Inverse relationship between reduced fatigue and severity of anemia in oncology patients treated with integrative medicine: understanding the paradox
- 28 Downloads
To assess the impact of integrative medicine (IM) on cancer-related fatigue in patients undergoing chemotherapy for early and advanced breast and gynecological (ovarian, endometrial, and cervical) cancer.
Patients reporting significant levels of fatigue (on the Edmonton Symptom Assessment Scale (ESAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), or Measure Yourself Concerns and Wellbeing questionnaire (MYCAW)) were offered complementary and integrative medicine (CIM) treatments in addition to standard supportive care. Patients who did not undergo IM treatments were designated as controls. Attending at least five CIM treatments less than 30 days between each session was considered as high adherence to integrative care (AIC).
Of 258 eligible patients reporting significant fatigue, follow-up assessment at 6 and 12 weeks was considered optimal for 120 patients in the intervention group and for 64 controls; 88 of treated patients found to be adherent to the IM intervention. At 12 weeks, ESAS (P < 0.001) and EORTC (p = 0.001) scores for fatigue improved more significantly in treated patients, with a higher percent with optimal relative dose intensity in the AIC subgroup, both at 6 weeks (P = 0.002) and at 12 weeks (P < 0.001). IM treatment was paradoxically associated with a greater decrease in hemoglobin levels at 12 weeks (P = 0.016), more so in the AIC subgroup (P = 0.024).
Integrative medicine program may alleviate cancer-related fatigue in patients with breast and gynecological cancer undergoing chemotherapy.
KeywordsCancer-related fatigue Integrative medicine Complementary medicine Relative dose intensity Quality of life Anemia
Contributions of authors
EBA, OD, and NS initiated the trial, collected the data, and analyzed this study. EBA, ISS, OD, and NS planned the study and wrote the manuscript draft. All authors participated in the revision of the manuscript.
Compliance with ethical standards
Conflict of interests
The authors declare that they have no conflict of interest.
- 1.Goldstein D, Bennett BK, Webber K, Boyle F, de Souza PL, Wilcken NR, Scott EM, Toppler R, Murie P, O’Malley L, McCourt J, Friedlander M, Hickie IB, Lloyd AR (2012) Cancer-related fatigue in women with breast cancer: outcomes of a 5-year prospective cohort study. J Clin Oncol 30(15):1805–1801CrossRefPubMedGoogle Scholar
- 4.Peoples AR, Roscoe JA, Block RC, Heckler CE, Ryan JL, Mustian KM, Janelsins MC, Peppone LJ, Moore DF Jr, Coles C, Hoelzer KL, Morrow GR, Dozier AM. Nausea and disturbed sleep as predictors of cancer-related fatigue in breast cancer patients: a multicenter NCORP study. Support Care Cancer 2017;25(4):1271–1278Google Scholar
- 5.Heckler CE, Garland SN, Peoples AR, Perlis ML, Shayne M, Morrow GR, Kamen C, Hoefler J, Roscoe JA (2016) Cognitive behavioral therapy for insomnia, but not armodafinil, improves fatigue in cancer survivors with insomnia: a randomized placebo-controlled trial. Support Care Cancer 24(5):2059–2066CrossRefPubMedGoogle Scholar
- 6.van Waart H, Stuiver MM, van Harten WH, Geleijn E, Kieffer JM, Buffart LM, de Maaker-Berkhof M, Boven E, Schrama J, Geenen MM, Meerum Terwogt JM, van Bochove A, Lustig V, van den Heiligenberg SM, Smorenburg CH, Hellendoorn-van Vreeswijk JA, Sonke GS, Aaronson NK (2015) Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol 33(17):1918–1927CrossRefPubMedGoogle Scholar
- 10.Barton DL, Liu H, Dakhil SR, Linquist B, Sloan JA, Nichols CR, McGinn TW, Stella PJ, Seeger GR, Sood A, Loprinzi CL (2013) Wisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. J Natl Cancer Inst 105(16):1230–1238CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Chen Z, Meng Z, Milbury K, Bei W, Zhang Y, Thornton B, Liao Z, Wei Q, Chen J, Guo X, Liu L, McQuade J, Kirschbaum C, Cohen L (2013) Qigong improves quality of life in women undergoing radiotherapy for breast cancer: results of a randomized controlled trial. Cancer 119(9):1690–1698CrossRefPubMedGoogle Scholar
- 17.Shalom-Sharabi I, Samuels N, Lavie O, Lev E, Keinan-Boker L, Schiff E, Ben-Arye E (2017) Effect of a patient-tailored integrative medicine program on gastro-intestinal concerns and quality of life in patients with breast and gynecologic cancer. J Cancer Res Clin Oncol 143(7):1243–1254CrossRefPubMedGoogle Scholar
- 19.Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, Johnson JA, Mumber M, Seely D, Zick SM, Boyce LM, Tripathy D (2017) Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin 67(3):194–232CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Cheng CS, Chen LY, Ning ZY, Zhang CY, Chen H, Chen Z, Zhu XY, Xie J (2017 Jul 13) Acupuncture for cancer-related fatigue in lung cancer patients: a randomized, double blind, placebo-controlled pilot trial. Support Care Cancer 25:3807–3814. https://doi.org/10.1007/s00520-017-3812-7. CrossRefPubMedGoogle Scholar
- 21.Bruera E, Kuehn N, Miller M, Selmser P, Macmillan K (1991) The Edmonton symptom assessment system (ESAS): a simple method for the assessment of palliative care patients. J Palliative Care 7(2):6–9Google Scholar
- 22.Oldenmenger W, de Raaf P, de Klerk C, van der Rijt C (2012) Cut points on 0–10 numeric rating scales for symptoms included in the Edmonton symptom assessment scale in cancer patients: a systematic review. J Pain Symp Manage. https://doi.org/10.1016/j.jpainsymman.2012.06.007
- 25.Yamaguchi T, Morita T, Nitto A, Takahashi N, Miyamoto S, Nishie H, Matsuoka J, Sakurai H, Ishihara T, Tarumi Y, Ogawa A (2016) Establishing cutoff points for defining symptom severity using the Edmonton Symptom Assessment System-Revised Japanese Version. J Pain Symptom Manag 51(2):292–297CrossRefGoogle Scholar
- 28.Gabrilove JL, Perez EA, Tomita DK, Rossi G, Cleeland CS (2007) Assessing symptom burden using the M. D. Anderson symptom inventory in patients with chemotherapy-induced anemia: results of a multicenter, open-label study (SURPASS) of patients treated with darbepoetin-alpha at a dose of 200 microg every 2 weeks. Cancer 110(7):1629–1640CrossRefPubMedGoogle Scholar
- 33.Shalom-Sharabi I, Lavie O, Samuels N, Keinan-Boker L, Lev E, Ben-Arye E (2017) Can complementary medicine increase adherence to chemotherapy dosing protocol? A controlled study in an integrative oncology setting. J Cancer Res Clin Oncol 143:2535–2543. https://doi.org/10.1007/s00432-017-2509-0 CrossRefPubMedGoogle Scholar