Cancer Related Fatigue

Fatigue is a highly prevalent and distressing symptom of cancer and its treatment. However, cancer patients often fail to communicate with their oncologists about fatigue. In this study, we attempted to identify the patient-related barriers to communication about fatigue, as cited by patients. Two hundred patients were sampled across the Community Cancer Care, Inc. (CCC) network of Indiana using the Cancer Behavior Inventory-Brief scale (CBI-B), the Zung Self-Rating Depression Scale (ZSDS), the Functional Assessment of Cancer Inventory-Fatigue scale (FACT-F), and the Fatigue Management Barriers Questionnaire (FMBQ), a questionnaire devised by experts in the field of cancer-related fatigue. There were no significant correlations between the instrument scores and demographic variables. Scores on the instruments did not differ significantly based on whether the patient was from a rural or urban site. One hundred thirty-two patients (66%) reported that they had never spoken to their doctor about fatigue. The most frequently reported reasons for this lack of patient communication about fatigue included the doctor's failure to offer interventions (47%), patients' lack of awareness of effective treatments for fatigue (43%), a desire on the patient's part to treat fatigue without medications (40%), and not wanting to complain to the doctor (28%). Patients reported that medical staff offered a mean of 11.63 recommendations for dealing with fatigue. The FMBQ was found to correlate significantly with self-efficacy

Purpose To establish physiotherapy management of cancer-related fatigue (CRF), in particular, to determine physiotherapy exercise management of CRF. Methods All physiotherapist members of the UK Association of Chartered Physiotherapists in Oncology and Palliative Care (ACPOPC) received a questionnaire. Results The response rate was 65% (223/341). Therapists had a mean of 6.8 years (+/−5.6) experience in oncology and/or palliative care. Seventy-eight percent of therapists recommend and/or use exercise as part of the management of CRF; 74% teach other strategies, most commonly energy-conservation techniques (79%). Therapists recommend and/or use exercise in similar frequencies with a range of cancer types, before (32%), during (53%) and following treatment (59%) and during advanced stages of the disease (68%). The most common barrier encountered by therapists in recommending and/or using exercise was related to the lack-of-exercise guidelines for patients with CRF (71%).

A prospective study was designed to investigate the factors predicting fatigue in breast cancer patients using the Cancer Fatigue Scale (CFS) in addition to the Hospital Anxiety and Depression Scale (HADS) and a questionnaire containing items on demographic and clinical data, and measures of patients' physical symptoms. The CFS measures total fatigue score ranging from 0 (lowest level) to 60 (highest level) and contains three subscales namely: physical, affective and cognitive fatigue. The questionnaires were administered to a consecutive sample of breast cancer patients attending the Iranian Center for Breast Cancer either for their treatment or follow-up examination. In all, 112 patients were studied. The mean age of the respondents was 45.7 years (SD11.0). Most had stage II breast cancer (67%) and had completed their initial treatment (45%). The mean total fatigue score of the patients was 18.7 (SD 13.5) and overall 49% reported experiencing fatigue to some degree (from quite a bit to very much). Severe anxiety and depression was reported by 16% and 32%, respectively. The regression analysis revealed that fatigue was predicted by depression (P=0.003), pain (P=0.005), current tamoxifen use (P=0.001), undergoing mastectomy (P=0.03) and anxiety (P=0.04). The other variables studied did not emerge as significant predictors of fatigue in the regression analysis. The study findings suggest that in comparison to treatment factors, physical and psychological symptoms have a more important role in cancer-related fatigue and that fatigue should be recognized and managed even before commencing breast cancer treatment.

We validated the Taiwanese version of the Brief Fatigue Inventory (BFI-T) in a sample of 439 Taiwanese patients with multiple cancer diagnoses. Internal consistency was indicated by Cronbach alphas of 0.96 for fatigue-related severity and 0.95 for interference. Test-retest reliability was 0.89 for fatigue severity and 0.91 for interference. Factor analysis revealed a one-factor structure. Convergent validity was examined by

sion. The etiological pathopsychophysiology underlying CRF is multifactorial and not well delineated. Mechanisms may include abnormal accumulation of muscle metabolites, dysregulation of the homeostatic status of cytokines, irregularities in neuromuscular function, abnormal gene expression, inadequate ATP synthesis, serotonin dysregulation, abnormal vagal afferent nerve activation, as well as an array of psychosocial mechanisms, including self-efficacy, causal attributions, expectancy, coping, and social support. An important first step in the management of CRF is the identification and treatment of associated comorbidities, such as anemia, hypothyroidism, pain, emotional distress, insomnia, malnutrition, and other comorbid conditions. However, even effective clinical management of these conditions will not necessarily alleviate CRF for a significant proportion of cancer survivors. For these individuals, intervention with additional therapeutic modalities may be required. The National Comprehensive Cancer Network guidelines recommend that integrative nonpharmacologic behavioral interventions be implemented for the effective management of CRF. These types of interventions may include exercise, psychosocial support, stress management, energy conservation, nutritional therapy, sleep therapy, and restorative therapy. A growing body of scientific evidence supports the use of exercise and psychosocial interventions for the management of CRF. Research on these interventions has yielded positive outcomes in cancer survivors with different diagnoses undergoing a variety of cancer treatments. The data from trials investigating the efficacy of other types of integrative nonpharmacologic behavioral therapies for the management of CRF, though limited, are also encouraging. This article provides an overview of current research on the relative merits of integrative nonpharmacologic behavioral interventions for the effective clinical management of CRF and makes recommendations for future research. The Oncologist 2007; 12(suppl 1):52-67

Cancer-related fatigue (CRF) is a distressing, persistent, subjective sense of tiredness or exhaustion that occurs in 70-100% of cancer patients. The purpose of this review was to provide an overview of the quality of research performed on existing CRF self-report questionnaires and compare their reported psychometric properties and user-friendliness. Database searches of CINAHL, Cochrane Library, EMBASE, MEDLINE, Scopus, PEDro, and PsycINFO were undertaken to find published scales. Standardized criteria were used to assess quality and user-friendliness. Thirty-five articles were included that described 18 questionnaires-seven one-dimensional questionnaires and 11 multidimensional questionnaires. The mean item count was 20.8 (range: 3-83). The mean overall score of the one-dimensional questionnaires was 10.4 of a maximum of 18 points (range: 7.6-14.3). The mean overall score of the multidimensional questionnaires was 9.4 of a maximum of 18 points (range: 4.3-14.4). Recommendations w...

The goal of this paper is to discuss cancer-related fatigue (CRF) and address issues related to the investigation into potential biological and genetic causal mechanisms. The objectives are to: (1) describe CRF as a component of quality of life (QOL); (2) address measurement issues that have slowed progress toward an understanding of mechanisms underlying this symptom; (3) review biological pathways and genetic approaches that have promise for the exploration of causal mechanisms of CRF; and (4) offer directions for future research. Review, synthesis, and interpretation of the literature. Until recently, CRF and QOL have been understood primarily as subjective patient-reported experiences. With increased understanding of human genetics, theories and research are being expanded to incorporate biological and genetic understandings of these subjective experiences. Proposed biological and genetic mechanisms of CRF that have been examined include cytokine dysregulation, hypothalamic-pituitary-adrenal (HPA) axis dysfunction, five hydroxy tryptophan (5-HT) neurotransmitter dysregulation, circadian rhythm disruption, alterations in adenosine triphosphate (ATP) and muscle metabolism, and vagal afferent activation. Approaches to the study of genetic mechanisms have also been addressed including candidate genes, genome-wide scanning, and gene expression. Based on the review and synthesis of the literature, directions for future research are proposed. Understanding the biological and genetic basis of CRF has the potential to contribute to a more complete understanding of the genetic determinants of QOL.

To evaluate the effects of an 8-week multimodal physical therapy program with multimedia support on cancer-related fatigue, cortisol and IgA salivary concentrations, α-amylase activity and neck-shoulder mobility, in breast cancer.This was a prospective randomised clinical trial using between-groups design. Seventy-eight breast cancer survivors during first year after treatment participated. Participants were assigned into 2 groups: CUIDATE group (multimodal program) or control group (usual care). CUIDATE program consisted of 24 h of individual physical training and 12 h of stretching and massage interventions. Measurements included the Piper Fatigue Scale, cortisol and IgA salivary levels, α-amylase activity and active cervical-shoulder range of motion.Compared to the control group, CUIDATE group showed a estimated improvement for total fatigue score of −2.49 points immediately after treatment (between-group effect size 0.68; P < 0.001) and −1.43 at 6 month follow-up (between group effect size: 0.43; P < 0.01). CUIDATE group showed a decrease in α-amylase activity of −41.77 U/ml immediately after treatment compared to the control group (between-group effect size: 0.24; P = 0.046). Further, significant between-group improvements for shoulder flexion, horizontal abduction, cervical extension and lateral-flexion (between-group effect sizes ranging 0.30–0.75; all P < 0.05) after treatment were also found.An 8-week multimodal physical therapy program was effective at short and 6 month follow-up for decreasing fatigue in breast cancer survivors. The program was also effective in decreasing α-amylase activity and improving shoulder and cervical range of motion.

A prospective study was designed to investigate the factors predicting fatigue in breast cancer patients using the Cancer Fatigue Scale (CFS) in addition to the Hospital Anxiety and Depression Scale (HADS) and a questionnaire containing items on demographic and clinical data, and measures of patients' physical symptoms. The CFS measures total fatigue score ranging from 0 (lowest level) to 60 (highest level) and contains three subscales namely: physical, affective and cognitive fatigue. The questionnaires were administered to a consecutive sample of breast cancer patients attending the Iranian Center for Breast Cancer either for their treatment or follow-up examination. In all, 112 patients were studied. The mean age of the respondents was 45.7 years (SD11.0). Most had stage II breast cancer (67%) and had completed their initial treatment (45%). The mean total fatigue score of the pa-

To validate the Greek version of the Brief Fatigue Inventory (BFI-Gr) in a sample of cancer patients, the scale was translated with the ''forwardebackward'' procedure to Greek. It was administered twice, at a three-day interval, to 102 eligible patients with cancer. Together with the BFI-Gr scale, the patients also completed the European Organization for Research and Treatment of Cancer QLQ-C30 (version 3.0) subscales of fatigue and emotional functioning, and the M. D. Anderson Symptom Inventory. The BFI-Gr had an overall Cronbach alpha for the nine items of 0.954. The assessment of the relationships between the BFI-Gr and the other measurements showed statistically significant correlations between all the assessed measurements (r values between 0.47 and 0.76, P < 0.0005), except with the emotional subscale of the European Organization for Research and Treatment of Cancer scale. Factor analysis yielded a one-factor solution, explaining 73.6% of the variance. Interitem correlations were high and ranged from 0.567 to 0.882 (P < 0.0005). The testeretest reliability of scale showed that the coefficient agreement was 0.901 (P < 0.0005). Univariate analysis revealed significant correlations between hemoglobin and fatigue (r ¼ À0.21, P ¼ 0.037), and between performance status (P < 0.0005) and opioids (P ¼ 0.009). These results support that the BFI-Gr is an instrument with satisfactory psychometric properties, and is a valid research tool for cancer-related fatigue in Greek cancer patients J Pain Symptom Manage 2008;36:367e373.

On October 22-23, 2008, an ACSM Roundtable was convened at the Uniformed Services University (Bethesda, MD) to discuss return-to-play or return-to-duty for people who have experienced exertional heat illness (EHI) and to develop consensus-based recommendations. The conference assembled experts from the civilian sports medicine community and the Department of Defense to discuss relevant EHI issues, such as potential long-term consequences, the concept of thermotolerance, and the role of thermal tolerance testing in return-to-play decisions. Although the group was unable to move forward with new consensus recommendations, they clearly documented critical clinical concerns and scientific questions, including the following: 1) no uniform core definitions of EHI; 2) limited validated criteria to assess recovery from exertional heat stroke (EHS); and 3) inadequate ability to predict who may be predisposed to a subsequent heat injury after EHS. Areas of potential future research are identi...

Objective: Fatigue is a multidimensional symptom that is described in terms of perceived energy, mental capacity, and psychological status: it can impair daily functioning and lead to negative effects on quality of life. It is one of the most common side effects of chemotherapy and radiotherapy. In recent studies, L-carnitine (LC) supplementation has been demonstrated to be able to improve fatigue symptoms in patients with cancer.

Objective: Cancer-related fatigue (CRF) is a distressing, persistent, subjective sense of tiredness or exhaustion that occurs in 70e100% of cancer patients. The purpose of this review was to provide an overview of the quality of research performed on existing CRF self-report questionnaires and compare their reported psychometric properties and user-friendliness.

On October 22-23, 2008, an ACSM Roundtable was convened at the Uniformed Services University (Bethesda, MD) to discuss return-to-play or return-to-duty for people who have experienced exertional heat illness (EHI) and to develop consensus-based recommendations. The conference assembled experts from the civilian sports medicine community and the Department of Defense to discuss relevant EHI issues, such as potential long-term consequences, the concept of thermotolerance, and the role of thermal tolerance testing in return-to-play decisions. Although the group was unable to move forward with new consensus recommendations, they clearly documented critical clinical concerns and scientific questions, including the following: 1) no uniform core definitions of EHI; 2) limited validated criteria to assess recovery from exertional heat stroke (EHS); and 3) inadequate ability to predict who may be predisposed to a subsequent heat injury after EHS. Areas of potential future research are identi...

Fatigue is one of the most debilitating conditions associated with cancer and anticancer therapy. The lack of reliable and valid self-report instruments has prevented accurate assessment of fatigue in pediatric oncology patients. The purpose of this study was to identify the most sensitive and specific score, i.e., the "cut score," on the Fatigue Scale-Child (FS-C) to identify those children with high cancer-related fatigue in need of clinical intervention. We first used Rasch methods to identify the items on the FS-C that distinguished children with high cancer-related fatigue from other children; our findings indicated that the FS-C needed to be reduced from 14 items to 10 items. We then assessed the 10-item FS-C for its psychometric properties and applied the receiver operating characteristics (ROC) curve analysis to the FS-C responses from 221 children (aged 7-12 years) receiving anticancer treatment. The cut score identified with 75% sensitivity and 73.5% specificity was 12; 73 (33%) patients scored 12 or higher. Findings from this validated instrument provide a needed guide for clinicians to interpret fatigue scores and provide clinical interventions for this debilitating condition to their pediatric patients with cancer.

Background: Cancerrelated fatigue (CRF) is one of the most distressing symptoms patients experience and is seen well after the completion of treatment. Methylphenidate (Ritalin) use includes the treatment of opiate-induced somnolence, depression, and reduced cognition. This phase II study was performed to evaluate the effects of methylphenidate on CRF. Patients and methods: The criteria for the eligibility of patients included the following: a history of breast cancer, absence of disease for greater than 6 months but less than 5 years, a hemoglobin level of >12 g%, less than moderate depression on the Brief Zung Self-administered Depression Scale, and a score of ≥4 on the Brief Fatigue Inventory (BFI). Patients received methylphenidate, 5 mg, orally, twice daily, for 6 weeks, with a dose escalation on week 2 if the BFI score remained ≥4 and no significant toxicities were reported. A response was defined as a decrease in the BFI score of at least two points on weeks 4 and 6 as compared to baseline. Results: Between May 2001 and May 2003, 37 patients were entered and treated. On weeks 4 and 6, 20 of 37 (54%) responded with a decreased BFI score greater than two points, averaging a decrease of 3.5. Although six patients (19%) withdrew due to adverse events, these were reported as grade 1. Conclusion: This study suggests that women with breast cancer who are suffering from moderate to severe fatigue may benefit from methylphenidate.

mance status (5.0 8 2.8 vs. 3.8 8 2.2; p ! 0.05). Compared with community adults, the patients with cancer reported significantly higher levels of fatigue. Conclusions: The BFI-F had satisfactory internal consistency and validity, and it was able to measure the severity of fatigue and its influence on Filipino cancer patients.

Purpose/Objectives: To determine the relationship between
fatigue and physical activity in older patients with cancer.
Design: Targeted analysis using data from a prospective
longitudinal study.
Setting: A cancer care facility in southeastern Ontario,
Canada.
Sample: 440 patients, aged 65 years and older, seeking
consultation for cancer treatment at a regional cancer clinic
for lymphoma or leukemia or lung, breast, genitourinary,
head or neck, gastrointestinal, or skin cancers.
Methods: Self-report questionnaires were mailed to consenting
participants and completed at baseline and three
and six months after consultation for cancer treatment.
Main Research Variables: Participants rated fatigue and
physical activity and reported comorbidities and personal
demographic characteristics. Clinical measures of disease
and treatment factors were obtained through chart abstraction.
Findings: Fatigue was the most prevalent symptom reported.
Higher fatigue was associated with lower physical
activity levels. Physical activity level significantly predicted
fatigue level, regardless of age.
Conclusions: Physical activity level is a modifiable factor
significantly predicting cancer-related fatigue at three and
six months following consultation for cancer treatment. The
results suggest that physical activity may reduce fatigue in
older patients with cancer.
Implications for Nursing: Physical activity interventions
should be developed and tested in older patients with
cancer.

Cancer-related fatigue (CRF) is a significant clinical problem for more than 10 million adults diagnosed with cancer each year worldwide. No "gold standard" treatment presently exists for CRF. To provide a guide for future research to improve the treatment of CRF, the authors conducted the most comprehensive combined systematic and meta-analytic review of the literature to date on non-pharmacological (psychosocial and exercise) interventions to ameliorate CRF and associated symptoms (vigor/vitality) in adults with cancer, based on 119 randomized controlled trials (RCTs) and non-RCT studies. Metaanalyses conducted on 57 RCTs indicated that exercise and psychological interventions provided reductions in CRF, with no significant differences between these 2 major types of interventions considered as a whole. Specifically, multimodal exercise and walking programs, restorative approaches, supportive-expressive, and cognitive-behavioral psychosocial interventions show promising potential for ameliorating CRF. The results also suggest that vigor and vitality are distinct phenomena from CRF with regard to responsiveness to intervention. With improved methodological approaches, further research in this area may soon provide clinicians with effective strategies for reducing CRF and enhancing the lives of millions of cancer patients and survivors.

Negli ultimi anni si è assistito ad un miglioramento della prognosi della patologia neoplastica della mammella grazie allo sviluppo di efficaci programmi di screening che permettono una sempre più precoce diagnosi e grazie al continuo sviluppo in campo terapeutico e farmacologico. L'aumento della sopravvivenza si accompagna però alla presenza di effetti collaterali fisici e psicologici, dovuti alla neoplasia stessa ed al successivo trattamento (quali il tipo di intervento chirurgico la chemioterapia, la radioterapia e l'ormonoterapia) come l'atrofia muscolare, la diminuita capacità aerobica, diminuita flessibilità e resistenza, nausea, fatica, depressione, dolore, che inevitabilmente incidono sulla qualità di vita dei pazienti.

To evaluate cancer-related fatigue (CRF) by objective measurements to determine if CRF is a more centrally or peripherally mediated disorder, cancer patients and matched noncancer controls completed a Brief Fatigue Inventory (BFI) and underwent neuromuscular testing. Cancer patients had fatigue measured by the BFI, were off chemotherapy and radiation (for more than four weeks), had a hemoglobin level higher than 10 g/dL, and were neither receiving antidepressants nor were depressed on a screening question. The controls were screened for depression and matched by age, gender, and body mass index. Neuromuscular testing involved a sustained submaximal elbow flexion contraction (SC) at 30% maximal level (30% maximum elbow flexion force). Endurance time (ET) was measured from the beginning of the SC to the time when participants could not maintain the SC. Evoked twitch force (TF), a measure of muscle fatigue, and compound action potential (M-wave), an assessment of neuromuscular-junction transmission were performed during the SC. Compared with controls, the CRF group had a higher BFI score (P < 0.001), a shorter ET (P < 0.001), and a greater TF with the SC (CRF > controls, P < 0.05). This indicated less muscle fatigue. There was a greater TF (P < 0.05) at the end of the SC, indicating greater central fatigue, in the CRF group, which failed to recruit muscle (to continue the SC), as well as the controls. M-Wave amplitude was lower in the CRF group than in the controls (P < 0.01), indicating impaired neuromuscular junction conduction with CRF unrelated to central fatigue (M-wave amplitude did not change with SC). These data demonstrate that CRF patients exhibited greater central fatigue, indicated by shorter ET

This aim of this systematic review was to determine the prevalence and pattern of cancer-related fatigue (CRF), and identify factors associated with its development. Relevant literature was identified through an electronic database search using specified keywords. Included studies investigated CRF in adult cancer patients using a multidimensional fatigue measure. The methodological quality was assessed using six published standards. CRF is apparent both during and after anti-cancer therapy, however, the prevalence of CRF varied between studies. The variables associated with the development and persistence of CRF remain to be identified. Inconsistencies were evident in the pattern of CRF and its associated factors. This is likely to have arisen from the inherent difficulties in the measurement of a subjective sensation, further complicated by the myriad of outcome measures used. More methodologically sound research; assessing CRF from the commencement of therapy, considering all pert...

EMG) signals and reduce muscle (peripheral) fatigue in cancer patients. Research objectives. Based on this, we hypothesized that signals from the central nervous system (proximal to NMJ) would undergo transmission difficulties distal to NMJ. This would lead to reduced functional corticomuscular coupling during voluntary muscle contraction. Methods. Fourteen patients with advanced solid cancer and significant CRF, as well as 14 age-and gender-matched healthy controls performed a sustained isometric elbow flexion contraction of the right arm at 30% maximal level (S30) until self-perceived exhaustion. High-density (128 channels) scalp EEG data and EMG signals of the elbow flexor and extensor muscles were recorded during the S30. Coherence between the EEG and EMG signals was determined during the first half (non-fatigue) and second half (fatigue) of the S30. Results. CRF patients exhibited lower EEG-EMG coherence (P < 0.05) at beta frequency band (15-35 Hz) during the S30. Coherence did not decrease as much in CRF as in controls under the condition of muscle fatigue. Conclusion. CRF was associated with weakened functional coupling between the brain and muscle activities in a sustained submaximal motor activity. Because muscle fatigue was less significant in CRF, which normally provides afferent feedback to coupling, fatigue in cancer influenced EEG-EMG coherence less than normal controls. Impairment in NMJ propagation function in CRF contributes to diminished corticomuscular signal coupling during voluntary motor activities. Implications for research, policy, or practice. EMG-EEG coherence is impaired in CRF. Interventions to improve coherence are likely to reduce fatigue. (All speakers have disclosed no relevant financial relationships.) Objectives 1. Discuss the association of excitation-contraction alterations with muscle fatigue and its association with contraction time and relaxation half-life after electrically stimulating muscle. 2. Discuss that the failure to find delays in contraction time and relaxation half-life during a twitch force at the time of exhaustion in CRF is an indicator of central fatigue and the failure to fully activate the muscle with task failure. Background. Patients with cancer-related fatigue (CRF) experience greater central nervous system fatigue (compared to healthy controls) during a prolonged voluntary motor task (Yavuzsen et al., J Pain Symptom Manag, 38:587e96, 2009) Research objectives. Based on this finding, we hypothesized that CRF patients would endure less muscle fatigue indicated by fewer changes in twitch force properties of muscle after voluntary muscle fatigue. Methods. Ten patients with advanced solid cancer and significant CRF and 12 age-matched healthy controls performed a sustained isometric elbow flexion contraction of the right arm at 30% maximal level (S30) until self-perceived exhaustion. The biceps brachii (BB) muscle was stimulated by applying single maximal-intensity electrical pulses onto skin surface overlying the muscle and the evoked twitch force (TF) was measured by a force transducer before and immediately after S30. Peak TF, rate of TF development, contraction time (CT, from initiation to peak of TF), and half relaxation time (HRT, from peak to 50% peak TF) were quantified. Results. Peak TF, CT, and HRT decreased significantly (P < 0.05) in healthy controls but these parameters remained the same after versus before during a sustained contraction at 30% maximum force. Conclusion. Because no voluntary muscle activation was involved with the electrical stimulationevoked muscle contraction, the measured TF parameters were pure muscle responses and their changes after S30 reflect effects of muscle fatigue. Implications for research, policy, or practice. Minimal reductions in peak TF, CT, and HRT in CRF patients suggest insignificant muscle fatigue in these individuals. Task failure in CRF patients is caused more by central fatigue and less by muscle fatigue.

The aim of this study is to co-create an evidence-based and theoretically informed web-based intervention (RESTORE) designed to enhance self-efficacy to live with cancer-related fatigue (CRF) following primary cancer treatment. A nine-step process informed the development of the intervention: (1) review of empirical literature; (2) review of existing patient resources; (3) establish theoretical framework; (4) establish design team with expertise in web-based interventions, CRF and people affected by cancer; (5) develop prototype intervention; (6) user testing phase 1; (7) refinement of prototype; (8) user testing phase 2; and (9) develop final intervention. Key stakeholders made a critical contribution at every step of intervention development, and user testing, which involved an iterative process and resulted in the final intervention. The RESTORE intervention has five sessions; sessions 1 and 2 include an introduction to CRF and goal setting. Sessions 3-5 can be tailored to user p...

BACKGROUND. This study was conducted to develop a brief measure of fatigue and functional impact in cancer patients with anemia. METHODS. Data were obtained from a multisite, phase 2 study of darbepoetin-a (n 5 1558). Eligible patients were !18 years with nonmyeloid malignancies and anemia (hemoglobin 11 g/dL) who were receiving chemotherapy. Items from the Functional Assessment of Cancer Therapy-Fatigue (FACT-F), Brief Fatigue Inventory (BFI), Fatigue Symptom Inventory (FSI), and items adapted from the Medical Outcomes Study SF-36 physical functioning scale were evaluated for inclusion in the measure. Items were selected by identifying the best predictors of total FACT-F scores, hemoglobin, and adjusted maximum oxygen uptake (VO 2 Max) in regression models. Correlations were examined between scale scores and adjusted VO 2 Max, hemoglobin, performance status, self-reported energy, and productivity. RESULTS. Data from 401 patients with complete data were used to identify 8 items for the Fatigue and Functional Impact Scale (FFIS), which was then evaluated using 1355 of the 1558 patients. The FFIS had an estimated internal consistency reliability of 0.90. The FFIS had significant correlations with the FACT-F (r 5 0.94), FSI (r 5 0.80), and BFI (r 5 0.86), from which it was derived. The FFIS also correlated substantially with single-item measures of energy (r 5 0.75) and productivity (r 5 0.72). CONCLUSIONS. The FFIS is a reliable, brief, and practical tool that is potentially suitable for identifying fatigue and functional impact in cancer patients.

Two prevalent unmet supportive care needs reported by the non-small cell lung cancer (NSCLC) population include the need to manage fatigue and attain adequate exercise to meet the physical demands of daily living. Yet, there are no guidelines for routine rehabilitative support to address fatigue and exercise for persons with NSCLC during the critical transition from hospital to home after thoracotomy. The objective of this study was to evaluate the feasibility, acceptability, safety, and changes in study end points of a home-based exercise intervention to enhance perceived self-efficacy for cancer-related fatigue (CRF) self-management for persons after thoracotomy for NSCLC transitioning from hospital to home. Guided by the principles of the Transitional Care Model and the Theory of Symptom Self-management, a single-arm design composed of 7 participants with early-stage NSCLC performed light-intensity walking and balance exercises in a virtual reality environment with the Nintendo Wii Fit Plus. Exercise started the first week after hospitalization for thoracotomy and continued for 6 weeks. The intervention positively impacted end points such as CRF severity; perceived self-efficacy for fatigue self-management, walking, and balance; CRF self-management behaviors (walking and balance exercises); and functional performance (number of steps taken per day). A home-based, light-intensity exercise intervention for patients after thoracotomy for NSCLC is feasible, safe, well tolerated, and highly acceptable showing positive changes in CRF self-management. Beginning evidence suggests that a light-intensity in-home walking and balance intervention after hospitalization for thoracotomy for NSCLC is a potentially effective rehabilitative CRF self-management intervention. Next steps include testing of this health-promoting self-management intervention in a larger-scale randomized controlled trial.

This article reviews the National Comprehensive Cancer Network's (NCCN's) guidelines for cancer-related fatigue (CRF) assessment and discusses many of the common barriers that hinder the translation of the CRF guidelines into practice settings. Current assessment and measurement scales validated in patients with cancer are highlighted, and case studies reflect the vital roles that oncology nurses can play in managing patients with CRF. Oncology nurses must remember to assess the "gang of 7" (i.e., anemia, pain, sleep difficulties, nutrition issues, deconditioning or changes in activity patterns, emotional distress [depression or anxiety], and presence of comorbidities) that may affect workup, treatment, and supportive care referrals. Teaching patients about the importance of viewing CRF as the "sixth vital sign" can emphasize this symptom's importance and significance. Oncology nurses also can recognize the many patient-, provider-and system-related barriers that exist and work with others in a systematic and collaborative fashion within the system to decrease these barriers and begin to incorporate a simple intensity scale for CRF assessment and screening, documentation, and ongoing monitoring. By using available resources, oncology nurses can play significant roles in the translation of the NCCN's evidence-based practice guidelines for CRF in their practice settings.

Objective: Cancer-related fatigue (CRF) is one of the most common unrelieved symptoms experienced by patients. CRF is underrecognized and undertreated due to a lack of clinically sensitive instruments that integrate easily into clinics. Modern computerized adaptive testing (CAT) can overcome these obstacles by enabling precise assessment of fatigue without requiring the administration of a large number of questions. A working item bank is essential for development of a CAT platform. The present report describes the building of an operational item bank for use in clinical settings with the ultimate goal of improving CRF identification and treatment.

Cancer-related fatigue (CRF) is a frequent and distressing symptom experienced after cancer treatment. RESTORE is the first web-based resource designed to enhance self-efficacy to manage CRF following curative-intent treatment. The aim of this study is to test the proof of concept and inform the design of an effectiveness trial. A multi-centre parallel-group two-armed (1:1) exploratory randomised controlled trial (RCT) with qualitative process evaluation was employed in the study. Participants (≥18 years; ≤5 years post treatment with moderate to severe fatigue) were recruited and randomly assigned to RESTORE or a leaflet. Feasibility and acceptability were measured by recruitment, attrition, intervention adherence, completion of outcome measures and process evaluation. Change in self-efficacy to manage CRF was also explored. Outcome measures were completed at baseline (T0), 6 weeks (T1) and 12 weeks (T2). Data were analysed using mixed-effects linear regression and directed content ...

Objectives: Existing instruments that measure the impact of cancerrelated fatigue on health-related quality of life do not usually incorporate the attitudes, beliefs and perspectives of patients. This study aimed to develop an instrument to measure the impact of cancer-related fatigue on the health-related quality of life of cancer patients. Methods: Items were generated from a literature review, focus groups of cancer patients and meetings with oncologists. Potential items were administered to cancer patients to facilitate item reduction, which was based on clinimetric and psychometric analyses and qualitative criteria. A preliminary assessment of feasibility, reliability and validity of the retained items was performed.

This review includes research findings from sleep-related studies on specific types of cancers, on specific types of treatment protocols, and on persons with endstage cancer regardless of treatment protocol. Since treatment protocols have evolved in the past decade, literature since 1990 is emphasized. We conclude that researchers should design studies that attend to prior sleep history, gender, type of cancer and treatment modalities, and the specific type of sleep problems experienced over the course of diagnosis, treatment, and recovery. More research is also needed to understand sleep problems in children with cancer and sleep problems in family caregivers. Research is also needed on effective pharmacological and non-pharmacological interventions. Daytime functioning, daytime sleepiness, and altered circadian rhythms should be considered salient outcomes in addition to severity of cancerrelated fatigue. Clinicians should consider whether a patient's sleep problem has been chronic and unrelated to cancer, or precipitated by diagnosis and treatment. The specific type of sleep problem should be ascertained so that appropriate interventions can be prescribed. Appropriate interventions can include either pharmacological medication or behavioral strategies, and each has the potential to promote restorative sleep and thereby improve the patient's quality of life, daytime functioning, and wellbeing. q

The aim of this study is to co-create an evidence-based and theoretically informed web-based intervention (RESTORE) designed to enhance self-efficacy to live with cancer-related fatigue (CRF) following primary cancer treatment. A nine-step process informed the development of the intervention: (1) review of empirical literature; (2) review of existing patient resources; (3) establish theoretical framework; (4) establish design team with expertise in web-based interventions, CRF and people affected by cancer; (5) develop prototype intervention; (6) user testing phase 1; (7) refinement of prototype; (8) user testing phase 2; and (9) develop final intervention. Key stakeholders made a critical contribution at every step of intervention development, and user testing, which involved an iterative process and resulted in the final intervention. The RESTORE intervention has five sessions; sessions 1 and 2 include an introduction to CRF and goal setting. Sessions 3-5 can be tailored to user p...

Fatigue is one of the most prevalent and distressing symptoms of cancer, and is a common side-effect of many of the treatments available for the management of malignant disease. We critically assess the evidence for cancer-related fatigue and its treatment in adults. Little is known about the cause and mechanisms of fatigue, and research into methods of alleviating the condition has focused on treatment for anaemia and behavioural interventions, such as exercise, both of which are effective in reducing fatigue. Although research into the condition has increased considerably in the past decade, important gaps in knowledge remain.