Will improvement in quality of life (QOL) impact fatigue in patients receiving radiation therapy for advanced cancer?
BACKGROUND
Fatigue has a significant impact on the quality of life (QOL) of cancer patients. Recent research has suggested that physical activity can reduce fatigue in patients receiving active cancer treatment. In this project, we examined the impact that participation in a randomized controlled trial of a multidisciplinary intervention designed to impact overall QOL had on fatigue for advanced cancer patients actively receiving treatment.


METHODS
Patients with newly diagnosed cancer were randomly assigned to an 8-session structured multidisciplinary intervention or a standard-care arm at the beginning of their course of radiotherapy (RT) designed to impact QOL. Ninety-minute sessions were led by either a psychiatrist or psychologist, collaborating with a nurse, physical therapist, chaplain, or social worker, depending on the session's theme. The fatigue assessments used in this trial included the Linear Analogue Self Assessment (LASA), the Profile of Mood States (POMS), Spielberger's State-Trait Anxiety Inventory (STAI), and the Symptom Distress Scale (SDS).


RESULTS
There were 115 participants enrolled and the 2 randomization arms were well balanced in terms of baseline characteristics and treatment received except for increased commuting distance for the patients in the intervention arm (P = 0.042). Most of scores indicated less fatigue (higher score) in the standard treatment group, but there were no statistically significant differences found at baseline and weeks 4, 8, and 27 except for SDS at week 8 (P = 0.018) with less patients reporting significant fatigue in the standard treatment arm. For the entire participant population, fatigue levels initially worsened with radiotherapy, stabilized at week 8, and returned to baseline by week 27. Disease site, chemotherapy use, and radiotherapy dose did not have a significant impact on fatigue levels.


CONCLUSIONS
Radiotherapy initially caused a worsening of fatigue but with time fatigue levels returned to baseline. Clinically, this structured multidisciplinary intervention had no impact on fatigue, and there was the suggestion the multiple sessions may have contributed to worse fatigue during active cancer treatment.
Brown
Paul
P
Department of Oncology, Mayo Clinic Rochester, Rochester, MN 55905, USA. brown.paul@mayo.edu
Clark
Matthew M
MM
Atherton
Pamela
P
Huschka
Mashele
M
Sloan
Jeff A
JA
Gamble
Gail
G
Girardi
Jean
J
Frost
Marlene H
MH
Piderman
Kate
K
Rummans
Teresa A
TA
D000328:Adult; D000368:Aged; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D004644:Emotions; D005081:Exercise Therapy; D005221:Fatigue / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology / Q000532:radiotherapy*; D010353:Patient Education as Topic; D011788:Quality of Life; D011832:Radiation Injuries; D016896:Treatment Outcome