Managing cancer‐related fatigue in men with prostate cancer: A systematic review of non‐pharmacological interventions

The aim of this systematic review was to synthesize the best available evidence informing the effectiveness of non‐pharmacological interventions for managing cancer‐related fatigue in men treated for prostate cancer. This review considered experimental studies that included men with prostate cancer (regardless of staging, previous treatment or comorbidities), aged 18 years and over who were undergoing any treatment, or had completed any treatment for prostate cancer within the previous 12 months. Three interventions were identified for the management of cancer‐related fatigue in men with prostate cancer. Evidence from five studies including 447 participants demonstrates the effectiveness of physical activity, both aerobic and resistance exercise, and from three studies including 153 participants suggesting the benefits of psychosocial interventions including education and cognitive behavioural therapy. Health professionals require knowledge of a range of effective interventions aimed at reducing cancer‐related fatigue in men with prostate cancer and should incorporate those interventions into their patient management. Although physical activity appears to show the greatest benefit, other non‐pharmacological interventions such as education and cognitive behavioural therapy have demonstrated benefit and should also be considered as a strategy in treating this debilitating side effect of cancer and its treatment.     

The needs of men with prostate cancer: results of a focus group study

Prostate cancer is the most common type of cancer diagnosed in men in the United States and accounts for 43% of all newly diagnosed malignancies. This year, approximately 218,890 men were diagnosed with prostate cancer (American Cancer Society, 2007). Of all men diagnosed with cancer each year, more than 30% will be diagnosed with prostate cancer. Receiving a diagnosis of cancer can be very difficult and emotionally challenging for patients and their families. There is limited research surrounding the psychosocial and educational needs of men diagnosed with prostate cancer and the effectiveness of existing support services for this population. The purpose of this qualitative and grounded theory study was to explore the psychosocial needs of men with prostate cancer using a previously developed cancer model. Demographic questionnaires and focus groups were used with a sample of 16 men aged between 49 and 81 years. The results of the qualitative analysis revealed consistency with a previously tested breast cancer model and identified unique concerns of men within three stages of the prostate cancer experience. Implications for nursing research and practice are presented.     

Tumorbedingte Fatigue und ihre psychosozialen Belastungen

Cancer-related fatigue (CRF) is a highly prevalent and the most distressing symptom during and after treatment for cancer. It is characterized by feelings of physical and mental tiredness, weakness, and lack of energy and is not influenced by rest or sleep. Approximately 40% of patients suffer from CRF at diagnosis and nearly all patients experience fatigue during the course of cancer therapy. The impact of CRF on daily living and patient quality of life (QoL) is substantial. It profoundly affects patient quality of life and limits personal, social and occupational roles. The fatigue is also associated with significant levels of distress and it imposes a financial burden by limiting the ability to work. The underlying causes of CRF are poorly understood as are the relationship between fatigue and psychosocial distress, depression or anxiety. This paper seeks to give an overview of cancer-related fatigue and its psychosocial burden.     

Cancer-related fatigue and its psychosocial burden

Cancer-related fatigue (CRF) is a highly prevalent and the most distressing symptom during and after treatment for cancer. It is characterized by feelings of physical and mental tiredness, weakness, and lack of energy and is not influenced by rest or sleep. Approximately 40% of patients suffer from CRF at diagnosis and nearly all patients experience fatigue during the course of cancer therapy. The impact of CRF on daily living and patient quality of life (QoL) is substantial. It profoundly affects patient quality of life and limits personal, social and occupational roles. The fatigue is also associated with significant levels of distress and it imposes a financial burden by limiting the ability to work. The underlying causes of CRF are poorly understood as are the relationship between fatigue and psychosocial distress, depression or anxiety. This paper seeks to give an overview of cancer-related fatigue and its psychosocial burden.     

Psychosocial characteristics of cancer patients who choose to attend an educational session on cancer-related fatigue

Little is known about cancer patients who seek specific educational interventions on cancer-related fatigue (CRF). The objectives of this study were (1) to describe the level of CRF, and emotional distress; social support; coping styles; and quality of life of patients who chose to attend a 1-hour educational session on CRF and (2) to examine the relationship between the selected demographic, psychosocial, and treatment-related variables and CRF. A questionnaire-based survey of 41 cancer patients who volunteered after a 1-hour education session on CRF at the Tom Baker Cancer Centre was conducted. The sample consisted mostly of married white women who lived in an urban environment. The average age was 56 years, and participants had an average of 14 years of education; 78% of the sample reported moderate to severe fatigue, 27% had significant levels of emotional distress, and 63% had a problematic coping style. Higher fatigue was associated with emotional distress, poorer quality of life, hopelessness, and reduced social support. To conclude, patients who self-refer to an educational session on CRF present a wide range of emotional difficulties and problematic coping styles. Therefore, educational sessions with patients with CRF should emphasize coping with emotional distress and building a support system.     

肺癌化疗患者癌因性疲乏及其对生活质量的影响分析

目的 了解肺癌化疗患者癌因性疲乏的发生率和严重程度,分析肺癌化疗患者癌囚性疲乏与生活质量的相关性.方法 采用横断面调查研究方法,应用Piper疲乏量表和简明健康测量量表(SF-36)对72例肺癌化疗患者进行问卷调查.结果 肺癌化疗患者疲乏的发生率为76.4%,整体疲乏和行为/严重性、情感、感觉等维度的中重度疲乏发生率分别为68.1%、63.9%、76.4%、65.3%,认知/情绪维度的轻中度疲乏发生率为41.7%,疲乏得分排序为情感维度＞行为俨重性维度＞感觉维度＞认知/情绪维度.肺癌化疗患者的癌因性疲乏与生活质量在多个维度上呈显著负相关.结论 肺癌化疗患者癌因性疲乏的发生率较高、程度较重,疲乏与生活质量两者相互影响,应采取减轻疲乏的干预措施,以提高肺癌化疗患者的生活质量.     

Why am I so tired all the time? Understanding cancer-related fatigue

DEFINITION: Cancer-related fatigue (CRF) is a "persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning" (National Comprehensive Cancer Network [NCCN] & American Cancer Society [ACS], 2005). Unlike other fatigue, CRF is not relieved by sleep or rest.     

Psychosocial adjustments in patients with prostate cancer from pre‐diagnosis to 6 months post‐treatment

We evaluated changes in psychosocial adjustment over time and its associated factors in prostate cancer patients. A total of 69 patients with prostate cancer were surveyed at pre‐diagnosis, 1 month and 6 months post‐treatment. The questionnaires distributed to the patients consisted of the Psychosocial Adjustment to Illness Scale and the UCLA Prostate Cancer Index. The generalized estimating equations were used to analyse the collected data. The results of adjustments to psychological distress, the domestic environment and the social environment worsened post‐treatment. However, the adjustment to health‐care orientation was worst at the time of pre‐diagnosis and improved during post‐treatment. Patients who perceived an unfavourable health status reported poor adjustment in psychological distress. Patients exhibiting poor urinary function poorly adjusted to the domestic environment. Patients with sexual dysfunction exhibited poor adjustment to the social environment. Patients with low education demonstrated poor adjustment to health‐care orientation. Further studies should assess the psychosocial adjustment among prostate cancer patients and provide interventions following pre‐diagnosis.     

Evaluating a psychosocial intervention for men with prostate cancer and their partners: Outcomes and lessons learned from a randomized controlled trial

AimThis study evaluated the process and outcome of a psychosocial intervention for men with prostate cancer and their partners. As more men survive prostate cancer, they and their partners need help and support to help them cope with the physical and psychosocial effects of the disease and treatment. There is a lack of psychosocial interventions for men with prostate cancer and their partners.MethodsA randomized controlled trial was conducted with 34 participants to measure the effects of the intervention on selected psychosocial outcomes, post-intervention and at one month’ follow-up. The nine-week program (CONNECT) consisted of three group and two telephone sessions. It focused on symptom management, sexual dysfunction, uncertainty management, positive thinking and couple communication. The outcomes, measured by validated tools were: self-efficacy, quality of life, symptom distress, communication, uncertainty and illness benefits.ResultsThe men in the intervention group did better on two outcomes (communication and support) than controls. Partners in the intervention group did better than controls on most outcomes. Less participants than expected participated in the trial. The reasons for non-participation included partners not wishing to participate, men not interested in group work, and not understanding the core purpose of the intervention. The cost of training facilitators and for delivering the intervention appeared to be low.ConclusionThe knowledge generated from this study will be beneficial for all those grappling with the challenges of developing, implementing and evaluating complex psychosocial interventions. This study has also highlighted the difficulties in recruiting men and their partners in clinical trials.     

Metastatic castrate‐resistant prostate cancer: a discussion of the physical and psychosocial effects

Management options for metastatic castrate‐resistant prostate cancer (mCRPC) have increased in recent years resulting in more men living for longer with the disease. The implications for patients and health care services are considered through an examination of the literature in relation to the physical and psychosocial effects of mCRPC and its treatment, looking at quality of life (QoL) and service delivery implications. QoL in advanced prostate cancer has been well documented in the literature but studies involving those with mCRPC are sparse. There is a lack of evidence regarding psychological distress and effective psychological interventions for men with mCRPC. There is a need for research to understand the impact of new treatments on QoL of men and their partners, to establish effective psychological interventions for men with mCRPC and to quantify the increased demand for services with prolonged survival. The purpose of this discussion paper is to examine the physical and psychosocial effects of both disease and treatment, alongside QoL issues and consideration of the implications for service delivery.     

Improving quality of life among latino cancer survivors: Design of a randomized trial of patient navigation

Latino cancer survivors have lower survival rates for most cancers relative to non-Latino whites, including, colorectal, prostate, and breast. In addition, Latinos experience health disparities in both access to care and quality of care. Experts recommend providing psychosocial services as an integral part of quality cancer care; however, there continues to be a paucity of information on the efficacy of Patient Navigators (PNs) in linking Latino cancer survivors to appropriate psychosocial services. Redes En Acción: The National Latino Cancer Research Network partnered with LIVESTRONG Cancer Navigation Services Patient Navigation program (PN-LCNS) to provide an intervention to improve wellness and increase access to psychosocial services among non-metastatic Latino cancer survivors from Texas and Chicago using trained bilingual, bicultural PNs. The study design involved a mixed-methods approach in two phases. Phase I used a Community-Based Participatory Research (CBPR) approach wherein PNs engaged community partners who provide services to breast, colorectal and prostate Latino cancer survivors. Phase II was a randomized controlled trial (RCT) that evaluated the efficacy of combining PN-facilitated interventions with the culturally tailored and CBPR-informed PN-LCNS in 300 breast, prostate and colorectal Latino cancer survivors. Outcomes investigated were improvements in: 1) quality of life (QOL), both general and disease-specific, and; 2) treatment follow-up compliance. While limited work has addressed the psychosocial needs of Latino cancer survivors, culturally-competent interventions using PNs have potential to address these needs and significantly improve Latino cancer survivorship.     

Psychosocial and educational intervention trials in prostate cancer

OBJECTIVES: To describe the nature and focus of published educational intervention trials in prostate cancer in the last 10 years and to examine the state of the research in this particular area of knowledge. DATA SOURCES: Health science and psychosocial electronic databases were searched for studies reporting trials of educational or psychosocial interventions for men with prostate cancer and for the partners or families of these men. CONCLUSIONS: Interventions were characterized by the aspect of the illness trajectory that was targeted. The majority of the studies focused on managing the disease, treatments, and side effects. IMPLICATIONS FOR NURSING PRACTICE: Psychosocial stressors and uncertainty are pervasive throughout the prostate cancer trajectory. Knowledge of psychosocial and educational interventions that have been tested is critical for nurses working with these patients and their families.     

全喉切除患者癌因性疲乏护理干预的效果观察

目的探讨全喉切除患者癌因性疲乏的护理干预方法及效果。方法2004年35例全喉切除患者接受常规护理,作为对照组。2005年成立护理干预质控小组,对观察组35例全喉切除癌因性疲乏患者,除常规护理外,由专职主管护师进行系统的癌因性疲乏护理干预。比较两组的癌因性疲乏状况、生存质量、特质应对方式、自我护理能力。结果入院第2天,两组患者疲乏程度比较,差异无统计学意义(P>0.05)。术后第15天,观察组疲乏程度低于对照组,生存质量高于对照组,差异有统计学意义(P<0.01)。特质应对方式比较,差异有统计学意义(P<0.01);自我护理能力比较除自我责任感外,差异有统计学意义(P<0.05);观察组均优于对照组。结论认知干预、社会心理支持、早期有氧锻炼等护理干预与术前肠内免疫营养,可以消除或缓解疲乏程度,提高患者的生存质量。     

The Impact of Exercise during Radiation Therapy for Prostate Cancer on Fatigue and Quality of Life: A Systematic Review and Meta-analysis

BackgroundRadiation therapy (RT) is clinically proven to improve survival in men with prostate cancer. Despite these advantages, it is known to cause adverse effects such as fatigue. This review proposes to summarize the totality of evidence from randomized controlled trials regarding the effectiveness of exercise on fatigue in men with prostate cancer as a primary outcome. Quality of life was a secondary outcome.MethodsRCTs that explored the effect of exercise during RT on fatigue for men with prostate cancer were searched using MEDLINE, Embase, CINAHL, Cochrane Library, AMED, ClinicalTrials.gov, and ISRTCN registry. Reference lists of included studies and reviews were also examined. Trials were excluded if they included a mixed cohort of patients where data could not be extracted for prostate cancer patients alone or if the intervention took place after RT had finished. Preferred Reporting Items for Systematic Reviews and Meta-Analyses standardized reporting guidelines were followed to ensure the standardised conduct and reporting of the research.ResultsThe search strategy yielded a total of 278 studies, of which five met the inclusion criteria. A meta-analysis pooled data of 392 participants using the Cochrane Review Manager 5.3 random-effects model (DerSimonian-Laird approach) with the post-test means of the control and intervention groups and associated standard deviations. Exercise was significant at alleviating fatigue when compared to the control group (standardized mean differences, −1.03; 95% confidence interval, −1.82 to −0.24).ConclusionExercise during RT is an effective approach to alleviate fatigue in men with prostate cancer. The effect on quality of life was not significant, possibly because of considerable heterogeneity across studies.     

Making sense of symptoms in men with prostate cancer: a longitudinal qualitative exploration

Within the UK, prostate cancer is now the most common cancer in men. Treatments for prostate cancer are associated with short‐term and long‐term side effects. Previous research in this area has mainly concentrated on symptom severity in relation to quality of life and has been largely quantitative in nature. The aim of this research study was to explore the perception and meaning of symptoms experienced by men with prostate cancer, from the patients' perspective. Ten men with newly diagnosed prostate cancer, undergoing treatment, were interviewed four times over 1 year. Interviews were analysed using an analytic framework underpinned by the common sense model. The men tended to minimize their symptom experience and cancer diagnoses over all four interviews. They were less likely to minimize symptoms if they believed their symptoms might be due to disease progression. Men appeared passive in their care and reluctant to ask questions; they did not appear to understand post‐treatment follow‐up procedures and this led to feelings of abandonment. This study is one of the only studies to explore how men perceive, appraise and manage symptoms related to prostate cancer over the first year after diagnosis. This may help health professionals when planning interventions and services for men with prostate cancer. Passivity in care appeared related to information deficits; patients need to be empowered to become active partners in their care.     

Black men are dying from prostate cancer

Prostate cancer is the most frequently diagnosed cancer in the United States, accounting for 33% of all cancer cases among men (American Cancer Society, 2004). In the United States the number of new cases of prostate cancer was estimated at 230,110 and 29,900 will die (American Cancer Society, 2004). It is anticipated that these numbers will continue to grow despite effective treatment regiments. Black men (African-American) are 2.5 times more likely to die of prostate cancer than White men (Peters, 2005). Recent studies suggest genetics, diet, knowledge, and socioeconomic status as contributory factors, however, there appears to be more to it.     

Fatigue in palliative care patients -- an EAPC approach

Fatigue is one of the most frequent symptoms in palliative care patients, reported in .80% of cancer patients and in up to 99% of patients following radio- or chemotherapy. Fatigue also plays a major role in palliative care for noncancer patients, with large percentages of patients with HIV, multiple sclerosis, chronic obstructive pulmonary disease or heart failure reporting fatigue.This paper presents the position of an expert working group of the European Association for Palliative Care (EAPC), evaluating the available evidence on diagnosis and treatment of fatigue in palliative care patients and providing the basis for future discussions. As the expert group feels that culture and language influence the approach to fatigue in different European countries, a focus was on cultural issues in the assessment and treatment of fatigue in palliative care. As a working definition, fatigue was defined as a subjective feeling of tiredness, weakness or lack of energy. Qualitative differences between fatigue in cancer patients and in healthy controls have been proposed, but these differences seem to be only an expression of the overwhelming intensity of cancer-related fatigue. The pathophysiology of fatigue in palliative care patients is not fully understood. For a systematic approach, primary fatigue, most probably related to high load of proinflammatory cytokines and secondary fatigue from concurrent syndromes and comorbidities may be differentiated. Fatigue is generally recognized as a multidimensional construct, with a physical and cognitive dimension acknowledged by all authors. As fatigue is an inherent word only in the English and French language, but not in other European languages, screening for fatigue should include questions on weakness as a paraphrase for the physical dimension and on tiredness as a paraphrase for the cognitive dimension. Treatment of fatigue should include causal interventions for secondary fatigue and symptomatic treatment with pharmacological and nonpharmacological interventions. Strong evidence has been accumulated that aerobic exercise will reduce fatigue levels in cancer survivors and patients receiving cancer treatment. In the final stage of life, fatigue may provide protection and shielding from suffering for the patient and thus treatment may be detrimental. Identification of the time point, where treatment of fatigue is no longer indicated is important to alleviate distress at the end of life.     

The long‐term quality of life and information needs of prostate cancer survivors

What are the quality of life (QoL) and information needs of long‐term prostate cancer survivors? Numbers of prostate cancer survivors are increasing and it is vital that their QoL issues and information needs are understood. The long‐term effects of surviving prostate cancer is poorly understood. Specialist nurses play a key role in their management. A cross‐sectional survey was used. The study questionnaire [(European Organization for Research and Treatment of Cancer‐Quality of Life Questionnaire) EORTC‐QLQ‐30 and EORTC QOL‐INFO25] was posted to 398 prostate cancer survivors attending an Irish centre managed by a clinical nurse specialist and consultant. Completed questionnaires (n = 195) were returned (response rate 49%). Overall, the men demonstrated a Global Health Status/QoL score of 77·6 (SD 20·7), demonstrating a high or healthy level of functioning. Men on hormonal therapy demonstrated inferior physical function in comparison to other treatment options. Fatigue and insomnia were the most frequent symptom experienced, while age was the most significant demographic variable affecting symptom scales. Men undergoing active surveillance for prostate cancer management were least happy with information received (p = 0·019). Comparison with EORTC QLQ‐C30 international reference values suggests that this cohort report a high/healthy QoL. However, a significant proportion of men expressed a need for the receipt of further information, especially men on active surveillance. Specialist nurses are in a unique position to meet the information needs of long‐term prostate cancer patients. However, planning is needed to ensure there are enough specialist nurses to meet the information needs of a growing number of men surviving prostate cancer.     

Psychosocial consequences of prostate cancer: 30 years of research

Carcinoma of the prostate is the leading source of solid-organ cancer in U.S. men. When the disease is discovered early, survival rates are high; survivorship, however, is commonly complicated by disease-specific treatment side effects that challenge a man's physical, mental, and social well-being and life satisfaction. This review comprises a search of scientific literature published between 1970 and March 2004 with the aims of 1) identifying the terms used to define the psychosocial consequences unique to men treated for prostate cancer and 2) describing the research aimed at improving the lives of survivors through psychosocial interventions.