Jane Rankin

The Cancer Rehabilitation Journey: Barriers to and Facilitators of Exercise Among Patients With Cancer-Related Fatigue

Background Despite the evidence to support exercise as an effective management strategy for patients with cancer-related fatigue (CRF), many of the general cancer population are sedentary. Objective The aim of this study was to explore the barriers to and facilitators of exercise among a mixed sample of patients with CRF. Design An exploratory, descriptive, qualitative design was used. Methods Purposive sampling methods were used to recruit patients with CRF who were representative of the cancer trajectory, that is, survivors of cancer and patients in palliative care who were recently diagnosed and undergoing treatment. Focus group discussions were transcribed verbatim and analyzed using a grounded theory approach. Lower-level concepts were identified and ordered into subcategories. Related subcategories then were grouped to form the main categories, which were linked to the core category. Results Five focus groups were conducted with 26 participants. Within the core category of the cancer rehabilitation journey were 3 main categories: (1) exercise barriers, (2) exercise facilitators, and (3) motivators of exercise. Exercise barriers were mainly related to treatment side effects, particularly fatigue. Fatigue was associated with additional barriers such as physical deconditioning, social isolation, and the difficulty of making exercise a routine. Environmental factors and the timing of exercise initiation also were barriers. Exercise facilitators included an exercise program being group-based, supervised, individually tailored, and gradually progressed. Exercise motivators were related to perceived exercise benefits. Conclusions Individuals with CRF have numerous barriers to exercise, both during and following treatment. The exercise facilitators identified in this study provide solutions to these barriers and may assist with the uptake and maintenance of exercise programs. These findings will aid physical therapists in designing appropriate exercise programs for patients with CRF.

Fatigue in gynecological cancer patients during and after anticancer treatment.

CONTEXT Research has indicated that individuals with gynecological cancer experience severe fatigue. OBJECTIVES This longitudinal survey aimed to analyze the fatigue experienced over the course of one year by a gynecological cancer population, to determine if the fatigue was more severe than that reported by females without cancer, and to identify variables associated with cancer-related fatigue (CRF). METHODS Data were collected over a 12-month period before, during, and after anticancer treatment. Fatigue was assessed using the Multidimensional Fatigue Symptom Inventory-Short Form. Participants with cancer also completed the Rotterdam Symptom Checklist. RESULTS Sixty-five cancer patients (mean age = 57.4 years, standard deviation [SD] = 13.9) and 60 control subjects (mean age = 55.4 years, SD = 13.6) participated. Descriptive analysis and repeated measurements modeling indicated that the cancer participants reported worse fatigue than the noncancer individuals before, during, and after anticancer treatment (P < 0.001) and that the level of fatigue in persons with cancer changed with time (P = 0.02). A forward stepwise regression demonstrated that psychological distress level was the only independent predictor of CRF during anticancer treatment (P < 0.00), explaining 44% of the variance in fatigue. After treatment, both psychological distress level (P < 0.00) and physical symptom distress (P = 0.03) were independent predictors of fatigue, accounting for 81% of the variance. CONCLUSION Psychological distress level is an important indicator of CRF in gynecological cancer. Interventions focused on the reduction of psychological distress may help alleviate CRF.

Fatigue in gynaecological cancer patients: A pilot study

RationaleFatigue is a frequent complaint of women with cancer. However, the incidence of fatigue has not been well studied, in particular gynaecological cancer, which despite its prevalence has received minimal investigation.Goals of workThe study aims were (1) to explore the symptoms experienced in a gynaecological cancer population, primarily fatigue and (2) to determine the acceptability of a fatigue questionnaire for use in a longitudinal survey.Patients and methodsOver the course of 1 month, women with gynaecological cancer attending a Regional Cancer Centre completed a demographic and symptom questionnaire and the Multidimensional Fatigue Symptom Inventory—Short Form (MFSI-SF).Main resultsOf the 32 individuals approached, 30 agreed to participate (mean age, 61 years; the most common treatment received was surgery followed by chemotherapy n=11; mean time from commencement of treatment, including surgery = 3 months). All participants completed the MFSI-SF. Tiredness was the most commonly reported symptom, experienced by 90% of subjects and the most frequently stated worst symptom, reported by 23.3%. Furthermore, 23 of 27 subjects reported that tiredness interfered completely with their daily living. The MFSI-SF mean total fatigue score was 14.4 (SD 15.9), ranging from −15 to 50. The possible total fatigue score ranges from −24 to 96.ConclusionDespite the heterogeneous nature of the group, all participants completed the MFSI-SF. The study suggests that fatigue could be a problem for this population group. Thus, a longitudinal survey using the MFSI-SF to investigate the phenomenon further would appear feasible and justified.

Translation research: ‘Back on Track’, a multiprofessional rehabilitation service for cancer-related fatigue

Objectives To assess the effectiveness and acceptability of an individually tailored rehabilitation intervention for patients with cancer-related fatigue (CRF). Methods Eighteen individuals, (16 female, two male, aged 40–83 years), who self-reported CRF (above four on a 10-point Likert scale) took part in an 8 week physical activity intervention weekly review and optional gym-based support. Fifteen participants had a primary diagnosis of breast cancer and along with the other participants had multiple myeloma, colorectal or prostate cancer. All participants took part in a goal-oriented walking and muscle strengthening programme with dietary advice and psychological support based on the Transtheoretical Model (TTM) of behaviour change. Effectiveness was assessed by physical and psychological outcomes. Focus groups with participants and individual interviews with the professionals delivering the intervention explored the feasibility and acceptability of the intervention. Results Statistically significant improvements were seen in the primary outcome of fatigue and on the secondary outcomes of physical function, depression and in triceps skin fold thickness reduction. Participants endorsed the intervention as being highly acceptable, holistic and as important as medical treatments for cancer. The importance of team working was highlighted as key to service delivery and success. Conclusions A multidisciplinary home-based tailored intervention with optional weekly gym attendance is acceptable to people with CRF, improving physical and psychosocial outcomes. Study limitations and suggestions for further research are discussed.

Biological markers as an outcome measure of exercise in cancer rehabilitation: A systematic review

The number of people living with and beyond cancer is at an all time high. These survivors are not necessarily living well, as adverse side effects from cancer and its treatment can last up to 5 years and leave patients at a higher risk of developing secondary cancers and other chronic illnesses. Exercise has been proven to be a safe and effective method of intervention to decrease mortality and overall improve health outcomes. The biological mechanism through which this occurs is an area of research that is in its infancy and not well defined. A systematic search was conducted of four databases for relevant randomized controlled trials (RCTs) published between January 2004 and December 2014. Studies had to include any blood/urine biological markers as an outcome measure to a physical activity intervention for cancer survivors posttreatment. Fifteen relevant articles were identified (12 RCTs). It was shown that randomized controlled trials of exercise for cancer survivors posttreatment may results in changes to circulating levels of insulin, insulin related pathways (insulin like growth factor II [IGF II], IGF binding protein 3), high density lipoprotein, total cholesterol, leptin, and osteocalcin. Due to small sample sizes, the evidence is still preliminary and therefore more research is warranted in this area in the form of larger, statistically powered RCTs for cancer survivors.