Education for cancer-related fatigue: could talking about it make people more likely to report it?
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Abstract
Purpose
Education-based interventions for cancer-related fatigue have shown promise in adults undergoing radiotherapy. Research on the cancer-related fatigue intervention trial (CAN-FIT) programme found that pre-radiotherapy fatigue information and support (pre-RFES) did not improve levels of fatigue, but was associated with improvements in activity-based outcomes. We aimed to measure whether pre-RFES resulted in greater participant self-ratings of their performance of daily living activities, fatigue, quality of life and distress.
Methods
Thirty people undergoing radiotherapy and/or chemotherapy were randomly allocated to either a 1-h RFES session from the CAN-FIT programme (delivered individually to participants and modified where necessary for patients undergoing chemotherapy) or standard care. Measures were taken pre- and post-treatment and 6 weeks after completing treatment.
Results
There was no significant difference between groups on performance of daily living activities or ratings of distress. Further analysis found a significant difference between the control and treatment groups for EQ-5D health state visual analogue scale (−9.05 [−18.09; −0.018]; p < 0.05) and physical fatigue (2.86 [0.58; 5.14]; p < 0.02) with the treatment group rating their overall health state worse and their physical fatigue higher than the controls.
Conclusions
Pre-RFES delivered individually did not significantly improve participants’ ratings of their performance of daily occupations and was unexpectedly associated with worse overall health state and higher physical fatigue. Future trials, ideally comparing individual and group education to exercise programmes or cognitive–behavioural approaches, are recommended to examine the broader question of whether discussing fatigue might actually make participants feel worse.
Keywords
Cancer-related fatigue CAN-FIT Chemotherapy Radiotherapy Quality of life Occupation DistressNotes
Acknowledgments
The authors wish to acknowledge the participants in this trial, who generously gave their time. We also thank the members of The Alfred Oncology department for their support and cooperation. This study was funded by the Southern Melbourne Integrated Cancer Service Supportive Care Research Grants 2010–11.
Conflict of interest
The authors have no conflict of interest to declare.
References
- 1.Hofman M et al (2007) Cancer-related fatigue: the scale of the problem. Oncologist 12(Supplement 1):4–10PubMedCrossRefGoogle Scholar
- 2.Purcell A et al (2010) A multidimensional examination of correlates of fatigue during radiotherapy. Cancer 116(2):529–537PubMedCrossRefGoogle Scholar
- 3.Chow E et al (2008) Symptom clusters in cancer patients with brain metastases. Clin Oncol (R Coll Radiol) 20(1):76–82CrossRefGoogle Scholar
- 4.Hickok JT et al (2005) Occurrence, severity, and longitudinal course of twelve common symptoms in 1129 consecutive patients during radiotherapy for cancer. J Pain Symptom Manag 30(5):433–442CrossRefGoogle Scholar
- 5.Ahlberg K, Ekman T, Gaston-Johansson F (2005) The experience of fatigue, other symptoms and global quality of life during radiotherapy for uterine cancer. Int J Nurs Stud 42(4):377–386PubMedCrossRefGoogle Scholar
- 6.de Jong N et al (2002) Fatigue in patients with breast cancer receiving adjuvant chemotherapy: a review of the literature. Cancer Nurs 25(4):283–297PubMedCrossRefGoogle Scholar
- 7.Hird A et al (2010) Exploration of symptoms clusters within cancer patients with brain metastases using the Spitzer Quality of Life Index. Supportive Care Cancer 18(3):335–342CrossRefGoogle Scholar
- 8.Brown LF, Kroenke K (2009) Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics 50(5):440–447PubMedGoogle Scholar
- 9.Jacobsen P, Weitzner M (2004) Fatigue and depression in cancer patients: conceptual and clinical issues. Fatigue in cancer. Oxford Univ Press, Oxford, pp 223–241Google Scholar
- 10.Kangas M, Bovbjerg DH, Montgomery GH (2008) Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull 134(5):700PubMedCrossRefGoogle Scholar
- 11.Multiple Risk Factor Intervention Trial (1997) Risk factor changes and mortality results. Multiple Risk Factor Intervention Trial Research Group. JAMA 277(7):582–594CrossRefGoogle Scholar
- 12.Hickok J et al (2005) Frequency, severity, clinical course, and correlates of fatigue in 372 patients during 5 weeks of radiotherapy for cancer. Cancer 104(8):1772–1778PubMedCrossRefGoogle Scholar
- 13.Barsevick A, Dudley W, Beck S (2006) Cancer-related fatigue, depressive symptoms, and functional status: a mediation model. Nurs Res 55(5):366–372PubMedCrossRefGoogle Scholar
- 14.Mock V (2004) Evidence-based treatment for cancer-related fatigue. JNCI Monogr 2004(32):112–118CrossRefGoogle Scholar
- 15.Rosenstock I (1966) Why people use health service. Milbank Mem Fund Q 44:94–123PubMedCrossRefGoogle Scholar
- 16.Purcell A et al (2010) Development of an educational intervention for cancer-related fatigue. Br J Occup Ther 73(7):327–333CrossRefGoogle Scholar
- 17.Purcell A et al (2011) Is education an effective management strategy for reducing cancer-related fatigue? Support Care Cancer 19(9):1429–1439PubMedCrossRefGoogle Scholar
- 18.Oken MM et al (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 5(6):649–656PubMedCrossRefGoogle Scholar
- 19.Baron K et al (2006) A user’s manual for the occupational self-assessment (version 2.2). University of Illinois, ChicagoGoogle Scholar
- 20.Kielhofner G et al (2009) Developing the occupational self assessment: the use of Rasch analysis to assure internal validity, sensitivity and reliability. Br J Occup Ther 72(3):94–104Google Scholar
- 21.Smets E et al (1995) The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39(3):315–325PubMedCrossRefGoogle Scholar
- 22.Purcell A et al (2010) Determining the minimal clinically important difference criteria for the Multidimensional Fatigue Inventory in a radiotherapy population. Support Care Cancer 18(3):307–315PubMedCrossRefGoogle Scholar
- 23.Dolan P, Roberts J (2002) Modelling valuations for EQ-5D health states: an alternative model using differences in valuations. Med Care 40(5):442–446PubMedCrossRefGoogle Scholar
- 24.National Comprehensive Cancer Network (2003) Distress management clinical practice guidelines. J Natl Comp Cancer Netw 1:344–374Google Scholar
- 25.Vodermaier A, Linden W, Siu C (2009) Screening for emotional distress in cancer patients: a systematic review of assessment instruments. J Nat Cancer Inst 101(21):1464–1488PubMedCrossRefGoogle Scholar
- 26.Ransom S, Jacobsen PB, Booth–Jones M (2006) Validation of the Distress Thermometer with bone marrow transplant patients. Psychol–Oncol 15(7):604–612CrossRefGoogle Scholar
- 27.Twisk JW (2004) Longitudinal data analysis. A comparison between generalized estimating equations and random coefficient analysis. Eur J Epidemiol 19(8):769–776PubMedCrossRefGoogle Scholar
- 28.Pickard AS, Neary MP, Cella D (2007) Estimation of minimally important differences in EQ-5D utility and VAS scores in cancer. Health Qual Life Outcomes 5:70PubMedCrossRefGoogle Scholar
- 29.Prue G et al (2006) Cancer-related fatigue: a critical appraisal. Eur J Cancer 42(7):846–863PubMedCrossRefGoogle Scholar
- 30.Servaes P, Verhagen C, Bleijenberg G (2002) Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions. Eur J Cancer 38(1):27–43PubMedCrossRefGoogle Scholar
- 31.Wee CC et al (2013) Expectations for weight loss and willingness to accept risk among patients seeking weight loss surgery. JAMA Surg 148(3):264–271PubMedCrossRefGoogle Scholar
- 32.Linde K et al (2007) The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain 128(3):264–271PubMedCrossRefGoogle Scholar
- 33.McPhail S, Haines T (2010) The response shift phenomenon in clinical trials. J Clin Res Best Pract 6(2):1–8Google Scholar