Knowledge, perceptions, and management of cancer-related fatigue: the patients' perspective

Martina E Schmidt, Susanne Bergbold, Silke Hermann, Karen Steindorf, Martina E Schmidt, Susanne Bergbold, Silke Hermann, Karen Steindorf

Abstract

Purpose: This study aimed to assess cancer patients' knowledge and perceptions regarding fatigue and to provide up-to-date information on the current fatigue management from the patients' perspective.

Methods: The FiX study recruited 2508 cancer patients approximately 2 years after diagnosis via a cancer registry in Germany. Participants completed a questionnaire on their knowledge and perceptions of fatigue and the management received.

Results: More than half of respondents (58%), especially among the elderly patients, did not feel well informed about fatigue. Overall, 41% reported having never been asked about being exhausted by their treating physician. Even fewer patients stated that general practitioners or nurses have asked if they felt exhausted. Only 13% of patients who had experienced severe fatigue had received a fatigue assessment by means of a rating scale or questionnaire-although this is recommended by existing guidelines for fatigue screening. Health care professionals seemed less likely to address fatigue with elderly as well as female patients. The most commonly reported measure against fatigue was exercise or regular physical activity (68%). However, this was mostly done on patients' own initiative. Psychological support was rarely used (13%) and only in approximately half of the cases upon the advice of a physician. Yoga, another promising intervention against fatigue, was performed by only 9% of patients.

Conclusions: Our study indicates deficits in terms of knowledge, education, screening, counseling, and treatment for fatigue and highlights starting points for targeted improvements in fatigue management based on patients' needs.

Keywords: Cancer survivorship; Exhaustion; Fatigue management; Patient perspective; Quality of life; Screening.

Conflict of interest statement

Karen Steindorf has received fees and travel costs for lectures and talks on physical activity and quality of life and for scientific reviews from non-profit organizations and companies.

Figures

Fig. 1
Fig. 1
Offers or measures applied by patients, stratified according to fatigue severity
Fig. 2
Fig. 2
Patients’ knowledge and perceptions

References

    1. Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, Cleeland C, Dotan E, Eisenberger MA, Escalante CP, Jacobsen PB, Jankowski C, LeBlanc T, Ligibel JA, Loggers ET, Mandrell B, Murphy BA, Palesh O, Pirl WF, Plaxe SC, Riba MB, Rugo HS, Salvador C, Wagner LI, Wagner-Johnston ND, Zachariah FJ, Bergman MA, Smith C, National comprehensive cancer network Cancer-related fatigue, Version 2.2015. J Natl Compr Canc Netw. 2015;13(8):1012–1039. doi: 10.6004/jnccn.2015.0122.
    1. Chelf JH, Agre P, Axelrod A, Cheney L, Cole DD, Conrad K, et al. Cancer-related patient education: an overview of the last decade of evaluation and research. Oncol Nurs Forum. 2001;28(7):1139–1147.
    1. Bennett S, Pigott A, Beller EM, Haines T, Meredith P, Delaney C. Educational interventions for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2016;11:CD008144.
    1. Network NCC (2018) NCCN Clinical Practice Guidelines in Oncology: cancer-related fatigue, version 2.2018
    1. Howell D, Keshavarz H, Broadfield L, Hack T, Hamel M, Harth T, et al. A pan Canadian guideline for the screening, assessment, and management of cancer-related fatigue in adults-Version 2-2015.
    1. Fabi A, Bhargava R, Fatigoni S, Guglielmo M, Horneber M, Roila F et al (2020) Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Ann Oncol 12
    1. Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA, Schnipper HH, Lacchetti C, Ligibel JA, Lyman GH, Ogaily MS, Pirl WF, Jacobsen PB, American Society of Clinical Oncology Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. J Clin Oncol. 2014;32(17):1840–1850. doi: 10.1200/JCO.2013.53.4495.
    1. Pearson EJM, Morris ME, McKinstry CE. Cancer related fatigue: implementing guidelines for optimal management. BMC Health Serv Res. 2017;17(1):496. doi: 10.1186/s12913-017-2415-9.
    1. Berger AM, Mooney K. Dissemination and implementation of guidelines for cancer-related fatigue. J Natl Compr Cancer Netw. 2016;14(11):1336–1338. doi: 10.6004/jnccn.2016.0144.
    1. Williams LA, Bohac C, Hunter S, Cella D. Patient and health care provider perceptions of cancer-related fatigue and pain. Support Care Cancer. 2016;24(10):4357–4363. doi: 10.1007/s00520-016-3275-2.
    1. Tian L, Yang Y, Sui W, Hu Y, Li H, Wang F, Qian K, Ji J, Tao M. Implementation of evidence into practice for cancer-related fatigue management of hospitalized adult patients using the PARIHS framework. PLoS One. 2017;12(10):e0187257. doi: 10.1371/journal.pone.0187257.
    1. Hilfiker R, Meichtry A, Eicher M (2018) Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. 52(10):651–658
    1. Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, Mohr D, Palesh OG, Peppone LJ, Piper BF, Scarpato J, Smith T, Sprod LK, Miller SM. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3(7):961–968. doi: 10.1001/jamaoncol.2016.6914.
    1. Wu C, Zheng Y, Duan Y, Lai X, Cui S, Xu N et al (2019) Nonpharmacological interventions for cancer-related fatigue: a systematic review and bayesian network meta-analysis. Worldviews Evid-Based Nurs 28
    1. Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ (2017) Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev 1
    1. Tian L, Lu HJ, Lin L, Hu Y. Effects of aerobic exercise on cancer-related fatigue: a meta-analysis of randomized controlled trials. Support Care Cancer. 2016;24(2):969–983. doi: 10.1007/s00520-015-2953-9.
    1. Basu N, Yang X, Luben RN, Whibley D, Macfarlane GJ, Wareham NJ, Khaw KT, Myint PK. Fatigue is associated with excess mortality in the general population: results from the EPIC-Norfolk study. BMC Med. 2016;14(1):122. doi: 10.1186/s12916-016-0662-y.
    1. Song S, Yu J, Ruan Y, Liu X, Xiu L, Yue X. Ameliorative effects of Tai Chi on cancer-related fatigue: a meta-analysis of randomized controlled trials. Support Care Cancer. 2018;26(7):2091–2102. doi: 10.1007/s00520-018-4136-y.
    1. Zeng Y, Xie X, Cheng ASK. Qigong or Tai Chi in cancer care: an updated systematic review and meta-analysis. Curr Oncol Rep. 2019;21(6):48. doi: 10.1007/s11912-019-0786-2.
    1. Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012;11:Cd006145.
    1. NCCN Clinical Practice Guidelines in Oncology. Cancer-related fatigue. Version 2.2018.
    1. Goedendorp MM, Gielissen MF, Verhagen CA, Bleijenberg G. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev. 2009;2009(1):Cd006953.
    1. Wayne PM, Lee MS, Novakowski J, Osypiuk K, Ligibel J, Carlson LE, Song R. Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis. J Cancer Surviv. 2018;12(2):256–267. doi: 10.1007/s11764-017-0665-5.
    1. Shin ES, Seo KH, Lee SH, Jang JE, Jung YM, Kim MJ (2016) et al, Massage with or without aromatherapy for symptom relief in people with cancer. Cochrane Database Syst Rev (6):Cd009873
    1. Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, et al. Exercise guidelines for cancer survivors: consensus statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019;51(11):2375–2390. doi: 10.1249/MSS.0000000000002116.
    1. Smith TG, Troeschel AN, Castro KM, Arora NK, Stein K, Lipscomb J, Brawley OW, McCabe RM, Clauser SB, Ward E. Perceptions of patients with breast and colon cancer of the management of cancer-related pain, fatigue, and emotional distress in community oncology. J Clin Oncol. 2019;37(19):1666–1676. doi: 10.1200/JCO.18.01579.
    1. James S, Wright P, Scarlett C, Young T, Jamal H, Verma R. Cancer-related fatigue: results from patient experience surveys undertaken in a UK regional cancer centre. Support Care Cancer. 2015;23(7):2089–2095. doi: 10.1007/s00520-014-2565-9.

Source: PubMed

3
Subscribe