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Julienne E. Bower - One of the best experts on this subject based on the ideXlab platform.
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Cancer-Related Fatigue—mechanisms, risk factors, and treatments
Nature reviews. Clinical oncology, 2014Co-Authors: Julienne E. BowerAbstract:Fatigue is one of the most common adverse effects of cancer that might persist for years after treatment completion in otherwise healthy survivors. Cancer-Related Fatigue causes disruption in all aspects of quality of life and might be a risk factor of reduced survival. The prevalence and course of Fatigue in patients with cancer have been well characterized and there is growing understanding of the underlying biological mechanisms. Inflammation seems to have a key role in Fatigue before, during, and after cancer-treatment. However, there is a considerable variability in the presentation of Cancer-Related Fatigue, much of which is not explained by disease-related or treatment-related characteristics, suggesting that host factors might be important in the development and persistence of this symptom. Indeed, longitudinal studies have identified genetic, biological, psychosocial, and behavioural risk factors associated with Cancer-Related Fatigue. Although no current gold-standard treatment for Fatigue is available, a variety of intervention approaches have shown beneficial effects in randomized controlled trials, including physical activity, psychosocial, mind-body, and pharmacological treatments. This Review describes the mechanisms, risk factors, and possible interventions for Cancer-Related Fatigue, focusing on recent longitudinal studies and randomized trials that have targeted Fatigued patients.
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Inflammation and Cancer-Related Fatigue: Mechanisms, contributing factors, and treatment implications
Brain Behavior and Immunity, 2013Co-Authors: Julienne E. Bower, Donald M. LamkinAbstract:Fatigue is one of the most common and distressing side effects of cancer and its treatment, and may persist for years after treatment completion in otherwise healthy survivors. Guided by basic research on neuro-immune interactions, a growing body of research has examined the hypothesis that Cancer-Related Fatigue is driven by activation of the pro-inflammatory cytokine network. In this review, we examine the current state of the evidence linking inflammation and Cancer-Related Fatigue, drawing from recent human research and from experimental animal models probing effects of cancer and cancer treatment on inflammation and Fatigue. In addition, we consider two key questions that are currently driving research in this area: what are the neural mechanisms of Fatigue, and what are the biological and psychological factors that influence the onset and/or persistence of inflammation and Fatigue in cancer patients and survivors? Identification of the mechanisms driving Cancer-Related Fatigue and associated risk factors will facilitate the development of targeted interventions for vulnerable patients.
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Cancer-Related Fatigue: links with inflammation in cancer patients and survivors.
Brain behavior and immunity, 2007Co-Authors: Julienne E. BowerAbstract:Fatigue is one of the most common and distressing side effects of cancer and its treatment and may persist long after successful treatment completion. Emerging evidence suggests that inflammatory processes may be involved in Cancer-Related Fatigue both during and after treatment. In this review, we consider the evidence for an association between inflammation and Fatigue in cancer patients and survivors. Further, we identify potential mechanisms for persistent inflammation, focusing on the HPA axis. Risk factors and treatments for Cancer-Related Fatigue are also discussed.
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Cancer related Fatigue: A focus on breast cancer and Hodgkin's disease survivors
Acta oncologica (Stockholm Sweden), 2007Co-Authors: Patricia A. Ganz, Julienne E. BowerAbstract:Background and Purpose. Fatigue is one of the most common and troubling symptoms in cancer survivors. In this paper we review information about cancer related Fatigue in survivors of breast cancer and Hodgkin's disease, discuss some of the potential biological mechanisms for this problem in cancer survivors, and briefly discuss potential interventions. Findings. Cancer-Related Fatigue persists long after cancer treatments end, and is associated with more intensive treatments (combined chemotherapy and radiation therapy) in these cancers. Fatigue prior to the onset of treatment is a strong predictor of persistent Fatigue. Studies in breast cancer survivors suggest elevated levels of pro-inflammatory cytokines in association with persistent Fatigue, as well as abnormalities in the hypothalamic-pituitary axis. Psychosocial and physical activity interventions have been shown in some studies to alleviate Fatigue. Conclusions. Recognizing the syndrome of Cancer-Related Fatigue is a high priority for the many ca...
Raphaële R. L. Van Litsenburg - One of the best experts on this subject based on the ideXlab platform.
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Sleep-wake rhythm disruption is associated with Cancer-Related Fatigue in pediatric acute lymphoblastic leukemia
Sleep, 2019Co-Authors: Lindsay M.h. Steur, Gertjan J.l. Kaspers, Eus J.w. Van Someren, Natasha K.a. Van Eijkelenburg, Inge M. Van Der Sluis, Natasja Dors, Cor Van Den Bos, Wim J. E. Tissing, Martha A. Grootenhuis, Raphaële R. L. Van LitsenburgAbstract:STUDY OBJECTIVES: To compare sleep-wake rhythms, melatonin, and Cancer-Related Fatigue in pediatric patients with acute lymphoblastic leukemia (ALL) to healthy children and to assess the association between sleep-wake outcomes and Cancer-Related Fatigue. METHODS: A national cohort of ALL patients (2-18 years) was included. Sleep-wake rhythms were measured using actigraphy and generated the following variables: Interdaily stability (IS): higher IS reflects higher stability; intradaily variability (IV): lower IV indicates less fragmentation; L5 and M10 counts: activity counts during the five least and 10 most active hours, respectively; and relative amplitude (RA): the ratio of L5 and M10 counts (higher RA reflects a more robust rhythm). The melatonin metabolite, 6-sulfatoxymelatonin (aMT6s), was assessed in urine. Cancer-Related Fatigue was assessed with the PedsQL Multidimensional Fatigue Scale. Using regression models sleep-wake rhythms, aMT6s, and Cancer-Related Fatigue were compared to healthy children and associations between sleep-wake outcomes and Cancer-Related Fatigue were assessed in ALL patients. RESULTS: In total, 126 patients participated (response rate: 67%). IS, RA, and M10 counts were lower in patients compared to healthy children (p < 0.001). aMT6s levels were comparable to healthy children (p = 0.425). Patients with ALL were more Fatigued compared to healthy children (p < 0.001). Lower IS, RA and M10 counts and higher IV were significantly associated with more parent-reported Cancer-Related Fatigue. Associations between sleep-wake rhythms and self-reported Cancer-Related Fatigue were not statistically significant. CONCLUSIONS: Sleep-wake rhythm impairment is associated with more Cancer-Related Fatigue in pediatric ALL patients. Interventions aimed to improve sleep hygiene and encourage physical activity may reduce Cancer-Related Fatigue.
Lindsay M.h. Steur - One of the best experts on this subject based on the ideXlab platform.
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Sleep-wake rhythm disruption is associated with Cancer-Related Fatigue in pediatric acute lymphoblastic leukemia
Sleep, 2019Co-Authors: Lindsay M.h. Steur, Gertjan J.l. Kaspers, Eus J.w. Van Someren, Natasha K.a. Van Eijkelenburg, Inge M. Van Der Sluis, Natasja Dors, Cor Van Den Bos, Wim J. E. Tissing, Martha A. Grootenhuis, Raphaële R. L. Van LitsenburgAbstract:STUDY OBJECTIVES: To compare sleep-wake rhythms, melatonin, and Cancer-Related Fatigue in pediatric patients with acute lymphoblastic leukemia (ALL) to healthy children and to assess the association between sleep-wake outcomes and Cancer-Related Fatigue. METHODS: A national cohort of ALL patients (2-18 years) was included. Sleep-wake rhythms were measured using actigraphy and generated the following variables: Interdaily stability (IS): higher IS reflects higher stability; intradaily variability (IV): lower IV indicates less fragmentation; L5 and M10 counts: activity counts during the five least and 10 most active hours, respectively; and relative amplitude (RA): the ratio of L5 and M10 counts (higher RA reflects a more robust rhythm). The melatonin metabolite, 6-sulfatoxymelatonin (aMT6s), was assessed in urine. Cancer-Related Fatigue was assessed with the PedsQL Multidimensional Fatigue Scale. Using regression models sleep-wake rhythms, aMT6s, and Cancer-Related Fatigue were compared to healthy children and associations between sleep-wake outcomes and Cancer-Related Fatigue were assessed in ALL patients. RESULTS: In total, 126 patients participated (response rate: 67%). IS, RA, and M10 counts were lower in patients compared to healthy children (p < 0.001). aMT6s levels were comparable to healthy children (p = 0.425). Patients with ALL were more Fatigued compared to healthy children (p < 0.001). Lower IS, RA and M10 counts and higher IV were significantly associated with more parent-reported Cancer-Related Fatigue. Associations between sleep-wake rhythms and self-reported Cancer-Related Fatigue were not statistically significant. CONCLUSIONS: Sleep-wake rhythm impairment is associated with more Cancer-Related Fatigue in pediatric ALL patients. Interventions aimed to improve sleep hygiene and encourage physical activity may reduce Cancer-Related Fatigue.
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Longitudinal development of Cancer-Related Fatigue and physical activity in childhood cancer patients
Pediatric blood & cancer, 2019Co-Authors: Elisabeth M. Van Dijk-lokkart, Lindsay M.h. Steur, Katja I. Braam, Margreet A. Veening, Jaap Huisman, Tim Takken, Marc Bierings, Johannes H.m. Merks, Marry M. Van Den Heuvel-eibrink, Gertjan J.l. KaspersAbstract:Purpose: Cancer-Related Fatigue is one of the most distressing side effects of childhood cancer treatment. Physical activity can decrease Fatigue and has positive effects on other health outcomes. Most research on physical activity pertains to adults, and the few studies that focus on children have limited follow-up time. This study evaluates Cancer-Related Fatigue in children and its association with physical activity over a one-year time period. Methods: Sixty-eight children with cancer (7–18 years) were recruited during or within the first year after treatment. Physical activity (Actical activity monitor) and Cancer-Related Fatigue (Pediatric Quality-of-Life Questionnaire Multidimensional Fatigue Scale (PedsQL-MFS), self- and parent- reports) were assessed at baseline, 4 months, and 12 months. PedsQL-MFS scores were compared with Dutch norms. Longitudinal association of Cancer-Related Fatigue with physical activity was evaluated (No. NTR 1531). Results: Generally, PedsQL-MFS scores were worse than norms at baseline and 4 months, and recovered by 12 months except for the parent-proxy scores in adolescents. Younger children (≤12 years) self-reported comparable or better scores than norms. Physical activity generally improved over time, but patients mostly remained sedentary. During follow-up, increased physical activity was associated with less Cancer-Related Fatigue. Conclusion: Cancer-Related Fatigue in children improves over time, and increased physical activity is associated with less Cancer-Related Fatigue. Given the sedentary lifestyle of this population, the positive effect of physical activity on Cancer-Related Fatigue, and the many other health benefits of an active lifestyle, it is important to stimulate physical activity in childhood cancer patients and survivors.
Lin Han - One of the best experts on this subject based on the ideXlab platform.
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Prevalence and risk factors of Cancer-Related Fatigue: A systematic review and meta-analysis.
International journal of nursing studies, 2020Co-Authors: Mengyao Jiang, Yanlin Yang, Chenxia Wang, Can Huang, Lin HanAbstract:Abstract Background Cancer-Related Fatigue, one of the most frequent side-effects of cancer treatment, affects the well-being of patients. Despite the fact that the estimated prevalence and risk factors of Cancer-Related Fatigue are widely reported, these results have not been synthesized. Objectives To systematically assess the prevalence of Cancer-Related Fatigue, including stratification by Fatigue degree, sex, age, therapeutic method, Cancer-Related Fatigue scales, countries, and risk factors for Cancer-Related Fatigue. Design Systematic literature review and meta-analysis. Data Sources PubMed, Cochrane Library, Web of Science, CINAHL Plus, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP) were comprehensively searched for observational studies investigating the prevalence and risk factors of Cancer-Related Fatigue from inception to March 31st, 2019. Review Methods Original journal articles were included which met the inclusion criteria. The quality of the included studies was evaluated independently by two investigators. Meta-analysis was conducted using Stata 12.0 software package, with estimates of Cancer-Related Fatigue from pooled using a random-effects model. Results In total, 2641 articles were screened and data from 84 studies involving 144,813 subjects were used in meta-analysis. The prevalence of Cancer-Related Fatigue in individual studies varied from 14.03% to 100%. The pooled prevalence of Cancer-Related Fatigue was 52% (95% confidence interval, CI: 48% to 56%, I2 = 99.7%, P Conclusion The current analysis indicates an overall pooled prevalence of Cancer-Related Fatigue of 52%. Poor performance status, chemoradiotherapy, female sex, insomnia, neuroticism, pain, and depression were identified as risk factors for Cancer-Related Fatigue. Understanding the risk factors of Cancer-Related Fatigue can provide the healthcare personnel with the theoretical basis for the management and treatment of the patients.
William Breitbart - One of the best experts on this subject based on the ideXlab platform.
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Cancer-Related Fatigue, Version 2.2015
Journal of the National Comprehensive Cancer Network : JNCCN, 2015Co-Authors: Ann M. Berger, William Breitbart, David Cella, Charles S. Cleeland, Mario A. Eisenberger, Kathi Mooney, Amy Alvarez-perez, Kristen M. Carpenter, Efrat Dotan, Carmen P. EscalanteAbstract:Cancer-Related Fatigue is defined as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. It is one of the most common side effects in patients with cancer. Fatigue has been shown to be a consequence of active treatment, but it may also persist into posttreatment periods. Furthermore, difficulties in end-of-life care can be compounded by Fatigue. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cancer-Related Fatigue provide guidance on screening for Fatigue and recommendations for interventions based on the stage of treatment. Interventions may include education and counseling, general strategies for the management of Fatigue, and specific nonpharmacologic and pharmacologic interventions. Fatigue is a frequently underreported complication in patients with cancer and, when reported, is responsible for reduced quality of life. Therefore, routine screening to identify Fatigue is an important component in improving the quality of life for patients living with cancer.
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Psychostimulants for Cancer-Related Fatigue
Journal of the National Comprehensive Cancer Network : JNCCN, 2010Co-Authors: William Breitbart, Yesne AliciAbstract:Fatigue is a highly prevalent and distressing symptom associated with significant psychological and functional morbidity and decreased quality of life among patients with cancer. Despite its impact on patients and caregivers, Fatigue is underreported and underrecognized, and remains untreated among patients with cancer because of various patient- and clinician-related factors. In addition to assessment for potentially reversible medical causes or medications exacerbating Fatigue, and the implementation of nonpharmacologic interventions, several pharmacologic treatment options have been considered for the treatment of Cancer-Related Fatigue. Among traditional psychostimulants, methylphenidate has been studied the most and is effective and well tolerated among patients with cancer despite common side effects. Modafinil, a novel psychostimulant commonly referred to as wakefulness-promoting agents as a group, has also been studied and seems to be well tolerated among patients with cancer. A large placebo effect has been reported in most randomized controlled trials with psychostimulants. Thus, randomized placebo-controlled trials with large sample sizes are needed to further assess the efficacy and tolerability of psychostimulants in the treatment of Cancer-Related Fatigue. This article presents a comprehensive review of the use of psychostimulant agents for Fatigue among patients with cancer, including an overview of the clinical trials with psychostimulants and of the clinical guidelines available for treatment of Cancer-Related Fatigue.
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Cancer-Related Fatigue
Journal of the National Comprehensive Cancer Network : JNCCN, 2010Co-Authors: Ann M. Berger, William Breitbart, Amy P. Abernethy, Ashley Atkinson, Andrea Barsevick, David Cella, Bernadine Cimprich, Charles S. Cleeland, Mario A. Eisenberger, Carmen P. EscalanteAbstract:Dr. Carmen Escalante, Professor and Chair of General Internal Medicine, Ambulatory Treatment, and Emergency Care at The University of Texas MD Anderson Cancer Center, presents the lecture, “Cancer-Related Fatigue.” Cancer-Related Fatigue is one of the most common symptoms experienced by cancer patients and cancer survivors. Dr. Escalante’s lecture provides a multidisciplinary perspective on Cancer-Related Fatigue and focuses on the prevalence, characteristics, hypothesized pathophysiology, and common causes of this condition. Patient assessment and customized strategies for management, including non-pharmacologic and pharmacologic interventions, are presented. Resumen:
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Update on psychotropic medications for Cancer-Related Fatigue.
Journal of the National Comprehensive Cancer Network : JNCCN, 2007Co-Authors: William Breitbart, Yesne Alici-evcimenAbstract:Fatigue is a common and highly distressing symptom of cancer associated with reduced quality of life and considerable psychological and functional morbidity. The reported prevalence of Cancer-Related Fatigue ranges from 4% to 91%, depending on the specific cancer population studied and the methods of assessment. Cancer-Related Fatigue has typically been underreported, underdiagnosed, and undertreated. Fatigue and depression may coexist in cancer patients, and considerable overlap of symptoms occurs. This is partly the reason for the interest in examining the role of psychotropic medications in treating Fatigue. Clarifying the relationship between depression and Fatigue is necessary to effectively evaluate and treat Cancer-Related Fatigue. Even with International Classification of Diseases criteria, differentiating Cancer-Related Fatigue is difficult. Psychotropic drugs that have been studied for Cancer-Related Fatigue include psychostimulants, wakefulness-promoting agents, and antidepressants. Methylphenidate has been studied most and seems to be effective and well tolerated despite common side effects. Some preliminary data support using modafinil in Cancer-Related Fatigue with less concern about tolerance or dependence. Antidepressant studies have shown mixed results. Paroxetine seems to show benefit for Fatigue primarily when it is a symptom of clinical depression. Bupropion, a norepinephrine/dopamine reuptake inhibitor, may have psychostimulant-like effects, and therefore may be more beneficial for treating Fatigue. However, studies are currently limited. Randomized, placebo-controlled trials with specific agents are needed to further assess the efficacy and tolerability of psychotropic medications in the treatment of Cancer-Related Fatigue.
