic rest/activity rhythm, and sleep regulation) included a sleep diary based on sleep hygiene, sleep restriction, and stimulus control consultation with individual recommendations.…”

Section: Methodsmentioning

confidence: 99%

“…6 The best available evidence for therapeutic effects on CRF in breast cancer patients exists for aerobic training, followed by sleep hygiene, sleep restriction, stimulus control, behaviour treatment, 10,11 and other modes of cognitive behaviour therapy. 12 Pharmacological therapies (apart from transfusion in the case of anemia) such as the use of erythropoietin are controversial because of a 17% elevated mortality risk.…”

Section: Introductionmentioning

confidence: 99%

Multimodal Therapy Concept and Aerobic Training in Breast Cancer Patients With Chronic Cancer-Related Fatigue

et al. 2012

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Hypothese: Cancer-related fatigue (CRF) and sleep disorders are some of the most wearing and common symptoms in disease-free breast cancer patients (BC). Aerobic training (AT) is the treatment with the best available evidence, even though it seems to be insufficient with regards to improvements in cognitive fatigue. We introduced a new multimodal therapy concept (MM) consisting of psycho-, sleep-education and new approaches based on anthroposophic medicine such as eurythmy and painting therapy. Study design: This pilot study will test the implementation of MM and yield first results of the MM and AE in our centres. Methods: 31 out of 34 patients suffering from BC and CRF were fully assessed in a ten-week intervention study. 21 patients chose MM and 10 decided on AT. CRF was measured with the help of the Cancer Fatigue Scale (CFS-D), and the global quality of sleep was measured with the Pittsburgh Sleep Quality Index (PSQI). We also captured autonomic regulation (aR) and patients' satisfaction with questionnaires. Statistical analysis was done with SAS 9.1.3 for windows. Results:The new MM therapy can be implemented with high satisfaction among patients. Significant improvements were found in the MM group with regards to CFS-D, global quality of sleep, sleep efficiency (PSQI), aR and rest/activity regulation compared to baseline (all p<0.05). In the AT group aR orthostatic-circulatory and rest/activity regulation improved significantly (p<0.05), too. However, no improvement in cognitive fatigue was seen in either group. Conclusion: The multimodal therapy concept was feasible and improved cancer fatigue, sleep quality, autonomic and rest-/ activity regulation in breast cancer patients. It may therefore constitute a valuable treatment option in addition to aerobic training for BC patients with CRF. A further study with larger sample size needs to be carried out to assess the efficacy of combined multimodal-aerobic therapy.

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Integrative Nonpharmacologic Behavioral Interventions for the Management of Cancer-Related Fatigue

Cited by 226 publications

References 159 publications

The Systemic Inflammatory Response and Its Relationship to Pain and Other Symptoms in Advanced Cancer

The Systemic Inflammatory Response and Its Relationship to Pain and Other Symptoms in Advanced Cancer

Cancer-Related Fatigue: Causes, Consequences, and Management

Multimodal Therapy Concept and Aerobic Training in Breast Cancer Patients With Chronic Cancer-Related Fatigue

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