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.

The primary aim was patient evaluation of the usefulness of information provided. The secondary aim was to assess whether patients reported exercising during cancer treatment.

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 combined with advice on starting aerobic walking exercise during treatment. Patients were also encouraged to attend workshops on fatigue management as listed on flyers in the folder. Materials included home exercise information, walking information, and a guide for good sleep.

• In total, 146 patients (90 females, 115 males) were included. 
• Mean age was 63.4 years. 
• Patients had genitourinary (n = 119), gynecologic (n = 37), breast (n = 46), and other (n = 3) cancers.
• There were four treatment groups:  radical radiotherapy, postoperative radiotherapy, palliative radiotherapy, and chemotherapy.

United Kingdom

This was an observational cohort study.

• The Brief Fatigue Inventory (BFI) was used to assess level of fatigue before and after cancer treatment. The tool was administered four times:  at baseline, end of treatment, and the first and second follow-up visits. 
• Two study evaluation questionnaires were used:  one rated 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. 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 other than breast cancer (p = 0.018), and who were not receiving chemotherapy (p < 0.05) reported lower fatigue scores on the BFI. Ten patients participated in a fatigue workshop.

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 were associated with the level of fatigue experienced. Findings suggested that the provision of written educational/informational materials can be helpful in encouraging patients to exercise.

• No appropriate control group was used.
• Time intervals varied between baseline and end of treatment for those receiving palliative radiotherapy (one to two weeks), radical or postoperative radiotherapy (four weeks), or 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 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.