Windsor, P. M., Potter, J., McAdam, K., & McCowan, C. (2009). Evaluation of a fatigue initiative: information on exercise for patients receiving cancer treatment. Clinical Oncology, 21, 473–482.

For patients to evaluate the usefulness of the information provided.

Patients starting a course of radiotherapy or chemotherapy (inpatient and outpatient) at Tayside Cancer Centre in the United Kingdom were given a “Fatigue Initiative” folder containing information on fatigue together with advice on starting aerobic walking exercise during treatment. Patients were also encouraged to attend workshops on fatigue management as listed on flyers included in the folder. Materials included home exercise information, walking information, and a guide for good sleep.

• The sample was comprised of 146 patients (90 women and 115 men). 
• Mean age was 63.4 years.
• Patients had genitourinary (n = 119), gynecologic (n = 37), breast (n = 46), and other (n = 3) cancers.
• The study included four treatment groups:  radical radiotherapy, postoperative radiotherapy, palliative radiotherapy, and chemotherapy.

• Single site
• United Kingdom

This was an observational cohort study.

• Brief Fatigue Inventory (BFI) to assess level of fatigue before and after cancer treatment. The tool was administered four times:  baseline, end of treatment, and the first and second follow-up visits.
• Two study evaluation questionnaires were used:  one rated the information usefulness, and one provided information regarding exercise. No questions or scores were provided.

Overall, patients reported an increase in fatigue from baseline to the end of cancer treatment and from baseline to the first follow-up visit. Of the patients, 70% to 78% rated the information on fatigue helpful. Patients who said they used the information were more likely to exercise (odds ratio [OR] 3.71; 95% confidence interval [CI] [1.19, 11.56]; p = 0.024). Patients who received radiotherapy were more likely to exercise than those receiving chemotherapy (OR 14.9; 95% CI [2.43, 81.53]; p = 0.003). Higher levels of fatigue were reported by patients who used the information provided. Patients who exercised (p < 0.001), were older (p = 0.001), had cancers other than breast (p = 0.018), and were not receiving chemotherapy (p < 0.05) reported lower fatigue scores on the BFI. Ten patients participated in a fatigue workshop.

The findings supported the positive effect of exercise on fatigue during cancer treatment and identified that age, breast cancer, and treatment with chemotherapy rather than radiotherapy are associated with the level of fatigue experienced. The findings suggest that the provision of written educational/informational materials can be helpful in encouraging patients to exercise.

• The study lacked an appropriate control group.
• Time intervals varied between baseline and end of treatment for those receiving palliative radiotherapy (one to two weeks), radical or postoperative radiotherapy (four weeks), and chemotherapy (four months). Workshops were held in palliative care centers.

Fatigue did not decrease in any group. The study demonstrated the importance of providing information on fatigue and encouraging a walking/home exercise program. Patients who were able to exercise during treatment had lower fatigue levels. The finding that those who used the information had higher levels of fatigue may suggest that patients who have the most fatigue are more likely to use information to help them cope with it.