Rogers, L.Q., Courneya, K.S., Anton, P.M., Verhulst, S., Vicari, S.K., Robbs, R.S., & McAuley, E. (2017). Effects of a multicomponent physical activity behavior change intervention on fatigue, anxiety, and depressive symptomatology in breast cancer survivors: Randomized trial. Psycho-Oncology, 26, 1901-1906.
To determine the effectiveness of a three-month intervention which includes a multicomponent physical activity change intervention on the symptoms of fatigue, depressive symptoms, and anxiety
Better Exercise Adherence after Treatment for Cancer (BEAT Cancer). Twelve supervised exercise sessions with an exercise specialist that were tapered over the first six weeks to an exclusively unsupervised home-based program. Face-to-face update counseling session with exercise specialist every two weeks during the final six weeks. Exercise and heart rate monitor sheets were provided to those who were randomized to the intervention. Group sessions for the participants. Those randomized to control received care as usual, which included handouts and publicly available printed materials.
PHASE OF CARE: Late effects and survivorship
Randomized control trial
Measurements happened at baseline, immediately postintervention, month 3, 3 months after intervention completion, and month 6. Instruments used were the Fatigue Symptom Inventory and the 14-item Hospital Anxiety and Depression Scale
Adjusted linear mixed‐model analyses demonstrated significant effects of BEAT Cancer versus usual care on fatigue intensity (month 3 mean between group difference [M] = −0.6; 95% confidence interval [CI] [−1, −0.2]; effect size [d] = −0.32; p = 0.004), fatigue interference (month 3 M = −0.8; CI [−1.3, −0.4]; d = −0.4; p < 0.001), depressive symptomatology (month 3 M = −1.3; CI [−2, −0.6]; d = −0.38; p < 0.001), and anxiety (month 3 M = −1.3; CI [−2, −0.5]; d = −0.33; p < 0.001). BEAT Cancer effects remained significant at month 6 for all outcomes.
This intervention reduced fatigue, depressive symptomatology, and anxiety up to three months postintervention compared to treatment as usual.
Intervention expensive, impractical, or training needs
Nurses can safely recommend exercise as tolerated to breast cancer survivors who have completed adjuvant treatment. There are several exercise programs widely available, including Livestrong and STARS Cancer rehabilitation programs.
Packel, L., Fang, C.Y., Handorf, E., & Rodoletz, M. (2017). A 12-week exercise and stress management pilot program from theory through implementation and assessment. Rehabilitation Oncology, 35, 172–180.
The purpose of the study was to assess the response of an exercise, education, and stress management program (12 weeks) on fatigue levels of community-dwelling cancer survivors.
12-week program that consisted of 10 weeks of supervised moderate-intensity aerobic and strength training combined with 2 unsupervised weeks of home exercise. Supervised weeks included 1 in-person and 2 at-home sessions. Participants also received education on nutrition, stress management (mindfulness), and sleep.
PHASE OF CARE: Late effects and survivorship
Single arm, pre-/post-test design
FACT-Fatigue, HADS, NCCN Distress Thermometer, 6-Minute Walk Test, and Sit-to-Stand Test
Significant improvements were noted in fatigue (p = 0.008), physical well-being (p = 0.004), and in the anxiety subscale scores of the HADS (p = 0.047). Increases in 6MWT distance (p = 0.002) and Sit-to-Stand Test score (p = 0.018) were also observed. Significant reductions in psychological distress were found (p = 0.003); however, no significant changes were observed in emotional well-being (p = 0.855), social well-being (p = 0.327), or depression (p = 0.221).
The program had some barriers to recruitment and retention but was able to identify a statistically significant improvement in fatigue, physical well-being, and anxiety as well as increased in the 6MWT distance and Sit-to-Stand Test score.
Exercise, stress management, and behavior change are moderately feasible and may have an impact on cancer-related fatigue and anxiety. Larger studies are needed to confirm these results.
Cobeanu, O., & David, D. (2018). Alleviation of side effects and distress in breast cancer patients by cognitive-behavioral interventions: A systematic review and meta-analysis. Journal of Clinical Psychology in Medical Settings, 25, 335–355.
PHASE OF CARE: Active anti-tumor treatment
Overall, results demonstrated a modest but statistically significant effect on side effect improvement (p = 0.005) with CBI. More specifically, CBI was associated with statistically significant improvements in nausea and vomiting (p < 0.001), overall distress (anxiety and depression, mood, stress, hostility) (p < 0.001), anxiety (p = 0.001), and quality of life (p < 0.001). The review results found non-significant effects on fatigue (p = 0.63), sleep disturbance (p = 0.314), pain (p = 0.854), and depression (p = 0.063). The authors hypothesized that this lack of significance could be due to low power of analysis across the studies on fatigue, sleep, and pain, as well as lack of tailored interventions specific to those symptoms. Lack of significance for CBI on depression could be due to failure to pre-screen participants for depression prior to beginning the intervention.
CBI is effective in reduction of many physical and psychological distress symptoms, including nausea and vomiting, anxiety, and quality of life. Additional research are studies with larger sample sizes are needed to further validate findings. In addition, further research is needed to examine which CBI protocols are most effective for specific symptoms, as well as greater uniformity in the reporting of CBI interventions.
CBI has efficacy in improving some physical and psychological symptoms and quality of life in breast cancer patients undergoing active therapy. It is important for nursing to assess and advocate for patients who may benefit from CBI and facilitate access to such interventions as part of the overall treatment plan.
Cognitive rehabilitation involves behaviorally-oriented interventions designed to improve performance in cognitive and functional areas (Bray et al., 2017; Levine et al., 2000). Computerized cognitive rehabilitation is the provision of such practice via a computer program.
Transversus abdominis plane (TAP) block refers to the infiltration of local anesthetics into the fascial plane between the internal oblique and transversus abdominis muscles (Oh et al., 2017).
Peripheral nerve block refers to the use of local anesthetics to block peripheral nerves, which blocks the signaling of pain stimuli from the tumor to the central nervous system (Klepstad et al., 2015; Swarm, Karanikolas, & Cousins, 2000). This intervention has been studied for treatment of cancer-related pain.
When opioids bind to their receptors, pain transmission is reduced (Baaklini, Arruda, & Sakata, 2017; Nechifor, 2012), but the sensitivity to pain may increase (Angst & Clark, 2006; Baaklini et al., 2017; DuPen, Shen, & Ersek, 2007). Magnesium plays a role in pain sensitivity (Baaklini et al., 2017; Célèrier et al., 2000) and has been studied in combination with opioids for cancer-related pain.
mHealth symptom management refers to the use of mobile health, or mHealth, devices to help manage symptoms in patients with cancer. mHealth involves the use of devices with mobile computing capabilities to monitor, track, and transmit health data continuously and in real time (Steinhubl, Muse, & Topol, 2015).
Steinhubl, S.R., Muse, E.D., & Topol, E.J. (2015). The emerging field of mobile health. Science Translational Medicine, 7, 283rv3. https://doi.org/10.1126/scitranslmed.aaa3487
Vitamin D is involved in maintaining the collagen-rich osteoid surface of the skeleton. Low levels of vitamin D may lead to demineralization of that surface, which may contribute to pressure and pain (Felson & Cummings, 2005; Holick, 2006, 2007; Shapiro et al., 2016). The active hormone 1a,25-dihydroxyvitamin D3 promotes muscle cell growth, which may foster better muscle function (Boonen et al., 2006; Ceglia, 2008; Shapiro et al., 2016) and decreased skeletal pain (Shapiro et al. 2016).
Mindfulness-based cognitive therapy combines the principles of cognitive therapy with meditation practices to foster mindfulness (MBCT.com, n.d.). Mindfulness focused on mentally attending to an experience in a nonjudgmental way (Johannsen et al., 2016, Piet, Wurtzen, & Zachariae, 2012). Mindfulness-based cognitive therapy has been studied in several symptoms and side effects of cancer treatment, including anxiety, depression, and pain.