Evidence-Based Nursing Plus Progressive Exercise for Cancer-Related Fatigue in Advanced Lung Cancer (ENPE-CRF)

Effect of Evidence-Based Nursing Combined With Progressive Gymnastics Training on Cancer-Related Fatigue, Quality of Life, and Treatment Adherence in Patients With Advanced Lung Cancer Undergoing Chemotherapy: A Randomized Controlled Trial

This study aims to evaluate the effectiveness and safety of evidence-based nursing combined with progressive exercise training in patients with advanced lung cancer undergoing chemotherapy. Cancer-related fatigue (CRF) is a common and distressing symptom in this population and is associated with poor quality of life and reduced treatment adherence.

In this single-center, prospective randomized controlled trial, 100 patients with stage III-IV lung cancer receiving platinum-based chemotherapy were randomly assigned to either a control group or an intervention group. The control group received routine nursing care, while the intervention group received evidence-based nursing combined with a structured progressive exercise program for 8 weeks.

The primary outcomes are cancer-related fatigue assessed by the Brief Fatigue Inventory (BFI) and functional exercise capacity assessed by the 6-minute walk test (6MWT). Secondary outcomes include quality of life (EORTC QLQ-C30), treatment adherence (MMAS-8), psychological status (HADS), sleep quality (PSQI), and safety outcomes.

The study is designed to determine whether a combined intervention approach integrating nursing care and exercise rehabilitation can provide greater benefits than routine care alone in improving both physical and psychological outcomes in patients with advanced lung cancer.

Study Overview

• Status: Completed
• Conditions: Cancer-related Fatigue; Advanced Lung Cancer
• Intervention / Treatment: Behavioral: Evidence-Based Nursing; Behavioral: Progressive Exercise Training; Other: Routine Nursing Care

Detailed Description

This study is a single-center, prospective, randomized controlled trial designed to evaluate the effectiveness and safety of evidence-based nursing combined with progressive exercise training in patients with advanced lung cancer undergoing chemotherapy.

Eligible patients with stage III-IV lung cancer receiving platinum-based chemotherapy were consecutively recruited and randomly assigned in a 1:1 ratio to either the control group or the intervention group using a random number table. Stratified randomization was performed according to age, sex, and Karnofsky Performance Status (KPS). Allocation was implemented using sealed opaque envelopes. Due to the nature of the intervention, participants and intervention providers were not blinded; however, outcome assessment and statistical analysis were conducted by independent personnel blinded to group allocation.

The control group received routine nursing care, including health education, symptom monitoring, dietary guidance, and general psychological support. The intervention group received, in addition to routine care, a comprehensive intervention consisting of evidence-based nursing and progressive exercise training. Evidence-based nursing included individualized health education, psychological support, symptom management, and family involvement strategies developed based on current best evidence. The progressive exercise program was supervised by rehabilitation specialists and included aerobic and resistance training with gradually increasing intensity, tailored to individual patient tolerance.

The intervention duration was 8 weeks. Patients were followed throughout the intervention period with regular monitoring of symptoms, adherence, and safety.

Primary outcomes included changes in cancer-related fatigue assessed by the Brief Fatigue Inventory (BFI) and functional exercise capacity assessed by the 6-minute walk test (6MWT). Secondary outcomes included quality of life measured by the EORTC QLQ-C30, treatment adherence measured by the MMAS-8, psychological status assessed by the Hospital Anxiety and Depression Scale (HADS), sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI), and the incidence of adverse events.

The study aims to provide evidence for a multidimensional supportive care model integrating nursing interventions and exercise rehabilitation to improve clinical outcomes in patients with advanced lung cancer.

• Study Type: Interventional
• Enrollment (Actual): 100
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Shanxi
    • Taiyuan, Shanxi, China, 030013
      • Shanxi Province Cancer Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Pathologically confirmed advanced lung cancer (stage III-IV)
• Currently receiving platinum-based chemotherapy (first to fourth cycle)
• Age ≥18 years
• Karnofsky Performance Status (KPS) score ≥60
• Presence of moderate or more severe cancer-related fatigue, defined as a Brief Fatigue Inventory (BFI) score ≥4
• Expected survival time of more than 6 months
• Ability to understand the study procedures and provide written informed consent

Exclusion Criteria:

• Severe cardiopulmonary insufficiency or other conditions that contraindicate exercise intervention
• Cognitive impairment or mental disorders affecting compliance with the intervention
• Musculoskeletal disorders that limit physical activity or exercise participation
• Presence of other advanced malignant tumors
• Rapid disease progression during the study period requiring discontinuation of the intervention

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention Group: Evidence-Based Nursing Plus Progressive Exercise; Participants in the intervention group received routine nursing care combined with evidence-based nursing and a structured progressive exercise training program for 8 weeks. Evidence-based nursing included individualized health education, psychological support, symptom management, and family involvement based on current best evidence. The exercise program consisted of aerobic and resistance training with gradually increasing intensity, tailored to each patient's physical condition and tolerance, and supervised by rehabilitation specialists and nursing staff.	Behavioral: Evidence-Based Nursing; Evidence-based nursing included individualized health education, psychological support, symptom management, and family involvement strategies based on current best available evidence. Nursing interventions were tailored to patients' clinical conditions and aimed to improve symptom control, treatment adherence, and overall quality of life.; Behavioral: Progressive Exercise Training; Progressive exercise training consisted of aerobic and resistance exercises with gradually increasing intensity over an 8-week period. The program was individualized based on patients' physical condition and tolerance, and included activities such as walking, Tai Chi, and light resistance training. Exercise sessions were supervised by rehabilitation specialists and nursing staff.; Other: Routine Nursing Care; Routine nursing care included standard health education, dietary guidance, symptom monitoring, and general psychological support provided during chemotherapy, without a structured evidence-based nursing protocol or exercise program.
Active Comparator: Control Group: Routine Nursing Care; Participants in the control group received routine nursing care, including standard health education, dietary guidance, symptom monitoring, and general psychological support. No structured exercise rehabilitation program or evidence-based nursing protocol was provided.	Other: Routine Nursing Care; Routine nursing care included standard health education, dietary guidance, symptom monitoring, and general psychological support provided during chemotherapy, without a structured evidence-based nursing protocol or exercise program.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Cancer-Related Fatigue Assessed by the Brief Fatigue Inventory (BFI)	Cancer-related fatigue is assessed using the Brief Fatigue Inventory (BFI), a validated scale ranging from 0 to 10, with higher scores indicating more severe fatigue. The outcome measure is the change in total BFI score.	Baseline; Week 8
Change in Functional Exercise Capacity Assessed by the 6-Minute Walk Test (6MWT)	Functional exercise capacity is assessed using the 6-minute walk test (6MWT), which measures the distance a participant can walk in 6 minutes. The outcome measure is the change in walking distance (meters).	Baseline; Week 8

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Quality of Life Assessed by the EORTC QLQ-C30	Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Scores were linearly transformed to a 0-100 scale, with higher scores on functional scales indicating better quality of life. The outcome measure was the change in functional domain scores from baseline to the end of the intervention.	Baseline; Week 8
Change in Treatment Adherence Assessed by the Morisky Medication Adherence Scale (MMAS-8)	Treatment adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8), with total scores ranging from 0 to 8 and higher scores indicating better adherence. The outcome measure was the change in MMAS-8 score from baseline to the end of the intervention.	Baseline; Week 8
Change in Psychological Status Assessed by the Hospital Anxiety and Depression Scale (HADS)	Psychological status was evaluated using the Hospital Anxiety and Depression Scale (HADS), which includes subscales for anxiety and depression. Higher scores indicate more severe symptoms. The outcome measure was the change in total HADS score from baseline to the end of the intervention.	Baseline; Week 8
Change in Sleep Quality Assessed by the Pittsburgh Sleep Quality Index (PSQI)	Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with total scores ranging from 0 to 21 and higher scores indicating poorer sleep quality. The outcome measure was the change in PSQI score from baseline to the end of the intervention.	Baseline; Week 8
Incidence of Adverse Events	All adverse events occurring during the study period were recorded, including exercise-related adverse events and chemotherapy-related complications such as myelosuppression and infection. The outcome measure was the incidence and type of adverse events observed during the intervention period.	Baseline through Week 8

Collaborators and Investigators

• Sponsor: Shanxi Province Cancer Hospital
• Investigators: Principal Investigator: Qingjuan Li, MD, Shanxi Province Cancer Hospital, Taiyuan, China

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2023
• Primary Completion (Actual): June 30, 2024
• Study Completion (Actual): August 30, 2024

Study Registration Dates

• First Submitted: March 18, 2026
• First Submitted That Met QC Criteria: March 24, 2026
• First Posted (Actual): March 27, 2026

Study Record Updates

• Last Update Posted (Actual): March 27, 2026
• Last Update Submitted That Met QC Criteria: March 24, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Quality of Life; Randomized Controlled Trial; Chemotherapy; Treatment Adherence; 6-Minute Walk Test; Evidence-Based Nursing; Exercise Rehabilitation; Progressive Exercise; Brief Fatigue Inventory
• Additional Relevant MeSH Terms: Behavior; Health Behavior; Treatment Adherence and Compliance
• Other Study ID Numbers: IIT-2025-162

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Individual participant data will be considered for sharing upon reasonable request to the corresponding author, subject to institutional policies and data protection regulations.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No