Are Fatigue and Pain Overlooked in Subjects with Stable Chronic Obstructive Pulmonary Disease?

Although there have been many published reports on fatigue and pain in patients with chronic obstructive pulmonary disease (COPD), it is considered that these symptoms are seldom, if ever, asked about during consultations in Japanese clinical practice. To bridge this gap between the literature and daily clinical experience, the authors attempted to gain a better understanding of fatigue and pain in Japanese subjects with COPD. The Brief Fatigue Inventory (BFI) to analyse and quantify the degree of fatigue, the revised Short–Form McGill Pain Questionnaire 2 (SF-MPQ-2) for measuring pain and the Kihon Checklist to judge whether a participant is frail and elderly were administered to 89 subjects with stable COPD. The median BFI and SF-MPQ-2 Total scores were 1.00 [IQR: 0.11–2.78] and 0.00 [IQR: 0.00–0.27], respectively. They were all skewed toward the milder end of the respective scales. A floor effect was noted in around a quarter on the BFI and over half on the SF-MPQ-2. The BFI scores were significantly different between groups regarding frailty determined by the Kihon Checklist but not between groups classified by the severity of airflow limitation. Compared to the literature, neither fatigue nor pain are considered to be frequent, important problems in a real-world Japanese clinical setting, especially among subjects with mild to moderate COPD. In addition, our results might suggest that fatigue is more closely related to frailty than COPD.

Nursing management of fatigue in cancer patients and suggestions for clinical practice: a mixed methods study

Background Fatigue is a complex and frequent symptom in cancer patients, influencing their quality of life, but it is still underestimated and undertreated in clinical practice. The aims of this study were to detect the presence of fatigue in cancer patients, describe how patients and nurses perceived it and how nurses managed fatigue. Methods This is a mixed methods study. Data were collected in two oncological wards using the Brief Fatigue Inventory (BFI), an ad hoc questionnaire, patient interviews, focus groups with nurses and the review of nursing records. Interviews and focus groups were analysed through thematic analysis. We used SPSS 22.0 for quantitative data and Nvivo 10 for qualitative data analysis. Results A total of 71 questionnaires were analysed (39 males, mean age 65.7 years). Fatigue was reported 5 times (7%) in nursing records, while in 17 cases (23.9%) problems associated to it were reported. Twelve patients were interviewed. Five themes were identified: feeling powerless and aggressive, my strategies or what helps me, feeling reassured by the presence of family members, feeling reassured by nurses’ gestures, and being informed. Three themes were identified through the focus groups: objectivity and subjectivity in the assessment of fatigue, nurses’ contribution to the multidisciplinary management of fatigue, and difficulty in evaluating outcomes. Conclusions The approach to the management of fatigue was unstructured. Patients were satisfied with the care they received but needed more information and specific interventions. Useful aspects were identified that could be used to change health professionals’ approach towards the management of fatigue.

Burosumab treatment in adults with X-linked hypophosphataemia: 96-week patient-reported outcomes and ambulatory function from a randomised phase 3 trial and open-label extension

ObjectivesTo report the impact of burosumab on patient-reported outcomes (PROs) and ambulatory function in adults with X-linked hypophosphataemia (XLH) through 96 weeks.MethodsAdults diagnosed with XLH were randomised 1:1 in a double-blinded trial to receive subcutaneous burosumab 1 mg/kg or placebo every 4 weeks for 24 weeks (NCT02526160). Thereafter, all subjects received burosumab every 4 weeks until week 96. PROs were measured using the Western Ontario and the McMaster Universities Osteoarthritis Index (WOMAC), Brief Pain Inventory-Short Form (BPI-SF) and Brief Fatigue Inventory (BFI), and ambulatory function was measured with the 6 min walk test (6MWT).ResultsSubjects (N=134) were randomised to burosumab (n=68) or placebo (n=66) for 24 weeks. At baseline, subjects experienced pain, stiffness, and impaired physical and ambulatory function. At week 24, subjects receiving burosumab achieved statistically significant improvement in some BPI-SF scores, BFI worst fatigue (average and greatest) and WOMAC stiffness. At week 48, all WOMAC and BPI-SF scores achieved statistically significant improvement, with some WOMAC and BFI scores achieving meaningful and significant change from baseline. At week 96, all WOMAC, BPI-SF and BFI achieved statistically significant improvement, with selected scores in all measures also achieving meaningful change. Improvement in 6MWT distance and percent predicted were statistically significant at all time points from 24 weeks.ConclusionsAdults with XLH have substantial burden of disease as assessed by PROs and 6MWT. Burosumab treatment improved phosphate homoeostasis and was associated with a steady and consistent improvement in PROs and ambulatory function.Trial registration numberNCT02526160.

Prevalência de Fadiga em Pacientes com Câncer de Cabeça e Pescoço Submetidos ao Tratamento de Radioquimioterapia: Revisão Sistemática

Introdução: A fadiga e considerada uma alteração reversível das funções biológicas, físicas e psíquicas, proveniente do desequilíbrio do organismo. Em pacientes com câncer, a fadiga e relatada como um dos sintomas mais frequentes, principalmente nos casos em que apresentam metástases, limitando de forma significativa as atividades diárias, sendo considerada como crônica. Objetivo: Avaliar a prevalência de fadiga em pacientes com câncer de cabeça e pescoço sob tratamento radioquimioterápico. Método: Foram instituídos a metodologia PRISMA e o anagrama PICO. Realizaram-se buscas nas bases de dados LILACS, PubMed, Google Academico e SciElo com os descritores “fatigue”; “cancer”; “prevalence”; “head and neck cancer”. Foram incluídos artigos científicos em inglês publicados entre 2009 a 2019. Cinco estudos avaliaram a ocorrência de fadiga isoladamente por meio do questionário Brief Fatigue Inventory (MBFI); e as variáveis coletadas por meio de entrevista utilizaram a Escala de Fadiga de Piper. Resultados: Do total de 243 pacientes, 70% apresentaram fadiga. Em outros 13 estudos, a fadiga foi avaliada em conjunto com outros sintomas por intermédio de questionários já validados na literatura. Houve aumento significativo nos escores de fadiga bem como nos sintomas relacionados a qualidade de vida a exemplo da dor, estresse e depressão nos 1908 pacientes entrevistados. Conclusão: A ocorrência de fadiga na população de pacientes com câncer de cabeça e pescoço foi alta e comumente esteve relacionada a outros sintomas como dor, distúrbios do sono, perda de apetite, dispneia, estresse emocional e depressão.

Nursing Management of Fatigue in Cancer Patients: Mixed Methods Study

BackgroundFatigue is a complex and frequent symptom in cancer patients, influencing their quality of life, but it is still underestimated in clinical practice and undertreated. The aims of this study were to detect the presence of fatigue in cancer patients, describe the perceptions of patients and nurses regarding it and describe the nursing management of fatigue.MethodsMixed methods study. Data were collected in two oncological wards using the Brief Fatigue Inventory (BFI), an ad hoc questionnaire, patient interviews, focus groups with nurses and the review of nursing records. Interviews and focus groups were analysed through thematic analysis. We used SPSS 22.0 for quantitative data and Nvivo 10 for qualitative data analysis.ResultsA total of 71 questionnaires were analysed (39 males, mean age 65,7(±14) years). Fatigue was reported 5 times (7%) in nursing records, while in 17 cases (23.9%) problems related to it were reported. Twelve patients were interviewed. Five themes were identified: feeling powerless and aggressive, my strategies or what helps me, feeling reassured by the presence of family members, feeling reassured by nurses’ gestures, being informed. Three themes were identified through the focus groups: objectivity and subjectivity in the assessment of fatigue, nursing contribution within the multidisciplinary management of fatigue, and difficulty in evaluating outcomes.DiscussionThe approach to the management of fatigue was unstructured. Patients were satisfied with the care received but needed more information and specific interventions. Useful aspects were identified that could be used to change the professional approach towards the management of fatigue.

A Randomized, Controlled, Parallel-Group, Trial on the Effects of Melatonin on Fatigue Associated with Breast Cancer and Its Adjuvant Treatments

Objective: Fatigue associated with malignant conditions and their treatments is a disabling condition. This trial assessed the anti-fatigue effects of melatonin coadministration during adjuvant treatment of patients with the breast cancer. Material and Methods: Patients with breast cancer were randomly assigned to receive melatonin or placebo during adjuvant chemotherapy and radiotherapy. Thirty-seven patients were randomly enrolled in each group. The mean ages of patients in the intervention and control groups were 50.47 ± 10.79 and 46.05 ± 10.55 years, respectively ( P = .223). The intervention group received oral melatonin (18 mg/day) from 1 week before until 1 month after the adjuvant radiotherapy. The level of fatigue was assessed before and after intervention using Brief Fatigue Inventory (BFI) in both groups. To analyze data, the Student’s t-test and the Chi-square test were used at a significance level of P ≤ .05. Results: The BFI score was similar before the intervention in both groups, however, after the intervention, it was significantly lower in the melatonin group ( P < .001). Moreover, the frequency of severe fatigue in the melatonin group was significantly lower than in the placebo group after intervention (42.1% vs 83.3%, P < .001). Conclusion: Coadministration of melatonin during adjuvant chemotherapy and radiotherapy of women with breast cancer decreased the levels of fatigue associated with the malignant condition and its treatments.

Pengaruh Aktifitas Fisik Walking Exercise Program (WEP) Terhadap Cancer Related Fatigue (CRF) pada Pasien Kanker Payudara di RSUP Sanglah

Tujuan: Untuk mengetahui pengaruh antara walking exercise programme (WEP) terhadap cancer related fatigue (CRF) pada pasien kanker payudara di RSUP Sanglah Denpasar. Metode: Penelitian randomized controlled trial group pretest-posttest design ini dilakukan pada seluruh pasien kanker payudara yang dirawat di RSUP Sanglah Denpasar pada tahun 2018, untuk dibedakan dalam kelompok kontrol dan kelompok perlakuan (yang menjalani WEP). Pengambil data dan pengolah data disamarkan mengenai kondisi randomisasi dan perlakuan. WEP dilaksanakan selama tiga minggu yang dilakukan sebanyak 3 kali dalam seminggu selama 30 menit. Pada kedua kelompok dilakukan penilaian skor brief fatigue inventory (BFI) sebelum dan sesudah perlakuan. Data kemudian dikumpulkan dan dilakukan analisis statistik dengan SPSS 25.0. Hasil: Penelitian awalnya terdiri dari 41 peserta di kelompok intervensi dan 41 di kelompok kontrol. Dua peserta dari kelompok kontrol mengundurkan diri dari penelitian. Pada analisis skor BFI setelah latihan, ditemukan bahwa skor BFI pada kelompok intervensi menurun secara signifikan dibandingkan kelompok kontrol (2,8±1,2 vs. 0,2±0,7; p<0,001). Dengan uji multivariat ANCOVA ditemukan bahwa setelah mengendalikan variabel perancu, aktivitas fisik WEP tetap dapat memberikan efek 2,5 kali lebih besar dibanding kontrol (p=0,001). Simpulan: Aktivitas fisik WEP menurunkan tingkat CRF pada pasien kanker payurada 2,5 lebih besar jika dibandingkan dengan kontrol sehingga direkomendasikan sebagai salah satu penanganan CRF pada pasien dengan kanker payudara.

EEG Correlates of Central Origin of Cancer-Related Fatigue

The neurophysiological mechanism of cancer-related fatigue (CRF) remains poorly understood. EEG was examined during a sustained submaximal contraction (SC) task to further understand our prior research findings of greater central contribution to early fatigue during SC in CRF. Advanced cancer patients and matched healthy controls performed an elbow flexor SC until task failure while undergoing neuromuscular testing and EEG recording. EEG power changes over left and right sensorimotor cortices were analyzed and correlated with brief fatigue inventory (BFI) score and evoked muscle force, a measure of central fatigue. Brain electrical activity changes during the SC differed in CRF from healthy subjects mainly in the theta (4-8 Hz) and beta (12-30 Hz) bands in the contralateral (to the fatigued limb) hemisphere; changes were correlated with the evoked force. Also, the gamma band (30-50 Hz) power decrease during the SC did not return to baseline after 2 min of rest in CRF, an effect correlated with BFI score. In conclusion, altered brain electrical activity during a fatigue task in patients is associated with central fatigue during SC or fatigue symptoms, suggesting its potential contribution to CRF during motor performance. This information should guide the development and use of rehabilitative interventions that target the central nervous system to maximize function recovery.

Psychological Burden in Meningioma Patients under a Wait-and-Watch Strategy and after Complete Resection Is High—Results of a Prospective Single Center Study

The diagnosis of intracranial meningiomas as incidental findings is increasing by growing availability of MRI diagnostics. However, the psychological distress of patients with incidental meningiomas under a wait-and-watch strategy is unknown. Therefore, we aimed to compare the psychosocial situation of meningioma patients under wait-and-watch to patients after complete resection to bridge this gap. The inclusion criteria for the prospective monocenter study were either an incidental meningioma under a wait-and-watch strategy or no neurologic deficits after complete resection. Sociodemographic, clinical, and health-related quality of life and clinical data were assessed. Psychosocial factors were measured by the Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), Brief Fatigue Inventory (BFI), and the Short Form (SF-36). A total of 62 patients were included (n = 51 female, mean age 61 (SD 13) years). According to HADS, the prevalence of anxiety was 45% in the postoperative and 42% in the wait-and-watch group (p = 0.60), and depression was 61% and 87%, respectively (p = 0.005). In total, 43% of patients under wait-and-watch and 37% of patients in the postoperative group scored ≥6 on the DT scale. SF-36 scores were similar in all categories except general health (p = 0.005) and physical component aggregate score (43.7 (13.6) vs. 50.5 (9.5), (p = 0.03), both lower in the wait-and-watch group. Multivariate analysis revealed the wait-and-watch strategy was associated with a 4.26-fold higher risk of a pathological depression score based on HADS (p = 0.03). This study demonstrates a high prevalence of psychological distress in meningioma patients. Further evaluation is necessary to identify the patients in need of psychooncological support.