Energy Conservation and Activity Management

The energy conservation and activity management (ECAM) intervention included completing a journal to monitor fatigue, sleep, rest, activity, and other symptoms; listing and prioritizing usual activities; and creating a tailored energy conservation plan. The intervention was delivered by nurse counselors in three telephone sessions of 15 to 30 minutes in length.

• The study sample included 38 adults in two groups:  radiotherapy (n = 18; mean age = 59.4 years; 70% female; 84% Caucasian) and chemotherapy (n = 20; mean age = 57.4 years; 91% female; 95% Caucasian).
• The control group included 182 adults (mean age = 55.1 years; 58% female; 95% Caucasian).

• Experimental participants were outpatients in a National Cancer Institute–designated cancer center.
• Patients in the control group were from a multi-site study on fatigue measurement.

Patients were undergoing the active treatment phase of care.

• The study used a single group pre-/posttest design.
• A nonequivalent control group from another study was used for posttest comparisons.

Profile of Mood States (POMS) Fatigue scale

• The intervention was well tolerated and acceptable to patients.
• Results showed a trend for the two groups to differ at both points in time, with the control group exhibiting higher fatigue scores than the ECAM group.

• The study had a small sample size.
• The control group was a nonequivalent.
• The population was vulnerable, with many medical problems that can effect adherence.

Minimal training with the intervention materials is needed.

The energy conservation and activity management (ECAM) intervention consisted of information provision, guidance in formulating and implementing a plan for energy conservation and activity management, and support in appraising the effectiveness of symptom management efforts. The intervention included completing a journal to monitor fatigue, sleep, rest, activity, and other symptoms; listing and prioritizing usual activities; and creating a tailored energy conservation plan. The intervention was delivered by nurse counselors in three telephone sessions that were 15 to 30 minutes in length.

• The study included 396 adults (age range 18–83 years); 85% were women, and most were Caucasian.
• Multiple diagnoses were included, but 71% of participants had breast cancer.
• All participants were initiating treatment with chemotherapy (47%), radiotherapy (44%), or concurrent chemoradiotherapy (9%).

Outpatient services of two large university cancer centers

Patients were undergoing the active treatment phase of care.

The study was a randomized, clinical trial with a repeated-measures design and an attentional control group.

• Profile of Mood States (POMS)
• Schwartz Cancer Fatigue Scale (SCFS)
• General Fatigue Scale (GFS)

• The ECAM intervention had a statistically significant effect in reducing fatigue, but the clinical effect was modest.
• The intervention group experienced significantly less disruption of usual activities compared with the control group, although the intervention was not associated with changes in overall functional status.

Efficacy findings were not confounded by the inability of patients who were in poorer health to complete the data collection process.

• Overrepresentation of women and a breast cancer diagnosis limits the generalizability to men, patients with other diagnoses, and those in poorer health.
• The amount of missing data was substantial. 
• Costs were not addressed.

Minimal training with the intervention materials is needed.

4,900 references were identified that were published between January 1, 1990 and December 31, 2013. 203 articles were included in the final review although only 174 were referenced. Grades used and reported here were A: recommended, high certainty of benefit, B: recommended, high certainty of moderate to substantial benefit, D: recommends against use, moderate to high certainty of no net benefit, and H: recommends against use, moderate to high certainty that harms outweigh benefits.

Interventions for specific symptoms that had strong recommendations for or against use were:

• Anxiety: Music therapy during RT and chemotherapy sessions, meditation, and yoga for patients undergoing therapy (B-level recommendation)
• Depression: Mindfulness-based stress reduction for patients undergoing radiotherapy, relaxation, and yoga (level A recommendation); massage and music therapy (level B)
• Fatigue: Energy conservation (level B)
• CINV: Acupressure and electroacupuncture in addition to antiemetics (B level)
• Neuropathy: Acetyl L carnitine was not recommended because of harm (H level).
• Radiodermatitis: Aloe vera and hyaluronic acid cream were not recommended as standard therapy because of lack of effect (D level).

It appears that only specific types of interventions were included, and there are numerous types of integrative or complementary interventions that were not considered in this review. The findings considered were limited to women with breast cancer. Quality rating of evidence was not discussed individually.

These guidelines provided an evidence-based evaluation of various integrative therapies in women with breast cancer. This set of interventions is not all-inclusive; however, it does provide some guidance to clinicians and others regarding evidence strength in these areas as assessed by this specific study group.

PHASE OF CARE: Multiple phases of care

Two hundred two references were retrieved. The total number of references included and reviewed for updating was not provided. No quality rating is identified.

• Energy conservation
• Physical activity
• Cognitive behavioral therapy (CBT) for sleep shown to be effective
• Counseling

• Limited evidence search
• No quality rating of studies considered
• Studies included for evidence level determination not specified

The guidelines provide suggestions for screening and identify some tools for fatigue assessment and some key interventions for the management of fatigue. They provide an overview of relevant evidence for multiple types of interventions. Major suggestions are identified in the recommendations section of this summary.