A randomized clinical trial of energy conservation for patients with cancer‐related fatigue Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. Moderators and long-term effectiveness of cognitive behaviour therapy for fatigue during cancer treatment. A rehabilitation program for lung cancer patients during postthoracotomy chemotherapy Cognitive behaviour therapy for fatigued cancer survivors: long-term follow-up A randomized clinical trial of a brief hypnosis intervention to control side effects in breast surgery patients. One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. Efficacy of dexmethylphenidate for the treatment of fatigue after cancer chemotherapy: a randomized clinical trial. Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial Six-Month Follow-up of Patient-Rated Outcomes in a Randomized Controlled Trial of Exercise Training during Breast Cancer Chemotherapy Systematic monitoring and treatment of physical symptoms to alleviate fatigue in patients with advanced cancer: a randomized controlled trial. Multimodal Therapy Concept and Aerobic Training in Breast Cancer Patients With Chronic Cancer-Related Fatigue Maintenance of effects of a home-based physical activity program among breast cancer survivors Effects of pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: a randomized controlled study. Managing symptoms in patients with advanced lung cancer during radiotherapy: results of a psychoeducational randomized controlled trial. Quality of Life After Self-Management Cancer Rehabilitation: A Randomized Controlled Trial Comparing Physical and Cognitive-Behavioral Training Versus Physical Training Long-term follow-up of a randomized study of support group intervention in women with primary breast cancer. Physical activity for patients undergoing an allogeneic hematopoietic stem cell transplantation: benefits of a moderate exercise intervention. Confronting the unexpected: temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors. Supportive-expressive group therapy: the transformation of existential ambivalence into creative living while enhancing adherence to anti-cancer therapies. A randomized controlled trial of a support group intervention on the quality of life and fatigue in women after primary treatment for early breast cancer Home-based physical activity intervention for breast cancer patients. Fatigue in cancer patients treated with cytotoxic drugs Feasibilty of a sleep intervention during adjuvant breast cancer chemotherapy. Maintenance of physical activity in breast cancer survivors after a randomized trial. Home-based exercise: promising rehabilitation for symptom relief, improved functional status and quality of life for post-surgical lung cancer patients. Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: results of a feasibility intervention study. Postoperative Physical Training following Colorectal Surgery: A Randomised, Placebo-Controlled Study Increased hemoglobin levels and improved quality-of-life assessments during epoetin alfa treatment in anemic cancer patients: results of a prospective, multicenter German trial. Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. Is increasing physical activity necessary to diminish fatigue during cancer treatment? Comparing cognitive behavior therapy and a brief nursing intervention with usual care in a multicenter randomized controlled trial. Cancer-Related Fatigue and Rehabilitation: A Randomized Controlled Multicenter Trial Comparing Physical Training Combined With Cognitive-Behavioral Therapy With Physical Training Only and With No Intervention
The efficacy of energy conservation and activity management ( ECAM ) for fatigue reduction and maintenance of functional performance has never been evaluated in adults with cancer who are undergoing treatment PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on  physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier OBJECTIVE A r and omised controlled trial ( RCT ) demonstrated that cognitive behaviour therapy ( CBT ) for fatigue during curative cancer treatment was effective shortly after cancer treatment . This study aim ed to identify which patient characteristics predict fatigue improvement after CBT . In addition , the long-term effectiveness was investigated . METHODS Patients with various malignancies participated in the RCT ( n = 210 ) . Participants were assessed before cancer treatment ( T1 ) , postintervention ( T2 ) , which was at least 2 months after cancer treatment , and after 1-year follow-up ( T3 ) . Monthly fatigue assessment s were completed between T2 and T3 . A regression analysis with interactions was performed to determine if domains of quality of life ( EORTC-QLQ-C30 ) functioning ( Health Survey Short Form-36 ) or psychological distress ( Symptom Checklist-90 ) moderated the effect of CBT on fatigue . Analyses of covariance were used to study the long-term effectiveness of CBT . RESULTS Fatigue at T2 was predicted by a significant interaction between self-reported cognitive functioning and CBT . No interactions were found between other domains of quality of life , functioning , psychological distress and CBT .  At T3 , no significant difference on fatigue was found between CBT and usual care . Exploratory analyses showed that the difference nearly reached significance until 7 months postintervention . CONCLUSIONS Patients who experienced more concentration and memory problems at T1 benefited more from CBT for fatigue and are indicators . After a year of follow-up , the effect of CBT for fatigue was no longer observed , and the effect on fatigue seemed to be diminished 7 months postintervention . The implication is that CBT for fatigue should be offered to patients with cancer with the highest chance to benefit Objective The objective of this pilot study was to describe the effects of a 16-week home-based rehabilitative exercise program on cancer-related fatigue ( CRF ) , other symptoms , functional status , and quality of life ( QOL ) for patients with non-small cell lung cancer ( NSCLC ) after thoracotomy starting within days after hospital discharge and continuing through the initiation and completion of chemotherapy .  Material s and methods Five patients with NSCLC completed the Brief Fatigue Inventory ( measuring CRF severity ) and the MD And erson Symptom Inventory ( measuring symptom severity ) before and after thoractomy , and at the end of each week of the 16-week exercise program . Additionally , the Medical Outcomes Study Short Form-36 ( measuring physical and mental functional status ) and the Quality of Life Index ( measuring QOL ) were completed before and after thoracotomy , after weeks 3 , 6 , 12 , and 16 ( the end of the exercise program ) . Further , the 6-minute walk test  ( measuring functional capacity ) was administered before thoracotomy , prior to the initiation of chemotherapy and /or radiation therapy , and at the end of the 16-week exercise program , after completion of chemotherapy . Results Participants had a mean age of 63 years and a mean of five comorbid conditions ; the exercise program was initiated within 4 days after hospital discharge . Participants ’ CRF severity scores were reduced to mild levels , while the mean number of symptoms decreased from 9 postthoracotomy to 6 after the exercise program , with mean levels of severity and interference decreasing to below prethoracotomy levels . Likewise , participants ’ functional status and QOL after completing the exercise program improved to near or above prethoracotomy levels . Conclusion The home-based , light-intensity exercise program for NSCLC patients receiving and completing adjuvant chemotherapy postthoracotomy showed promising trends in improving CRF severity , other symptom severity , functional status , and QOL . Further testing via a two-arm r and omized controlled trial is being conducted An earlier r and omised-controlled trial demonstrated the positive effects of cognitive behaviour therapy ( CBT ) , especially design ed for fatigued cancer survivors in reducing fatigue , functional impairments and psychological distress . In the current prospect i ve study , we were able to examine the long-term effect of CBT in patients who completed the therapy . Predictors of fatigue severity at follow-up were exploratory investigated . Sixty-eight patients who completed CBT  were assessed at pretreatment , post-treatment and at follow-up ( mean follow-up 1.9 years ( s.d . 1.0 ) , range : 1–4 years ) . To analyse possible predictors of treatment outcome a linear regression ( enter ) was carried out . Improvements on fatigue severity , functional impairment and psychological distress after CBT appeared to remain stable during a follow-up period . Patients who were not fatigued anymore at follow-up were not different from a reference group of non-fatigued cancer survivors . The explorative regression analysis showed that fatigue severity , psychological distress and somatic attributions at pretreatment contributed to persistent fatigue severity at follow-up . Cognitive behaviour therapy , especially design ed for post-cancer fatigue , is successful in reducing fatigue and functional impairment in cancer survivors . Moreover , these positive effects were maintained at about 2 years after finishing CBT BACKGROUND Breast cancer surgery is associated with side effects , including postsurgical pain , nausea , and fatigue . We carried out a r and omized clinical trial to test the hypotheses that a brief presurgery hypnosis intervention would decrease intraoperative anesthesia and analgesic use and side effects associated with breast cancer surgery and that it would be cost effective . METHODS We r and omly assigned 200 patients who were scheduled to undergo excisional breast biopsy or lumpectomy ( mean age 48.5 years ) to a 15-minute presurgery hypnosis session conducted by a psychologist or nondirective empathic listening ( attention control ) . Patients were not blinded to group assignment . Intraoperative anesthesia use ( i.e. , of the analgesics lidocaine and fentanyl and the sedatives propofol and midazolam ) was assessed . Patient-reported pain and other side effects as measured on a visual analog scale ( 0 - 100 ) were assessed at discharge , as was use of analgesics in the recovery room . Institutional costs and time in the operating room were assessed via chart review . RESULTS Patients in the hypnosis group required less propofol ( means = 64.01 versus 96.64 microg ; difference = 32.63 ; 95 % confidence interval [ CI ] = 3.95 to 61.30 ) and lidocaine ( means = 24.23 versus 31.09 mL ; difference = 6.86 ; 95 % CI = 3.05 to 10.68 ) than patients in the control group . Patients in the hypnosis group also reported less pain intensity ( means = 22.43 versus 47.83 ; difference = 25.40 ; 95 % CI = 17.56 to 33.25 ) , pain unpleasantness ( means = 21.19 versus 39.05 ; difference = 17.86 ; 95 % CI = 9.92 to 25.80 ) , nausea ( means = 6.57 versus 25.49 ; difference = 18.92 ; 95 % CI = 12.98 to 24.87 ) , fatigue ( means = 29.47 versus 54.20 ; difference = 24.73 ; 95 % CI = 16.64 to 32.83 ) , discomfort ( means = 23.01 versus 43.20 ; difference = 20.19 ; 95 % CI = 12.36 to 28.02 ) , and emotional upset ( means = 8.67 versus 33.46 ; difference = 24.79 ; 95 % CI = 18.56 to 31.03 ) . No statistically significant differences were seen in the use of fentanyl , midazolam , or recovery room analgesics .  Institutional costs for surgical breast cancer procedures were $ 8561 per patient at Mount Sinai School of Medicine . Patients in the hypnosis group cost the institution $ 772.71 less per patient than those in the control group ( 95 % CI = 75.10 to 1469.89 ) , mainly due to reduced surgical time . CONCLUSIONS Hypnosis was superior to attention control regarding propofol and lidocaine use ; pain , nausea , fatigue , discomfort , and emotional upset at discharge ; and institutional cost . Overall , the present data support the use of hypnosis with breast cancer surgery patients PURPOSE To determine 1-year outcomes of a four-component behavioral therapy ( BT ) sleep intervention ( Individualized Sleep Promotion Plan [ ISPP ] ) versus a healthy eating control ( HEC ) on cancer-related fatigue in women receiving breast cancer adjuvant chemotherapy treatment ( CTX ) . PATIENTS AND METHODS A total of 219 participants from 12 oncology clinics were r and omly assigned in a clinical trial . Before CTX , research nurses coached intervention participants to develop a BT plan including stimulus control , modified sleep restriction , relaxation therapy , and sleep hygiene . BT plans were revised before each CTX and 30 , 60 , and 90 days after the last CTX and reinforced 7 to 9 days later . HEC participants received nutritional information and equal attention . Pittsburgh Sleep Quality Index ( PSQI ) , Daily Diary , Wrist Actigraph , and Piper Fatigue Scale measures and Repeated Linear Mixed Model analysis following the Intent to Treat paradigm were used . RESULTS Sleep quality differed over 1 years time ( F [ 4,162 ] = 7.7 , P < .001 ; by group , F [ 1,173 ] = 4.8 , P = .029 ; and over time by group , F [ 4,162 ] = 3.3 , P = .013 ) . Pairwise comparisons revealed significant differences between groups at 90 days ( P = .002 ) but not at 1 year ( P = .052 ) . Seven days of diary and actigraphy data did not corroborate with monthly reflections ( PSQI ) . The night awakenings ( Actigraph ) pattern was significantly different by group over time ( P = .046 ) , with no differences between groups at 90 days or at 1 year . Fatigue was lower at 1 year than before CTX ; no group effects were found . CONCLUSION The BT group , on average , experienced significant improvement on global sleep quality compared with the HEC group , but not on objective sleep or fatigue outcomes Cancer and its treatment can induce subjective and objective evidence of diminished functional capacity encompassing physical fatigue and cognitive impairment . Dexmethylpheni date ( D-MPH ; the D-isomer of methylpheni date ) was evaluated for treatment of chemotherapy-related fatigue and cognitive impairment . A r and omized , double-blind , placebo-controlled , parallel-group study evaluated the potential therapeutic effect and safety of D-MPH in the treatment of patients with chemotherapy-related fatigue . Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale ( FACIT-F ) total score at Week 8 was the primary outcome measure . One hundred fifty-four patients ( predominantly with breast and ovarian cancers ) were r and omized and treated . Compared with placebo , D-MPH-treated subjects demonstrated a significant improvement in fatigue symptoms at Week 8 in the FACIT-F ( P=0.02 ) and the Clinical Global Impression-Severity scores ( P=0.02 ) , without clinical ly relevant changes in hemoglobin levels . Cognitive function was not significantly improved . There was a higher rate of study drug-related adverse events ( AEs ) ( 48 of 76 [ 63 % ] vs. 22 of 78 [ 28 % ] ) and a higher discontinuation rate because of AEs ( 8 of 76 [ 11 % ] vs. 1 of 78 [ 1.3 % ] ) in D-MPH-treated subjects compared with placebo-treated subjects . The most commonly reported AEs independent of study drug relationship in D-MPH-treated subjects were headache , nausea , and dry mouth , and in placebo-treated subjects were headache , diarrhea , and insomnia .  D-MPH produced significant improvement in fatigue in subjects previously treated with cytotoxic chemotherapy . Further studies with D-MPH or other agents to explore treatment response in chemotherapy-associated fatigue should be considered Fatigue is a frequent problem after surgical treatment of solid tumours . Aerobic exercise and psychosocial interventions have been shown to reduce the severity of this symptom in cancer patients . Therefore , we compared the effect of the two therapies on fatigue in a r and omised controlled study . Seventy-two patients who underwent surgery for lung ( n=27 ) or gastrointestinal tumours ( n=42 ) were assigned to an aerobic exercise group ( stationary biking 30 min five times weekly ) or a progressive relaxation training group ( 45 min three times per week ) . Both interventions were carried out for 3 weeks . At the beginning and the end of the study , we evaluated physical , cognitive and emotional status and somatic complaints with the European Organization for Research and Treatment of Cancer Quality of Life Question naire Core Module ( EORTC-QLQ-30 ) question naire , and maximal physical performance with an ergometric stress test . Physical performance of the training group improved significantly during the programme ( 9.4±20 watts , p=0.01 ) but remained unchanged in the relaxation group ( 1.5±14.8 watts , p=0.37 ) . Fatigue and global health scores improved in both groups during the intervention ( fatigue : training group 21 % , relaxation group 19 % ; global health of both groups 19 % , p for all ≤0.01 ) ; however , there was no significant difference between changes in the scores of both groups ( p=0.67 ) . We conclude that a structured aerobic training programme improves the physical performance of patients recovering from surgery for solid tumours . However , exercise is not better than progressive relaxation training for the treatment of fatigue in this setting Background : Few exercise trials in cancer patients have reported longer-term follow-up . Here , we report a 6-month follow-up of exercise behavior and patient-rated outcomes from an exercise trial in breast cancer patients . Methods : Breast cancer patients initiating adjuvant chemotherapy ( n = 242 ) were r and omly assigned to usual care ( n = 82 ) , resistance exercise training ( RET ; n = 82 ) , or aerobic exercise training ( AET ; n = 78 ) for the duration of their chemotherapy . At 6-month follow-up , participants were mailed a question naire that assessed quality of life , self-esteem , fatigue , anxiety , depression , and exercise behavior . Results : Two hundred one ( 83.1 % ) participants provided 6-month follow-up data . Adjusted linear mixed-model analyses showed that , at 6-month follow-up , the RET group reported higher self-esteem [ adjusted mean difference , 1.6 ; 95 % confidence interval ( 95 % CI ) , 0.1 - 3.2 ; P = 0.032 ] and the AET group reported lower anxiety ( adjusted mean difference , −4.7 ; 95 % CI , −0.0 to −9.3 ; P = 0.049 ) compared with the usual care group . Moreover , compared with participants reporting no regular exercise during the follow-up period , those reporting regular aerobic and resistance exercise also reported better patient-rated outcomes , including quality of life ( adjusted mean difference , 9.5 ; 95 % CI , 1.2 - 17.8 ; P = 0.025 ) . Conclusions : Improvements in self-esteem observed with RET during breast cancer chemotherapy were maintained at 6-month follow-up whereas reductions in anxiety not observed with AET during breast cancer chemotherapy emerged at 6-month follow-up . Moreover , adopting a combined aerobic and resistance exercise program after breast cancer chemotherapy was associated with further improvements in patient-rated outcomes . Exercise training during breast cancer chemotherapy may result in some longer-term and late effects for selected patient-rated outcomes . ( Cancer Epidemiol Biomarkers Prev 2007;16(12):2572–8 PURPOSE Several guidelines on the treatment of cancer-related fatigue recommend optimizing treatment of accompanying symptoms . However , evidence for this recommendation from r and omized clinical trials is lacking . We investigated whether monitoring and protocol ized treatment of physical symptoms alleviates fatigue . PATIENTS AND METHODS In all , 152 fatigued patients with advanced cancer were r and omly assigned to protocol ized patient-tailored treatment ( PPT ) of symptoms or care as usual . The PPT group had four appointments with a nurse who assessed nine symptoms on a 0 to 10 numeric rating scale ( NRS ) . Patients received a nonpharmacologic intervention for symptoms with a score ≥ 1 and a medical intervention for symptoms with a score ≥ 4 . Fatigue dimensions , fatigue NRS score , interference of fatigue with daily life , symptom burden , quality of life , anxiety , and depression were measured at baseline and after 1 , 2 , and 3 months . Differences between the groups over time were assessed by using mixed modeling . RESULTS Seventy-six patients were r and omly assigned to each study arm . Mean age was 58 ± 10 years , 57 % were female , and 65 % were given palliative chemotherapy . We found significant improvements over time in favor of PPT for the primary outcome general fatigue ( P = .01 ) , with significant group differences at month 1 ( effect size , 0.26 ; P = .007 ) and month 2 ( effect size , 0.35 ; P = .005 ) . Improvements in favor of PPT were also found for the following secondary outcomes : fatigue dimensions " reduced activity " and " reduced motivation , " fatigue NRS , symptom burden , interference of fatigue with daily life , and anxiety ( all P ≤ .03 ) . CONCLUSION In fatigued patients with advanced cancer , nurse-led monitoring and protocol ized treatment of physical symptoms is effective in alleviating fatigue Hypothese : Cancer-related fatigue ( CRF ) and sleep disorders are some of the most wearing and common symptoms in disease-free breast cancer patients ( BC ) .  Aerobic training ( AT ) is the treatment with the best available evidence , even though it seems to be insufficient with regards to improvements in cognitive fatigue . We introduced a new multimodal therapy concept ( MM ) consisting of psycho- , sleep-education and new approaches based on anthroposophic medicine such as eurythmy and painting therapy . Study design : This pilot study will test the implementation of MM and yield first results of the MM and AE in our centres . Methods : 31 out of 34 patients suffering from BC and CRF were fully assessed in a ten-week intervention study . 21 patients chose MM and 10 decided on AT .  CRF was measured with the help of the Cancer Fatigue Scale ( CFS-D ) , and the global quality of sleep was measured with the Pittsburgh Sleep Quality Index ( PSQI ) . We also captured autonomic regulation ( aR ) and patients ’ satisfaction with question naires . Statistical analysis was done with SAS 9.1.3 for windows . Results : The new MM therapy can be implemented with high satisfaction among patients . Significant improvements were found in the MM group with regards to CFS-D , global quality of sleep , sleep efficiency ( PSQI ) , aR and rest/activity regulation compared to baseline ( all p<0.05 ) . In the AT group aR orthostatic-circulatory and rest/activity regulation improved significantly ( p<0.05 ) , too . However , no improvement in cognitive fatigue was seen in either group . Conclusion : The multimodal therapy concept was feasible and improved cancer fatigue , sleep quality , autonomic and rest-/activity regulation in breast cancer patients . It may therefore constitute a valuable treatment option in addition to aerobic training for BC patients with CRF . A further study with larger sample size needs to be carried out to assess the efficacy of combined multimodal-aerobic therapy Purpose Although physical activity ( PA ) adoption improves fitness and psychological well-being among cancer survivors , PA maintenance has not been examined . This paper presents follow-up of a home-based PA program for women treated for early-stage breast cancer . Material s and methods Eighty-six sedentary women ( mean age = 53.14 years , SD = 9.70 ) were r and omly assigned to a  PA or contact control group . The PA group received a 12-week telephone counseling program to adopt PA . Assessment s were conducted at baseline , end-of-intervention ( 12 weeks ) , 6 , and 9 months post-baseline . Results When comparing change from end-of-intervention ( 12 weeks ) between groups , a significant reduction was observed in minutes of PA at 6 months ( t = −2.10 , p < 0.05 ) , but there was no decrease in intervention effect at 9 months ( t = −0.19 , p = 0.84 ) . Similarly , post-intervention reductions in fatigue were lost at 6 months ( t = 3.27 , p < 0.01 ) , but remained present at 9 months ( t = 1.65 , p = 0.10 ) . PA group ’s fitness improvements were maintained at both follow-ups ( t = 1.04 , p = 0.30 and t = 0.05 , p = 0.96 ) . The previously significant intervention effect on vigor was maintained at 6 months ( t = 1.32 , p = 0.19 ) but was significantly reduced at 9 months ( t = −2.15 , p < 0.05 ) . PA participants were more likely to progress in motivational readiness at 6 ( OR = 5.95 , 95 % CI = 2.30 , 15.36 ) and 9 months ( OR = 4.09 , 95 % CI = 1.69 , 9.87 ) ; however , group differences in meeting PA guidelines were not maintained . ConclusionS ome positive effects of a home-based PA intervention for breast cancer patients were maintained at 6 and 9 months BACKGROUND There are very few r and omized controlled studies on exercise in cancer patients . Consequently , there are no guidelines available with regard to the exercises that can be recommended and difficulties are encountered in the clinical practice as to which exercise is more suitable to the patients . AIM The purpose of this study was to investigate the impact of pilates exercises on physical performance , flexibility , fatigue , depression and quality of life in women who had been treated for breast cancer . DESIGN R and omized controlled trial . SETTING Out patient group , Department of Physical Medicine and Rehabilitation and Medical Oncology Department , University Hospital . POPULATION Fifty-two patients with breast cancer were divided into either pilates exercise ( group 1 ) and control group ( group 2 ) . METHODS Patients in Group 1 performed pilates and home exercises and patients in group 2 performed only home exercises . Pilates exercise sessions were performed three times a week for a period of eight weeks in the rehabilitation unit . MAIN OUTCOME MEASURES Subjects were assessed before and after rehabilitation program , with respect to , 6-min walk test ( 6MWT ) , modified sit and reach test , Brief Fatigue Inventory ( BFI ) , Beck Depression Index ( BDI ) and the European Organisation for Research and Treatment of Cancer Quality of Life C30 ( EORTC QLQ-C30 ) and EORTC QLQ BR23 . RESULTS After the exercise program , improvements were observed in Group 1 in 6-minute walk test , BDI , EORTC QLQ-C30 functional , and EORTC QLQ-C30 BR23 functional scores ( P<0.05 ) . In contrast , no significant improvement was observed in Group 2 after the exercise program in any of parameters in comparison to the pre-exercise period ( P>0.05 ) . When the two exercise groups were compared , there were significant differences in 6MWT in pilates-exercise group ( P<0.05 ) . CONCLUSION Pilates exercises are effective and safe in female breast cancer patients . There is a need for further studies so that its effect can be confirmed . CLINICAL REHABILITATION IMPACT This study addressed the effects of pilates exercise , as a new approach , on functional capacity , fatigue , depression and quality of life in breast cancer patients in whom there are doubts regarding the efficacy and usefulness of the exercise CONTEXT Breathlessness , fatigue , and anxiety are distressing symptoms for patients with advanced lung cancer . Usually managed as isolated symptoms , they often can occur simultaneously . Previous research often has addressed management of discrete symptoms rather than considering them as a cluster , which , in reality , is the situation faced by patients . OBJECTIVES This study aim ed to examine the effectiveness of a psychoeducational intervention ( PEI ) on the symptom cluster of anxiety , breathlessness , and fatigue , compared with usual care . METHODS A pretest/post-test , two-group , r and omized , controlled trial was conducted . Education on symptom management and coaching in the use of progressive muscle relaxation were delivered to patients one week prior to commencing radiotherapy ( RT ) , and repeated three weeks after beginning RT . Symptom data were collected at four time points : prior to the intervention , three weeks , six weeks , and 12 weeks postintervention . RESULTS One hundred forty lung cancer patients receiving palliative RT were recruited from a publicly funded hospital in Hong Kong . Doubly multivariate analysis of variance revealed a significant difference ( time × group interaction effect , P=0.003 ) over time between the PEI and usual care control group on the pattern of change of the symptom cluster . Significant effects on the patterns of changes in breathlessness ( P=0.002 ) , fatigue ( P=0.011 ) , anxiety ( P=0.001 ) , and functional ability ( P=0.000 ) also were found . CONCLUSION PEI is a promising treatment for relieving the symptom cluster and each of the individually assessed symptoms . More effort needs to be directed at study ing impact of interventions on common symptom clusters Objective : To conduct a r and omized controlled trial and compare the effects on cancer survivors ’ quality of life in a 12-week group-based multidisciplinary self-management rehabilitation program , combining physical training ( twice weekly ) and cognitive-behavioral training ( once weekly ) with those of a 12-week group-based physical training ( twice weekly ) . In addition , both interventions were compared with no intervention . Methods : Participants ( all cancer types , medical treatment completed ≥3 months ago ) were r and omly assigned to multidisciplinary rehabilitation ( n = 76 ) or physical training ( n = 71 ) . The nonintervention comparison group consisted of 62 patients on a waiting list . Quality of life was measured using the R AND -36 . The rehabilitation groups were measured at baseline , after rehabilitation , and 3-month follow-up , and the nonintervention group was measured at baseline and 12 weeks later . Results : The effects of multidisciplinary rehabilitation did not outperform those of physical training in role limitations due to emotional problem ( primary outcome ) or any other domains of quality of life ( all p > .05 ) . Compared with no intervention , participants in both rehabilitation groups showed significant and clinical ly relevant improvements in role limitations due to physical problem ( primary outcome ; effect size ( ES ) = 0.66 ) , and in physical functioning ( ES = 0.48 ) , vitality ( ES = 0.54 ) , and health change ( ES = 0.76 ) ( all p < .01 ) . Conclusions : Adding a cognitive-behavioral training to group-based self-management physical training did not have additional beneficial effects on  cancer survivors  ’ quality of life . Compared with the nonintervention group , the group-based self-management rehabilitation improved cancer survivors ’ quality of life . PT = physical training ; CBT = cognitive-behavioral training ; PT+CBT = physical training plus cognitive-behavioral training ; WLC = waiting-list comparison ; QoL = quality of life ; ANOVA = analysis of variance ; ES = effect size BACKGROUND Despite a fairly good prognosis , many breast-cancer patients suffer from symptoms such as anxiety , depression and fatigue , which may affect health-related quality of life and may persist for several years . The aim of the present study was to perform a long-term follow-up of a r and omized study of support group intervention in women after primary breast cancer treatment . MATERIAL S AND METHODS Three hundred and eighty two women with primary breast cancer were r and omized to support group intervention or control group , 181 in each group . Women in the intervention group participated in 1 week of intervention followed by 4 days of follow-up 2 months later . This is a long-term follow-up undertaken , in average , 6.5 years after r and omization . Patients answered the question naires the European Organisation for Research and Treatment of Cancer , quality of life question naire ( EORTC QLQ-C30 ) and the breast cancer module question naire ( BR 23 ) , the hospital anxiety and depression scale ( HAD ) and the Norwegian version of the fatigue scale ( FQ ) . RESULTS After adjusting for treatment with chemotherapy , age , marriage , education and children at home , there was a significant improvement in physical , mental and total fatigue ( FQ ) , cognitive function , body image and future perspective ( EORTC QLQ C30 and BR23 ) in the intervention group compared with controls . The proportion of women affected by high anxiety and depression scores were not significantly different between the groups . CONCLUSION Support intervention significantly improved cognitive function , body image , future perspective and fatigue , compared with to the findings in the control group UNLABELLED An allogeneic hematopoietic stem cell transplantation ( HSCT ) can have profound and lasting adverse effects on a patient 's physical and psychological well-being . So far , only few studies have investigated the effectiveness of physical activity over the entire inpatient phase of an allogeneic HSCT . PURPOSE We performed a r and omized controlled study to examine the influence of a controlled moderate exercise program starting parallel to chemotherapeutic conditioning and total body irradiation on the patient 's physical and psychological constitution . PATIENTS AND METHODS Forty-seven patients undergoing an allogeneic HSCT were r and omly assigned to an exercise group ( EG ) or a control group ( CG ) . While the EG took part in an endurance and activity of daily living-training twice a day , the CG received the clinic 's st and ard physiotherapy program once a day . RESULTS Significant differences and /or trends in favor of the EG were observed regarding the primary endpoint endurance performance ( P=0.002 ) , muscular strength ( P=0.022 ) , fatigue ( P=0.046 ) , and emotional state ( P=0.028 ) without posing an additional risk for the individual . CONCLUSION The results show that the training program is feasible and seems to have positive influences on physical performance and quality of life in patients undergoing an allogeneic HSCT . However , further studies are necessary to confirm these results PURPOSE / OBJECTIVES To describe women 's unexpected and distressing symptom experiences after breast cancer treatment . RESEARCH APPROACH Qualitative and descriptive . SETTING Depending upon their preference , participants were interviewed in their homes or in a private office space in a nearby library . PARTICIPANTS Purposive sample of 13 women 1 - 18 years after breast cancer treatment . METHOD OLOGIC APPROACH Secondary analysis of phenomenologic data ( constant comparative method ) . MAIN RESEARCH VARIABLES Breast cancer symptom distress , ongoing symptoms , and unexpected experiences . FINDINGS Women described experiences of unexpected and distressing symptoms in the years following breast cancer treatment . Symptoms included pain , loss of energy , impaired limb movement , cognitive disturbance , changed sexual experience , and lymphedema . Four central themes were derived : living with lingering symptoms , confronting unexpected situations , losing precancer being , and feeling like a has-been . Distress intensified when women expected symptoms to disappear but symptoms persisted instead . Increased distress also was associated with sudden and unexpected situations or when symptoms elicited feelings of loss about precancer being and feelings of being a has been . Findings suggest that symptom distress has temporal , situational , and attributive dimensions . CONCLUSIONS Breast cancer survivors ' perceptions of ongoing and unexpected symptoms have important influences on quality of life . Underst and ing temporal , situational , and attributive dimensions of symptom distress empowers nurses and healthcare professionals to help breast cancer survivors prepare for subsequent ongoing or unexpected experiences in the years after breast cancer treatment . INTERPRETATION Follow-up care for breast cancer survivors should foster dialogue about ways that symptoms might emerge and that unexpected situations might occur . Prospect i ve studies are needed to examine symptom distress in terms of temporal , situational , and attributive dimensions and explore the relationship between symptom distress and psychological distress after breast cancer treatment Supportive-Expressive Group Therapy ( SEGT ) has been developed and manualised in the research setting , but there have been few clinical accounts of its utility . In this qualitative review of its application in the Melbourne-based r and omised control trial ( RCT ) for women with advanced breast cancer , SEGT is considered from the perspective of the structure and framework of therapy , its therapists , the issues that develop in exploring its common themes and what constitutes a well functioning group . Groups move through identifiable developmental phases . The mature group process transforms existential ambivalence into creative living , evidence d by humour , celebration , assertiveness , altruism , new creative pursuits and eventually courageous acceptance of dying . Challenges and pitfalls include avoidance , non-containment of ambivalence , intolerance of difference , anti-group phenomena and splitting . A key element is the medicalization of the group culture whereby members and co-therapists explore health beliefs and attitudes about care . This promotes compliance with anti-cancer treatments , including both the initiation of and perseverance with chemotherapy .  This mechanism could prove to be a potentially important pathway in promoting longer survival Background When diagnosed with breast cancer , most women ’s lives change as well as their perspectives on and appreciation of life . The aim of the present study was to evaluate whether psychosocial support intervention could influence health-related quality of life ( HRQOL ) and fatigue during the first year after diagnosis . Material and methods Of 382 patients with newly diagnosed breast cancer , 191 patients were r and omized to an intervention group and 191 patients were r and omized to a routine control group .  The intervention group received support intervention that lasted 1 week on a residential basis , followed by 4 days of follow-up 2 months later . The support intervention included informative educational parts , relaxation training , mental visualization , and nonverbal communication .  HRQOL was measured using the European Organization for Research and Treatment of Cancer ( EORTC ) QLQ-C30 and QLQ-BR23 question naires and fatigue with the Norwegian version of the fatigue scale at baseline and at 2 , 6 , and 12 months after intervention . Result There was a time-dependent improvement in both functional and symptom scales between baseline and 12 months as measured by the EORTC QLQ-C30 and BR23 question naires and there was a decrease in fatigue between baseline and after 2 months with further improvement up to 12 months in both groups , but there were no differences between the intervention and control groups at any point in time . Conclusion HRQOL improves and symptoms of fatigue decrease over time , but we could not see any additional effect from the rehabilitation program in this setting PURPOSE The efficacy of a home-based physical activity ( PA ) intervention for early-stage breast cancer patients was evaluated in a r and omized controlled trial . PATIENTS AND METHODS Eighty-six sedentary women ( mean age , 53.14 years ; st and ard deviation , 9.70 years ) who had completed treatment for stage 0 to II breast cancer were r and omly assigned to a PA or contact control group . Participants in the PA group received 12 weeks of PA counseling ( based on the Transtheoretical Model ) delivered via telephone , as well as weekly exercise tip sheets . Assessment s were conducted at baseline , after treatment ( 12 weeks ) , and 6 and 9 month after baseline follow-ups . The post-treatment outcomes are reported here . RESULTS Analyses showed that , after treatment , the PA group reported significantly more total minutes of PA , more minutes of moderate-intensity PA , and higher energy expenditure per week than controls . The PA group also out-performed controls on a field test of fitness . Changes in PA were not reflected in objective activity monitoring . The PA group was more likely than controls to progress in motivational readiness for PA and to meet PA guidelines . No significant group differences were found in body mass index and percent body fat . Post-treatment group comparisons revealed significant improvements in vigor and a reduction in fatigue in the PA group . There was a positive trend in intervention effects on overall mood and body esteem . CONCLUSION The intervention successfully increased PA and improved fitness and specific aspects of psychological well-being among early-stage breast cancer patients . The success of a home-based PA intervention has important implication s for promoting recovery in this population Study objectives . Cancer-related fatigue is a significant and distressing problem for the cancer patient , affecting their physical and psychosocial function negatively , and reducing their quality of life . The aims of this study were to assess frequency , severity , and the consequence of fatigue in cancer out patients receiving cytotoxic drugs  , using an existing international fatigue scale applied for Swedish use . Methods . The study used a non-r and omized , prospect i ve design to evaluate fatigue and its impact on quality of life in out patients receiving cytotoxic drugs .  Once a week , 147 cancer patients , in an outpatient ward for cytotoxic drug administration , filled out question naires containing 13 items from the Fatigue Symptom Inventory ( FSI ) , and five additional questions . Results . Prevalence of fatigue was 92 % in the week after all patients had received cytotoxic drugs , and patients were statistically significantly more fatigued during than before treatment . The degree of fatigue was highest the week after treatment , and declined over the following week . Other symptoms , especially depressed mood , showed a strong correlation with cancer and cytotoxic-induced fatigue . Lung and breast cancer patients experienced the highest degree of fatigue . Some cytotoxic drug regimens were , apart from the underlying disease , associated with high fatigue scores , eg , those with cyclophosphamide or gemcitabine . Patients not receiving first line treatment scored significantly higher fatigue with more influence on daily living . Conclusion . The study verified that fatigue is a common side effect , and affects quality of life negatively , even for out patients receiving cytotoxic drugs . The clinical oncology pharmacist must inform patients that a severe tiredness , fatigue , may follow cytotoxic drug administration PURPOSE / OBJECTIVES To evaluate the feasibility of an intervention design ed to promote sleep and modify fatigue during four cycles of adjuvant breast cancer chemotherapy . DESIGN Prospect i ve , repeated measures , quasi-experimental feasibility study . SETTING Midwestern urban oncology clinics . SAMPLE 25 women between the ages of 40 - 65 ( mean = 54.3 ) with stage I-II breast cancer receiving doxorubicin-based chemotherapy . METHODS Each woman developed , reinforced , and revised an individualized sleep promotion plan ( ISPP ) with four components : sleep hygiene , relaxation therapy , stimulus control , and sleep restriction techniques . A daily diary , the Pittsburgh Sleep Quality Index , a wrist actigraph , and the Piper Fatigue Scale were used to collect data two days before and seven days after each treatment . MAIN RESEARCH VARIABLES Adherence , sleep and wake outcomes , and fatigue . FINDINGS Adherence rates with the components of the ISPP varied during treatments one through four : sleep hygiene ( 68%-78 % ) , relaxation therapy ( 57%-67 % ) , stimulus control ( 46%-67 % ) , and sleep restriction ( 76%-80 % ) . Mean sleep and wake outcomes at baseline , peak , and rebound times were that ( a ) sleep latency remained brief ( less than 30 minutes per night ) , ( b ) time awake after sleep onset exceeded the desired less than 30 minutes per night , ( c ) sleep efficiency scores remained stable at 85%-90 % , ( d ) total rest time remained stable at 8 - 10 hours per night , ( e ) subjective ratings of feelings on arising were stable , and ( f ) nighttime awakenings were 8 - 10 per night . Fatigue outcomes were that fatigue was stable two days after each treatment and mean daily fatigue intensity was lower at treatment three than at treatment one but rebounded at treatment four . CONCLUSIONS The intervention was feasible , adherence rates improved over time , and most sleep and wake patterns were consistent with normal values . Revisions will focus on decreasing nighttime awakenings . IMPLICATION S FOR NURSING Adopting behaviors to promote sleep may assist in maintaining sleep and managing fatigue during chemotherapy PURPOSE The purpose of this study was to examine the longer-term effects of pedometers and print material s on changes in physical activity ( PA ) and health-related quality of life ( HRQoL ) in breast cancer survivors who participated in a 3-month behavior change intervention . METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive either ( a ) a st and ard public health recommendation for PA ( SR ) , ( b ) previously developed breast cancer-specific PA print material s ( PM ) , ( c ) a step pedometer ( PED ) , or ( d ) a combination of the two ( COM ) . The primary endpoint was self-reported moderate/vigorous PA minutes per week at 6-month follow-up after the initial 3-month intervention period . RESULTS Seventy-one percent ( 266/377 ) of participants completed the 6-month follow-up assessment . According to intention-to-treat linear mixed-model analyses , self-reported moderate to vigorous PA increased by 9 min x wk(-1 ) in the SR group compared with 39 min x wk(-1 ) in the PM group ( mean difference = 30 min x wk(-1 ) ; 95 % CI = -44 to 104 ; P = 0.425 ) , 69 min x wk(-1 ) in the PED group ( mean difference = 60 min x wk(-1 ) ; 95 % CI = -13 to 132 ; P = 0.107 ) , and 56 min x wk(-1 ) in the COM group ( mean difference = 47 min x wk(-1 ) ; 95 % CI = -26 to 119 ; P = 0.210 ) . The same pattern was observed for self-reported , brisk walking . No differences were found for HRQoL or fatigue . CONCLUSION ( S ) Breast cancer-specific PM and PED did not maintain significantly higher PA or HRQoL at 6-month follow-up in breast cancer survivors , but the magnitude of the effect on PA ( 30 - 60 min x wk(-1 ) ) was consistent with the immediate postintervention effect observed at the 3-month postintervention time point . Issues of power result ing from additional loss to follow-up may account for the failure to achieve statistical significance . Additional research with larger sample sizes and more complete follow-up is warranted BACKGROUND Post-thoracotomy non-small cell lung cancer ( NSCLC ) patients report cancer-related fatigue ( CRF ) as a severe symptom that may increase the occurrence and severity of other symptoms while decreasing functional status and quality of life ( QOL ) . The aim of this pilot study was to describe the effects of a home-based rehabilitative exercise intervention on CRF , other symptoms , functional status , and QOL for post-surgical NSCLC patients starting within days after hospital discharge . METHODS Seven post-thoracotomy NSCLC patients completed the  Brief Fatigue Inventory ( BFI ) measuring CRF severity , and the  M.D. And erson Symptom Inventory measuring symptom severity at pre- and post-surgery , and at the end of each week of the six-week intervention . Additionally , the Medical Outcomes Short-Form-36 measuring physical and mental functional status ; and the Quality of Life Index ( QLI ) measuring QOL were completed pre- and post-surgery , after week 3 , and at the end of the intervention ( week 6 ) . RESULTS Participants had a mean age of 65 years , a mean of 6 co-morbid conditions , and initiated the intervention within 4 days after hospital discharge . Participants ' CRF severity scores were reduced to mild levels while the mean number of symptoms decreased from 10.4 post-surgery to 7.0 at week 6 with lower levels of severity and interference . Likewise , participants ' post-intervention functional status and QOL improved to near or above pre-surgical levels . CONCLUSIONS The exercise intervention for post-surgical NSCLC patients showed promising preliminary efficacy in improving CRF , other symptom severity , functional status , and QOL . Further testing via a two-arm r and omized controlled trial is being conducted PURPOSE / OBJECTIVES To evaluate outcomes of an intervention design ed to promote sleep and modify fatigue after adjuvant breast cancer chemotherapy . DESIGN Prospect i ve , repeated measures , quasi-experimental , feasibility study . SETTING Midwestern urban oncology clinics . SAMPLE 21 female participants , ages 43 - 66 years ( meanX = 55.3 ) with stage I or II breast cancer status post four cycles of doxorubicin chemotherapy .  Eight had four additional cycles of paclitaxel , 10 also had radiation , and 18 took tamoxifen . METHODS each woman continued to revise her Individualized Sleep Promotion Plan ( ISPP ) , developed during her first cycle of chemotherapy , that included sleep hygiene , relaxation therapy , stimulus control , and sleep restriction components . The  daily diary , Pittsburgh Sleep Quality Index , wrist actigraph , and Piper Fatigue Scale  were used for seven days 30 , 60 , and 90 days after the last chemotherapy treatment and one year after the first chemotherapy treatment . MAIN RESEARCH VARIABLES Adherence and sleep and wake , fatigue , and ISPP components . FINDINGS Adherence to the ISPP components remained high at all times ( 77%-88 % ) except for stimulus control ( 36%-56 % ) . Sleep outcome means and the actigraph revealed that ( a ) sleep latency remained less than 30 minutes per night , ( b ) the time awake after sleep onset exceeded the desired less than 30 minutes per night , ( c ) sleep efficiency scores ranged from 82%-92 % , ( d ) total rest time ranged from seven to eight hours per night , ( e ) feelings on arising ranged from 3.7 - 3.8 ( on a 0 - 5 scale ) , ( f ) nighttime awakenings ranged from 10 - 11 per night , and ( g ) daytime naps ranged from 10 - 15 minutes in length . Fatigue remained low , from 2.9 - 3.5 on a 0 - 10 scale . CONCLUSIONS Adherence rates remained high for most components . Sleep and wake patterns were within normal limits except for the number and duration of night awakenings . Fatigue remained low . IMPLICATION S FOR NURSING Future testing using an experimental design will focus on increasing ISPP adherence and decreasing nighttime awakenings . Adopting behavioral techniques to promote sleep may result in improved sleep and lower fatigue after chemotherapy Background and Aims : Major surgery is often followed by fatigue and reduced physical function . We wished to study if postoperative physical training reduced fatigue and improved physical function . Material and Methods : R and omised , placebo-controlled , single-blinded study . Participants were unselected patients ≥ 60 years undergoing elective colorectal surgery without disseminated cancer or inflammatory bowel disease . Group A trained muscular strength and work capacity . Group B performed relaxation exercises and received hot wrappings and massage . Main outcome measures were : fatigue ( visual analogue scale ) , muscular strength , walking speed , physical performance test , and physical function questions ( SF-36 ) . Results : Preoperatively the two groups were similar except that A was more fatigued than B. By postoperative day seven fatigue had increased compared to preoperatively , more in B than A , but by day 30 and 90 there were no significant differences between groups . All indices of physical function decreased postoperative day seven and were at the preoperative level day 90 with no significant differences between groups in change in function . Day seven the change in knee extension strength tended to be lower in B than A but by day 30 changes were similar in both groups . Conclusion : Postoperative training did not improve physical function , but reduced fatigue in hospital This prospect i ve , open-label , multicenter study was undertaken to determine the safety and efficacy of epoetin alfa in increasing hemoglobin levels and improving quality of life ( QOL ) , specifically fatigue , in cancer patients receiving chemotherapy with or without radiotherapy ( n=702 ) .  Epoetin alfa , 10,000 IU three times a week s.c . for 8 - 18 weeks , increased the mean hemoglobin level relative to baseline ( 1.0 + /- 1.5 g/dl by week 4 and > or = 1.7 g/dl from week 10 through the end of the trial ) , with 63.4 % of patients experiencing > or = 2 g/dl increases in hemoglobin above baseline at some time during the study . Fatigue is an important component of QOL . Physicians , nurses , and patients independently assessed patient fatigue level on a linear-analogue scale . Although all three groups reported improvements in patient fatigue over the course of the study ( p < .0001 ) , the magnitude of fatigue ratings and their relationship to tumor response and to hemoglobin level varied by group . Overall , epoetin alfa was well tolerated and effective in improving hemoglobin levels and decreasing fatigue in patients undergoing chemotherapy BACKGROUND To determine whether sleep quality and fatigue associated with breast cancer adjuvant chemotherapy treatments can be improved with behavioral therapy ( BT ) [ Individualized Sleep Promotion Plan ( ISPP ) ] including modified stimulus control , modified sleep restriction , relaxation therapy , and sleep hygiene . METHODS R and omized-controlled trial based on Piper Integrated Fatigue Model , 219 stages I-IIIA breast cancer patients . Prior to the initial chemotherapy treatment , BT participants developed an ISPP plan that was regularly reinforced and revised . Controls received healthy eating information and attention . Pittsburgh Sleep Quality Index ( PSQI ) , daily diary , actigraph , and Piper Fatigue Scale ( PFS ) data were collected 2 days prior , during the 7 days after each treatment , and 30 days after the last treatment . Repeated measures analysis of variance was used . RESULTS Prior to chemotherapy , participants reported mild fatigue and fairly poor sleep quality . All variables changed over time . A group by time interaction was found for sleep quality ( PSQI ) improving in the BT group . Diary revealed group differences on number of awakenings , minutes awake after sleep onset , and sleep efficiency . Fatigue ( PFS ) was similar between groups . CONCLUSIONS The BT group showed improved sleep quality over time and better sleep ( diary ) . Perceptions of improved sleep quality over time are not consistently associated with diary or actigraph , or result in lower fatigue PURPOSE Persistent fatigue is a long-term adverse effect experienced by 30 % to 40 % of patients cured of cancer . The main objective of this r and omized controlled trial was to show the effectiveness of cognitive behavior therapy ( CBT ) especially design ed for fatigue in cancer survivors . PATIENTS AND METHODS A total of 112 cancer survivors with somatically unexplained fatigue were allocated r and omly to immediate cognitive behavior therapy or to a waiting list condition for therapy . Both conditions were assessed two times , at baseline and 6 months later . The primary outcome variables were fatigue severity ( Checklist Individual Strength ) and functional impairment ( Sickness Impact Profile ) . Data were analyzed by intention to treat . RESULTS Analyses were based on 50 patients in the intervention condition and 48 patients in the waiting list condition . Patients in the intervention condition reported a significantly greater decrease than patients in the waiting list condition in fatigue severity ( difference , 13.3 ; 95 % CI , 8.6 to 18.1 ) and in functional impairment ( difference , 383.2 ; 95 % CI , 197.1 to 569.2 ) . Clinical ly significant improvement for the CBT group compared with the waiting list group was seen in fatigue severity ( 54 % v 4 % of the patients , respectively ) and in functional impairment ( 50 % v 18 % of the patients , respectively ) . CONCLUSION Cognitive behavior therapy has a clinical ly relevant effect in reducing fatigue and functional impairments in cancer survivors BACKGROUND Two interventions for fatigue were given during curative cancer treatment .  The aim of this multicenter r and omized controlled trial ( RCT ) with three conditions was to demonstrate the efficacy and to determine the contribution of physical activity . METHODS Recruited from seven hospitals , 220 patients with various malignancies participated in a RCT . The brief nursing intervention ( BNI ) consisted of two 1-hour sessions , 3 months apart , given by 12 trained nurses , focusing only on physical activity . Cognitive behavior therapy ( CBT ) consisted of up to ten 1-hour sessions , within 6 months , provided by two therapists , focusing on physical activity and psychosocial elements . The control group received only usual care ( UC ) . Assessment s took place before and at least 2 months after cancer treatment , when patients had recovered from acute fatigue . Fatigue was the primary outcome . Efficacy was tested using analyses of covariance . A nonparametric bootstrap approach was used to test whether the effect on fatigue was mediated by physical activity . RESULTS The CBT group was significantly less fatigued than the UC group . Between the BNI and the UC groups , no significant difference was found in fatigue . The mediation hypothesis was rejected . DISCUSSION CBT given during curative cancer treatment proved to be an effective intervention to reduce fatigue at least 2 months after cancer treatment . The BNI was not effective . Contrary to what was expected , physical activity did not mediate the effect of CBT on fatigue . Thus , the reduction in fatigue elicited by CBT was realized without a lasting increase in physical activity Background Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer . To date , it is unclear what type of rehabilitation is most beneficial . Objective This r and omized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention . Design In this multicenter r and omized controlled trial , 147 survivors of cancer were r and omly assigned to a group that received physical training combined with cognitive-behavioral therapy ( PT+CBT group , n=76 ) or to a group that received physical training alone ( PT group , n=71 ) . In addition , a nonintervention control group ( WLC group ) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included . Setting The study was conducted at 4 rehabilitation centers in the Netherl and s. Patients All patients were survivors of cancer . Intervention Physical training consisting of 2 hours of individual training and group sports took place twice weekly , and cognitive-behavioral therapy took place once weekly for 2 hours . Measurements Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention ( 12 weeks after enrollment ) . The WLC group completed question naires at the same time points . Results Baseline fatigue did not differ significantly among the 3 groups . Over time , levels of fatigue significantly decreased in all domains in all groups , except in mental fatigue in the WLC group . Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue , on physical and mental fatigue , and on reduced activation but not on reduced motivation . Compared with the WLC group , the PT group reported significantly greater decline in 4 domains of fatigue , whereas the PT+CBT group reported significantly greater decline in physical fatigue only . No significant differences in decline in fatigue were found between the PT+CBT and PT groups . Conclusions Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention . Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue , suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training
Cancer-related fatigue ( CRF ) is common and can be distressing for some survivors .
There is increasing interest in measuring levels of CRF , highlighting its impact on quality of life .
This review describes the nature and scope of evidence relating to interventions for CRF .