Home-based exercise to alleviate fatigue and improve functional capacity among breast cancer survivors. Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial Randomized controlled trial of an educational intervention for managing fatigue in women receiving adjuvant chemotherapy for early-stage breast cancer. Fatigue states after cancer treatment occur both in association with, and independent of, mood disorder: a longitudinal study Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. Effects of Supervised Exercise Therapy in Patients Receiving Radiotherapy for Breast Cancer Factors correlated with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale Randomized Controlled Trial of a Structured Training Program in Breast Cancer Patients with Tumor-Related Chronic Fatigue Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. Six-Month Follow-up of Patient-Rated Outcomes in a Randomized Controlled Trial of Exercise Training during Breast Cancer Chemotherapy Randomized trial of exercise therapy in women treated for breast cancer. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Fatigue and quality of life outcomes of exercise during cancer treatment. A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Restorative yoga for women with breast cancer: findings from a randomized pilot study. A Brief Intervention for Fatigue Management in Breast Cancer Survivors The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Daily fatigue patterns and effect of exercise in women with breast cancer. Home-based physical activity intervention for breast cancer patients. Treatment of Radiotherapy-Induced Fatigue Through a Nonpharmacological Approach Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer. Effectiveness of a home care nursing program in the symptom management of patients with colorectal and breast cancer receiving oral chemotherapy: a randomized, controlled trial. Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part II: Immunologic effects. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Fatigue in patients with cancers of the breast or prostate undergoing radical radiotherapy.
This pilot study examined the efficacy of two home-based exercise programs on alleviating fatigue and improving functional capacity in breast cancer survivors . Participants were r and omly assigned into one of three groups : aerobic exercise ( AE ) , resistance exercise ( RE ) , or usual care control ( CON ) . After receiving individualized instruction and training , participants assigned to the AE and RE groups were asked to perform the prescribed exercise(s ) 3 times per week for 12 weeks at home . Both groups were instructed to keep their perceived exercise intensity in the " fairly light " to " somewhat hard " range using the Borg Perceived Exertion Scale . All participants completed the revised Piper Fatigue Scale ( PFS ) and the 6-minute walk test ( 6MWT ) at baseline and 12-week post-exercise program . Analysis of pre- and post-training data revealed a significant reduction in fatigue levels on the PFS among participants in the AE group ( Z=2.521 , one-tailed P=0.006 ) , and a significant improvement in the distance of the 6MWT for the RE group ( Z=2.366 , one-tailed P=0.009 ) at the end of 12-week study period . No significant changes in fatigue or functional status were observed in the CON group . Findings provide preliminary support for RE as a viable strategy for improving functional capacity in breast cancer survivors , while AE may be more effective in attenuating cancer-related fatigue . Incorporating RE training for future research may help advance the growing body of knowledge in symptom management for breast cancer survivors Few r and omized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy . Breast cancer survivors ( N = 58 ) within 2 years of completing adjuvant therapy were r and omly assigned to an immediate exercise group ( IEG ; n = 29 ) or a delayed exercise group ( DEG ; n = 29 ) . The IEG completed 12 weeks of supervised aerobic and resistance exercise , three times per week . The DEG completed the program during the next 12 weeks . Participants completed patient-rated outcomes at baseline , 6 , 12 , 18 and 24 weeks . The primary endpoint was overall quality of life ( QoL ) measured by the Functional Assessment of Cancer Therapy-Breast scale . Secondary endpoints were fatigue , social physique anxiety , and physical fitness . Follow-up data was obtained on 97 % of participants and exercise adherence was 61.3 % . Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL ( P < 0.001 ) . Specifically , QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points ( mean group difference = 26.1 ; 95 % CI = 18.3–32.7 ; P < 0.001 ) . From 12 to 24 weeks , QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG ( mean group difference = 23.0 ; 95 % CI = 16.3–29.1 ; P < 0.001 ) . Similar results were obtained for the secondary endpoints . Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes PURPOSE To evaluate the efficacy of a psychoeducational intervention in improving cancer-related fatigue .  PATIENTS AND METHODS This r and omized controlled trial involved 109 women commencing adjuvant chemotherapy for stage I or II breast cancer in five chemotherapy treatment centers . Intervention group patients received an individualized fatigue education and support program delivered in the clinic and by phone over three 10- to 20-minute sessions 1 week apart . Instruments included a numeric rating scale assessing confidence with managing fatigue ; 11-point numeric rating scales measuring fatigue at worst , average , and best ; the Functional Assessment of Cancer Therapy-Fatigue and Piper Fatigue Scales ; the Cancer Self-Efficacy Scale ; the European Organisation for Research and Treatment of Cancer Quality of Life Question naire C30 ; and the Hospital Anxiety and Depression Scale . For each outcome , separate analyses of covariance of change scores between baseline ( T1 ) and the three follow-up time points ( T2 , T3 , and T4 ) were conducted , controlling for the variable 's corresponding baseline value . RESULTS Compared with the intervention group , mean difference scores between the baseline ( T1 ) and immediate after the test ( T2 ) assessment s increased significantly more for the control group for worst and average fatigue , Functional Assessment of Cancer Therapy-Fatigue , and Piper fatigue severity and interference measures . These differences were not observed between baseline and T3 and T4 assessment s. No significant differences were identified for any pre- or post-test change scores for confidence with managing fatigue , cancer self-efficacy , anxiety , depression , or quality of life . CONCLUSION Preparatory education and support has the potential to assist women to cope with cancer-related fatigue in the short term . However , further research is needed to identify ways to improve the potency and sustainability of psychoeducational interventions for managing cancer-related fatigue Background Persistent fatigue is recognised as one of the most common , ongoing symptoms reported by patients following cancer treatment and may have profound effects on the quality of life . However , recent cross-sectional studies also highlight the close relationship between cancer related fatigue ( CRF ) and diagnoses of depression or anxiety disorder . There is currently limited information about the relationships between these conditions over time . We sought to examine the longitudinal relationships between fatigue and mood disorder in women treated with adjuvant therapy for early stage breast cancer . Methods Women who had recently completed adjuvant therapy for Stage I or II breast cancer ( n = 212 ) were sent a question naire with established case thresholds for clinical ly-significant fatigue and psychological disorder , as well as a question naire assessing disability . Potentially relevant variables linked to fatigue states , including age , treatment modality , menopausal status , and hematological indices were recorded . The illness outcomes were assessed over 48 months of follow-up . Results The 176 women who responded to the question naire ( 84 % ) had a mean age of 55 ( range 24–83 ) years and had completed adjuvant treatment on average 10 ( range 4.7 – 16.3 ) months previously .  Radiotherapy had been administered , either alone ( 50 % of women ) or in combination with chemotherapy ( 36 % ) . Responses from 87 women ( 48 % ) indicated a significant fatigue state ( termed here post-cancer fatigue ; PCF ) , and from 59 women ( 33 % ) responses indicated significant psychological distress . Thirty-four women ( 19 % ) were cases of fatigue alone ( i.e. unaccompanied by psychological disorder ) , whereas 52 ( 30 % ) were cases of both disorders . Multivariate analysis did not reveal any association between demographic , clinical or laboratory variables , and caseness for PCF . Self-reported functional disability was significantly associated with fatigue . Follow-up at 24 , 36 and 48 months revealed high rates of ongoing PCF in conjunction with psychological distress , despite falling rates of psychological distress alone and fatigue alone . Conclusion Post-cancer fatigue was prevalent and sustained on follow-up . Concurrent psychological disorder was evident in the majority , but not all , cases of PCF and tended to be sustained over time . Further prospect i ve cohort studies to define the longitudinal co-morbid relationships between fatigue , mood disorder , and ongoing disability after cancer treatment are indicated 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 PURPOSE Cancer treatment-related fatigue is the most prevalent and distressing symptom of cancer therapy . Interventions to minimize fatigue are needed . The purpose of this study was to examine the relationship between exercise and fatigue over the first three cycles of chemotherapy in women receiving either cyclophosphamide , methotrexate , and fluorouracil ( CMF ) or doxorubicin and cyclophosphamide ( AC ) for breast cancer . METHODS Seventy-two newly diagnosed women with breast cancer were instructed in a home-based moderate-intensity exercise intervention . Measures of functional ability , energy expenditure , and fatigue were obtained at baseline and posttest . Subjects maintained daily records of four types of fatigue , and exercise duration , intensity , and type . RESULTS Exercise significantly reduced all four levels of fatigue ( P < 0.01 ) . As the duration of exercise increased , the intensity of fatigue declined ( P < 0.01 ) . There was a significant carry-over effect of exercise on fatigue , but the effect lasted only 1 d. The level of fatigue at study entry was not associated with number of days of exercise or amount of exercise a woman engaged in . CONCLUSIONS The impact of exercise on fatigue was significant and suggests the effectiveness of a low- to moderate-intensity regular exercise program in maintaining functional ability and reducing fatigue in women with breast cancer receiving chemotherapy 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 Purpose Postoperative radiotherapy for breast cancer has a number of associated complications . This study examined whether supervised moderate-intensity exercise could mitigate the complications that occur during radiotherapy . Patients and Methods Forty women were r and omized before radiotherapy after various operations for breast cancer . Seventeen patients who were assigned to the exercise group performed supervised moderate-intensity exercise therapy for 50 min 3 times per week for 5 weeks . Twenty-three patients in the  control group were asked to perform self-shoulder stretching exercise . The World Health Organization Quality of Life-BREF ( WHOQOL-BREF ) , brief fatigue inventory ( BFI ) , range of motion ( ROM ) of the shoulder , and pain score were assessed before and after radiotherapy . Results There were no significant differences noted at baseline between groups . In the exercise group , there was an increase in the WHOQOL-BREF and shoulder ROM and decrease in BFI and pain score after radiotherapy . On the other h and , patients in the control group showed decrease in the WHOQOL-BREF and shoulder ROM and increase in BFI and pain score after radiotherapy . There were statistically significant differences in the changes in the WHOQOL , BFI , shoulder ROM , and pain score between the groups . Conclusion Patients receiving radiotherapy for breast cancer may benefit in physical and psychological aspects from supervised moderate-intensity exercise therapy Abstract Fatigue is one of the most frequent symptoms in cancer patients . However , the precise causes of this fatigue are still unknown , and this situation makes it difficult to combat the problem . The present study was conducted to investigate factors correlated with fatigue in disease-free breast cancer patients . A group of 134 r and omly selected ambulatory breast cancer patients who had undergone successful surgical treatment participated . They completed the  Cancer Fatigue Scale , the Hospital Anxiety and Depression Scale , the Mental Adjustment to Cancer Scale , and an ad hoc question naire detailing physical symptoms , social support , and demographic variables at home and returned them by mail the following day . Multiple regression analysis revealed that fatigue was significantly correlated with dyspnea , insufficient sleep , and depression , and that these three variables accounted for a total of 46 % of variance in fatigue . Factors concerned with the cancer and treatment , such as disease stage , lymph node metastasis , number of days since operation , past intravenous chemotherapy , radiotherapy  , current use of fluoropyrimidine compounds , and current use of tamoxifen citrate were not correlated with fatigue . The results suggest that fatigue in this population is determined by current physical and psychological distress rather than by the cancer itself and prior cancer treatments , and that the management of dyspnea , insomnia , and depression might be important in reducing fatigue in this population Cancer-related fatigue is the most disabling symptom experienced by breast cancer patients following the cancer treatment . The positive effects of physical activity in the rehabilitation of breast cancer patients are documented in several studies . In a r and omized controlled study the effects of a structured physical training program on fatigue and health-related quality of life were evaluated . Patients and Methods : 63 breast cancer patients with cancer-related chronic fatigue were r and omized at the beginning of the inpatient rehabilitation . The control group received the st and ard complex rehabilitation program , the intervention group a structured physical training program and additional muscle strength and aerobic exercises . The effects of the treatment were evaluated by question naires at the start of rehabilitation ( t1 ) , end of rehabilitation ( t2 ) , and 3 months after t2 ( t3 ) . Isometric muscle strength and aerobic capacity were evaluated at t1 and t2 . Results : There was an improvement of muscle strength at the end of rehabilitation for both groups . The increase from t1 to t2 was significantly higher for the training group . The scores for global quality of life , physical well-being , and functionality increased from t1 to t2 , but further improvement in the follow-up ( t3 ) was only observed in the training group . The cancer-related fatigue was significantly reduced in the training group from t1 to t3 , however , not in the control group . Conclusions : Structured physical training programs initiated during inpatient rehabilitation and continuously practice d in the time thereafter can improve symptoms of chronic fatigue and quality of life in breast cancer patients AIM This paper is a report of a study to describe the efficacy of cognitive behavioural therapy for insomnia on fatigue , mood and quality of life in breast cancer survivors . BACKGROUND Women who receive primary treatment for breast cancer often complain of insomnia . Rarely evaluated in insomnia intervention studies is the effect of cognitive behavioural treatment on the psychosocial outcomes of fatigue , mood and quality of life . METHOD Data were collected between December 2002 and March 2004 with 72 women who were at least 3 months post-completion of primary treatment without current evidence of disease . Women were r and omly assigned to either the cognitive behavioural therapy for insomnia group , which received stimulus control instructions , sleep restriction therapy and sleep education and hygiene , or the component control group which received sleep education and hygiene only . The 10-week study consisted of 2 weeks of pre-treatment , 6 weeks of treatment and 2 weeks of post-treatment . Fatigue , mood and quality of life were measured at pre- and post-treatment . FINDINGS Women receiving cognitive behavioural therapy for insomnia had significant improvements in fatigue , trait anxiety , depression and quality of life . The component control group also had statistically significant increases in quality of life , with a trend suggestive of lower depression at post-treatment . CONCLUSION Globally , as the number of survivors in this population continues to grow , it is imperative that nurses continue testing interventions that may positively affect quality of life and the commonly experienced symptoms of fatigue , anxiety and depression 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 To examine the effects of aerobic exercise therapy on quality of life ( QoL ) and associated outcomes in women treated for breast cancer . Evidence suggests that exercise may be beneficial , but no trial has included an exercise-placebo and a usual-care group to control for the attention effects that might be associated with aerobic exercise interventions in cancer patients . PATIENTS AND METHODS A total of 108 women who had been treated for breast cancer 12 to 36 months previously were r and omly assigned to supervised aerobic exercise therapy ( n = 34 ) , exercise-placebo ( body conditioning ; n = 36 ) , or usual care ( n = 38 ) . Exercise therapy and exercise-placebo sessions took place three times per week for 8 weeks . Outcomes included QoL , depression , exercise behavior , aerobic fitness ; outcomes were assessed at baseline and at the 8- and 24-week follow-up . RESULTS Analyses of covariance revealed a significant mean difference of 9.8 units in Functional Assessment of Cancer Therapy-General ( primary outcome ) favoring aerobic exercise therapy at 8 weeks , relative to usual care . Significant differences that favored aerobic exercise therapy relative to usual care were recorded for Functional Assessment of Cancer Therapy-Breast , social/family well-being , functional well-being , and breast cancer subscale scores at 8-week follow-up . Psychological health outcomes improved modestly for both intervention groups ; these improvements were sustained for several end points . CONCLUSION Exercise therapy had large , clinical ly meaningful , short-term beneficial effects on QoL in women treated for breast cancer ; this finding can not be attributable to attention , given that the exercise-placebo group did not report similar effects relative to usual care PURPOSE Breast cancer chemotherapy  may cause unfavorable changes in physical functioning , body composition , psychosocial functioning , and quality of life ( QOL ) . We evaluated the relative merits of aerobic and resistance exercise in blunting these effects . PATIENTS AND METHODS We conducted a multicenter r and omized controlled trial in Canada between 2003 and 2005 that r and omly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care ( n = 82 ) , supervised resistance exercise  ( n = 82 ) , or supervised aerobic exercise  ( n = 78 ) for the duration of their chemotherapy ( median , 17 weeks ; 95 % CI , 9 to 24 weeks ) . Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy-Anemia scale . Secondary end points were fatigue , psychosocial functioning , physical fitness , body composition , chemotherapy completion rate , and lymphedema . RESULTS The follow-up assessment rate for our primary end point was 92.1 % , and adherence to the supervised exercise was 70.2 % . Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem ( P = .015 ) , aerobic fitness ( P = .006 ) , and percent body fat ( adjusted P = .076 ) . Resistance exercise was superior to usual care for improving self-esteem ( P = .018 ) , muscular strength ( P < .001 ) , lean body mass ( P = .015 ) , and chemotherapy completion rate ( P = .033 ) . Changes in cancer-specific QOL , fatigue , depression , and anxiety favored the exercise groups but did not reach statistical significance . Exercise did not cause lymphedema or adverse events . CONCLUSION Neither aerobic nor resistance exercise significantly improved cancer-specific QOL  in breast cancer patients receiving chemotherapy , but they did improve self-esteem , physical fitness , body composition , and chemotherapy completion rate without causing lymphedema or significant adverse events PURPOSE Despite the recognition of fatigue as a common and distressing symptom during cancer treatment , there are few evidence -based interventions available to manage such fatigue . The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue , physical functioning , emotional distress , and quality of life ( QOL ) during breast cancer treatment . DESCRIPTION OF STUDY Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design . Subjects were r and omly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer . Symptoms , physical functioning , and QOL were measured at baseline , midtreatment , and at the end of treatment . RESULTS Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment . CLINICAL IMPLICATION S A home-based walking exercise program is a potentially effective , low-cost , and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer . This health-promoting self-care activity needs further testing in large r and omized clinical trials This pilot study examined whether exercise as an adjunctive rehabilitation therapy could benefit women who have early stage breast cancer and are currently receiving chemotherapy/radiotherapy . The study was design ed as a r and omised controlled trial ( RCT ) . Physical functioning , fatigue and Quality of Life ( QoL ) outcomes were evaluated pre and post a 12-week intervention . The results showed that after 12 weeks the women who participated in the exercise programme ( n = 12 ) displayed significantly higher levels of physical functioning and reported higher QoL scores than the controls ( n = 10 ) . Changes in fatigue and satisfaction with life favoured the intervention group but did not reach significance . These results are encouraging and suggest that a structured group exercise programme during adjuvant treatment is a safe , well tolerated and effective way of providing physical and psychological health benefits to women during treatment for early stage breast cancer . Since this was a pilot study the numbers did not allow appropriately powered analyses of some variables of interest and favoured relatively young and socio-economically advantaged women . Future studies need to address these issues and determine if these short-term benefits can be sustained OBJECTIVES Restorative yoga ( RY ) is a gentle type of yoga that may be beneficial for cancer patients and post-treatment survivors . Study goals were : to determine the feasibility of implementing a RY intervention for women with breast cancer ; and to examine group differences in self-reported emotional , health-related quality of life , and symptom outcomes . METHODS Women with breast cancer ( n=44 ; mean age 55.8 years ) enrolled in this study ; 34 % were actively undergoing cancer treatment . Study participants were r and omized to the intervention ( 10 weekly 75-minute RY classes ) or a waitlist control group . Participants completed question naires at Week 0 ( baseline ) and Week 10 ( immediately post-intervention for the yoga group ) . RESULTS Group differences favoring the yoga group were seen for mental health , depression , positive affect , and spirituality ( peace/meaning ) . Significant baseline*group interactions were observed for negative affect and emotional well-being . Women with higher negative affect and lower emotional well-being at baseline derived greater benefit from the yoga intervention compared to those with similar values at baseline in the control group . The yoga group demonstrated a significant within-group improvement in fatigue ; no significant difference was noted for the control group . CONCLUSIONS Although limited by sample size , these pilot data suggest potential benefit of RY on emotional outcomes and fatigue in cancer patients . This study demonstrates that a RY intervention is feasible for women with breast cancer ; implication s for study design and implementation are noted with an emphasis on program adoption and participant adherence The purpose of this r and omized control trial was to verify the effectiveness of a brief group intervention that combines stress management psycho-education and physical activity ( ie , independent variable ) intervention in reducing fatigue and improving energy level , quality of life ( mental and physical ) , fitness ( VO2submax ) , and emotional distress ( ie , dependent variables ) in breast cancer survivors . This study applied Lazarus and Folkman stress-coping theoretical framework , as well as Salmon 's unifying theory of physical activity . Eighty-seven French-speaking women who had completed their treatments for nonmetastatic breast cancer at a university hospital in Quebec City , Canada , were r and omly assigned to either the group intervention ( experimental ) or the usual-care ( control ) condition . Data were collected at baseline , postintervention , and at 3-month follow-up . The 4-week group intervention was cofacilitated by 2 nurses . Results showed that participants in the intervention group showed greater improvement in fatigue , energy level , and emotional distress at 3-month follow-up , and physical quality of life at postintervention , compared with the participants in the control group . These results suggest that a brief psycho-educational group intervention focusing on active coping strategies and physical activity is beneficial to cancer survivors after breast cancer treatments PURPOSE / OBJECTIVES To examine the effects of a seated exercise program on fatigue and quality of life ( QOL ) in women with metastatic breast cancer . DESIGN R and omized , controlled , longitudinal trial . SETTING Outpatient clinic of a comprehensive cancer center . SAMPLE Convenience sample of 38 women who were beginning outpatient chemotherapy . METHODS Subjects were r and omized to a control or intervention group ; the intervention was performance of a seated exercise program using home videotape three times per week for four cycles of chemotherapy . All subjects completed the Functional Assessment of Chronic Illness Therapy Fatigue Version IV ( FACIT F ) at baseline and at the time of the next three cycles . Subjects were asked to document the frequency , duration , and intensity of all exercise participation on monthly calendars . MAIN RESEARCH VARIABLES Exercise , fatigue , and QOL . FINDINGS 32 subjects , 16 per group , completed the study follow-up . With a mixed modeling approach , total FACIT F scores for the entire sample declined at a significant rate ( p = 0.003 ) beginning with cycle 3 but at a slower rate for the experimental group ( p = 0.02 ) . Fatigue scores indicated less increase and physical well-being subscale scores showed less decline for the experimental group ( p = 0.008 and p = 0.02 , respectively ) . CONCLUSIONS Women with advanced breast cancer r and omized to the seated exercise intervention had a slower decline in total and physical well-being and less increase in fatigue scores starting with the third cycle of chemotherapy . IMPLICATION S FOR NURSING Seated exercise may be a feasible exercise program for women with advanced cancer for controlling fatigue and improving physical well-being OBJECTIVES Cancer treatment-related fatigue is a common and disruptive side effect of chemotherapy . Exercise is an intervention proposed to reduce fatigue in cancer patients . The purpose of this study was to describe the patterns of daily fatigue in women with breast cancer who did and did not exercise while receiving the first three cycles of adjuvant chemotherapy .  MATERIAL S AND METHODS Women received instruction to follow an 8-week home-based exercise program and to maintain daily exercise and fatigue diaries . Functional ability ( 12-minute walk ) was measured pretest and post-test . RESULTS Several distinct patterns of fatigue emerged . The most common pattern of fatigue after chemotherapy demonstrated a sharp rise in fatigue . However , several women demonstrated a chaotic pattern with erratic and wide swings in their fatigue throughout the entire study period . Women who adopted exercise experienced fewer days of high fatigue levels and more days of low levels of fatigue for both average and worst levels of fatigue . Women who did not exercise experienced more bad days ( high fatigue ) and fewer good days ( low fatigue ) . CONCLUSIONS Exercise appears to reduce the levels of average and worst fatigue and may help women recognize their pattern of fatigue . Exercise may reduce the intensity of fatigue by reorganizing women 's interpretation of fatigue . Routine clinical assessment and education about fatigue by health professionals can help patients to underst and their pattern of fatigue and may help them to manage the symptom 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 Background : Cancer-related fatigue ( CRF ) is a frequently occurring , burdensome side effect of radiation therapy that can result in detrimental effects to health-related quality of life ( HRQL ) . The findings from a pilot study examining the efficacy of the complementary and alternative practice of Polarity Therapy ( PT ) in reducing CRF and improving HRQL are reported . Methods : Fifteen women undergoing radiation therapy for breast cancer and experiencing fatigue were r and omized to receive 1 , 2 , or no PT treatments . Treatments were given 1 week apart to the patients receiving 2 treatments . Fatigue and HRQL were assessed at baseline prior to PT , 3 days following the first PT treatment ( week 1 ) , and 3 days following the second PT treatment ( week 2 ) . Results : There was a statistically significant improvement in both CRF and HRQL in the 10 patients who received a PT treatment compared to the 5 control patients at the week 1 assessment . In addition , there was a statistically significant difference among the 3 treatment groups in improvement in CRF at the week 2 assessment . This finding , coupled with a visual inspection of the means , supports the plausibility of a dose response concerning PT . Conclusion : Results from this pilot investigation suggest that PT may have a positive influence on CRF and HRQL in women undergoing radiation treatment for breast cancer . R and omized , controlled clinical trials with larger sample sizes are needed PURPOSE Use a proposed case-definition approach to identify the prevalence of  cancer-related fatigue ( CRF )  , demographic , clinical and psychosocial predictors of subsequent CRF , and psychosocial factors associated with concurrent CRF . PATIENTS AND METHODS Women ( n = 288 ) undergoing adjuvant therapy for early-stage breast cancer were recruited from two outpatient clinics . Women completed a baseline assessment before adjuvant therapy and a post-treatment assessment at the conclusion of an initial course of adjuvant chemotherapy or radiotherapy . At both assessment s , women completed a  clinical interview  and measures of  fatigue , distress , coping , and quality of life ( QOL ) . The clinical interview consisted of modules from the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition ( DSM-IV ) and a diagnostic interview to identify cases of CRF . RESULTS CRF prevalence at the baseline and post-treatment assessment s was 10 % and 26 % , respectively . Multivariate analyses identified factors prospect ively associated with greater risk for CRF at the post-treatment assessment , including receipt of adjuvant chemotherapy and a tendency to catastrophize in response to fatigue . Patients with and without CRF differed on a host of concurrent measures of fatigue , depression , functioning , and QOL with mean effect sizes in the range of 1.0 st and ard deviation . CONCLUSION CRF is a clinical syndrome experienced before and during adjuvant therapy for breast cancer . Results suggest CRF has a multifactorial etiology and support use of the proposed case definition approach to defining CRF . Future research is necessary to determine the scientific value of these criteria for underst and ing the etiology and management of fatigue in the oncology setting PURPOSE To assess the effectiveness of a symptom-focused home care program in patients with cancer who were receiving oral chemotherapy in relation to toxicity levels , anxiety , depression , quality of life , and service utilization . PATIENTS AND METHODS A r and omized , controlled trial was carried out with 164 patients with a diagnosis of colorectal ( n = 110 ) and breast ( n = 54 ) cancers who were receiving oral capecitabine .  Patients were r and omly assigned to receive either a home care program by a nurse or st and ard care for 18 weeks ( ie , six cycles of chemotherapy ) . Toxicity assessment s were carried out weekly for the duration of the patients ' participation in the trial , and vali date d self-report tools assessed anxiety , depression , and quality of life . RESULTS Significant improvements were observed in the home care group in relation to the symptoms of oral mucositis , diarrhea , constipation , nausea , pain , fatigue ( first four cycles ) , and insomnia ( all P < .05 ) . This improvement was most significant during the initial two cycles . Unplanned service utilization , particularly the number of inpatient days ( 57 v 167 days ; P = .02 ) , also was lower in the home care group . CONCLUSION A symptom-focused home care program was able to assist patients to manage their treatment adverse effects more effectively than st and ard care . It is imperative that patients receiving oral chemotherapy are supported with such programs , particularly during initial treatment cycles , to improve their treatment and symptom experiences 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 Cross-sectional studies suggest that clinical insomnia is associated with immune downregulation . However , there is a definite need for experimental studies on this question . The goal of this r and omized controlled study was to assess the effect of an 8-week cognitive-behavioral therapy ( CBT ) for chronic insomnia on immune functioning of breast cancer survivors . Previous analyses of this study showed that CBT was associated with improved sleep and quality of life , and reduced psychological distress . PATIENTS AND METHODS Fifty-seven women with chronic insomnia secondary to breast cancer were r and omly assigned to CBT ( n = 27 ) or to a waiting-list control condition ( WLC ; n = 30 ) . Peripheral-blood sample s were taken at baseline and post-treatment ( and postwaiting for WLC patients ) , as well as at 3- , 6- , and 12-month follow-up for immune measures , including enumeration of blood cell counts ( ie , WBCs , monocytes , lymphocytes , CD3 + , CD4 + , CD8 + , and CD16+/CD56 + ) and cytokine production ( ie , interleukin-1-beta [ IL-1beta ] and interferon gamma [ IFN-gamma ] ) . RESULTS Patients treated with CBT had higher secretion of IFN-gamma and lower increase of lymphocytes at post-treatment compared with control patients . Pooled data from both treated groups indicated significantly increased levels of IFN-gamma and IL-1beta from pre- to post-treatment . In addition , significant changes in WBCs , lymphocytes , and IFN-gamma were found at follow-up compared with post-treatment . CONCLUSION This study provides some support to the hypothesis of a causal relationship between clinical  insomnia  and immune functioning . Future studies are needed to investigate the clinical impact of such immune alterations Fatigue is the most prevalent and debilitating symptom experienced by breast cancer patients receiving adjuvant chemotherapy or radiation therapy and few evidence -based treatments are available to manage this distressing side-effect . The purpose of this multi-institutional r and omized controlled trial was to determine the effects of exercise on fatigue levels during treatment for breast cancer . Sedentary women ( N=119 ) with Stage 0-III breast cancer receiving outpatient adjuvant chemotherapy or radiation therapy were r and omized to a home-based moderate-intensity walking exercise program or to usual care for the duration of their cancer treatment . Of participants r and omized to exercise , 72 % adhered to the exercise prescription ; 61 % of the usual care group adhered . The intention-to-treat analysis revealed no group differences in part because of a dilution of treatment effect as 39 % of the usual care group exercised and 28 % of the exercise group did not . When exercise participation was considered using the data analysis method of instrumental variables with principal stratification , a clinical ly important and statistically significant ( p=0.03 ) effect of exercise on pretest-to-posttest change in fatigue levels was demonstrated . Adherence to a home-based moderate-intensity walking exercise program may effectively mitigate the high levels of fatigue prevalent during cancer treatment To determine the prevalence , severity , and correlates of fatigue among patients with cancers of the prostate or breast receiving high dose radiotherapy with curative intent , a prospect i ve , question naire-based study evaluated a convenience sample of 62 patients who were about to start a course of radiotherapy .  Patients were assessed immediately prior to treatment , and again within a week of finishing . Fatigue was assessed using the Fatigue Severity Scale ( FSS ) and the Bidimensional Fatigue Scale ( BFS ) . Quality of life was assessed using the European Organisation for Research and Treatment of Cancer 30-item Quality of Life Question naire ( EORTC QLQc30 ) . Psychological distress was assessed using the Hospital Anxiety and Depression Scale ( HADS ) . Personality Traits were assessed using the Eysenck Personality Inventory ( EPI ) . Fatigue severity increased significantly on 3 out of the 5 assessment instruments used . Radiotherapy was associated with a decline in global quality of life , role , cognitive and social functioning , and an increase in nausea/vomiting , pain , insomnia , diarrhea , and financial difficulty . At baseline , 39 % of the variation in fatigue scores among the patients could be explained by a combination of measures of their global quality of life and physical functioning . A combination of fatigue and anxiety scores at baseline was able to predict 54 % of the variation in fatigue scores at the completion of radiotherapy . These data indicate that fatigue is a significant problem for patients receiving radical radiotherapy , although its severity is relatively modest
Cancer-related fatigue ( CRF ) is a distressing symptom that affects the quality of life ( QOL ) of patients with breast cancer and their families .
The effectiveness of pharmacologic therapies alone has not been sufficient in the management of CRF ; therefore , a combination of pharmacologic and nonpharmacologic approaches is justified .
The purpose of this article is to critically review the literature related to nonpharmacologic supportive strategies in enhancing QOL among patients with breast cancer experiencing CRF .