Fisher, H.M., Jacobs, J.M., Taub, C.J., Lechner, S.C., Lewis, J.E., Carver, C.S., . . . Antoni, M.H. (2017). How changes in physical activity relate to fatigue interference, mood, and quality of life during treatment for non-metastatic breast cancer. General Hospital Psychiatry, 49, 37-43.
To determine the effectiveness of physical activity following surgery for breast cancer in improving depression and quality of life
Participants were randomized between a CBSM (cognitive behavioral stress management) intervention group (which corresponds to a 2 hours per week meeting for 10 consecutive weeks) and a single-day psychoeducational control group. The CBMS intervention consist in a structured intervention with relaxation and cognitive behavioral therapy, coping effectiveness training, assertiveness, and anger management.
PHASE OF CARE: Active anti-tumor treatment
Randomized control trial
7-item Perceived Interference Subscale of the 12-item Fatigue Symptom Inventory, IBS for depression, 7-Item Functional Well-Being Subscale of the Functional Assessment of Cancer Therapy (FACT-B)
Both the control and the intervention arm saw significant changes in clinician-rated depression and depressed mood (control: standardized B = 0.15; B = 0.29, p = 0.049; p < 0.001) (intervention: standardized B = 0.14; B = 0.29, p < 0.001;p < 0.001) with regard to FRDI; however, there were no significant changes in functional QOL with either arms with regard to FRDI.
The study shows that a moderate physical activity improves fatigue, depression, and quality of life for patients with breast cancer , and nurses should make a point of encouraging this. Future replications are needed, the sample chosen may already have the awareness of the health benefits of physical activity before the study was enacted.
Nurses should encourage physical activity in patients with breast cancer.
Lundt, A., & Jentschke, E. (2019). Long-term changes of symptoms of anxiety, depression, and fatigue in cancer patients 6 months after the end of yoga therapy. Integrative Cancer Therapies, 18, 1534735418822096.
To examine the long-term changes of anxiety, depression, and fatigue in patients with cancer six months after a yoga intervention
Gentle hatha yoga provided to the participants in small groups under supervision and guidance. 60 minutes once a week for 8 weeks total. Participants also received a CD and a printed manual to motivate training at home.
PHASE OF CARE: Active anti-tumor treatment
Prospective observational one group pre-/post-test design
Self-reported Generalized Anxiety Disorder Scale (GAD-7) to measure anxiety, Patient Health Questionnaire (PHQ-2) to measure depression, European Organization for Research and Treatment of Cancer QOL (EORTC) Questionnaire-Fatigue scale to measure fatigue
There was a statistically significant reduction in the anxiety, depression, and fatigue levels after six months from the baseline. A small time effect on anxiety (SES = 0.22, CI [-0.3, 0.47]) and fatigue (SES = 0.27, CI [-0.11, 0.13]) indicating slight nonsignificant increase of symptoms. No time effect found in terms of depression (SES = 0.01, CI = [-0.11, 0.13]).
Although the study shows reduction in outcomes, studies with larger sample sizes with better study designs (i.e., RCT) are needed to confirm the findings.
Yoga appears to have some benefit in reducing the symptoms of anxiety, depression, and fatigue, and the benefits may be lasting. Additional research with randomized studies will be important to confirm these results.
Griffiths, R.R., Johnson, M.W., Carducci, M.A., Umbricht, A., Richards, W.A., Richards, B.D., . . . Klinedinst, M.A. (2016). Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial. Journal of Psychopharmacology, 30, 1181–1197.
To examine the effect of two psilocybin doses on symptoms of anxiety and depression among patients with advanced cancer
Participants were assigned to two groups: one received low-dose psyilocybin in the first session and high-dose psyilocybin in a second session. The other group received psilocybin doses in reverse order. The first session was done about one month after study entry, and the second session was five weeks later. Study measures were obtained at baseline, during, and at the end of each session, and approximately six months later. Session monitors met with patients prior to sessions to establish rapport and prepare the patient for the sessions. Drug session were done in a living room-like environment with two monitors present.
Crossover, double blind, randomized study
There were no serious adverse effects of the intervention. There were transient moderate increases in blood pressure after psilocybin. Transient psychological distress was seen in some patients with high-dose psilocybin. All measures of depression, anxiety, and total mood disturbance showed significant improvement with high dose (p < 0.001). Death acceptance and optimism also were increased with high-dose intervention (p < 0.01). These changes were maintained at 6 months.
High-dose psilocybin under supportive conditions was shown to decrease symptoms of depression and anxiety, and improve mood, optimism, acceptance of death and spirituality. These effects were generally maintained for months after drug use.
Administration of psilocybin under controlled supportive conditions was shown to have multiple benefits for patients with terminal cancers. Further confirmatory research is warranted, and research comparing outcomes with psilocybin to other appropriate interventions would be helpful.
Gregoire, C., Bragard, I., Jerusalem, G., Etienne, A.M., Coucke, P., Dupuis, G., . . . Faymonville, M.E. (2017). Group interventions to reduce emotional distress and fatigue in breast cancer patients: A 9-month follow-up pragmatic trial. British Journal of Cancer, 117, 1442–1449.
To determine the long-term (nine months) effectiveness of three different group interventions compared to usual care for patients with breast cancer
Participants were allowed to select one of three groups to receive either cognitive behavioral therapy, yoga, and self-hypnosis. People who declined to participate were in a control group. Measurements were taken T0 through T3 to include before and after the short-term interventions, at month 3, and at month 9 follow-up.
PHASE OF CARE: Multiple phases of care
Three group intervention self-selection; testing at T0, T1, T2 (month 3), T3 (month 9)
Demographics; medical history; Hospital Anxiety Depression Scale (anxiety and depression emotional distress); Quality of Life 30-item questionnaire (fatigue); Insomnia Severity Index (sleep quality)
Only results from baseline (T0) and the month 9 follow-up (T3) were reported using MANOVA with repeated analysis and post-hoc analysis.
Post-hoc comparisons of time T0-T1: hypnosis group showed significant decreases in anxiety (p = 0.000), depression (p = 0.004), and fatigue (p = 0.045). Yoga group showed significant decrease in anxiety (p = 0.01).
Post-hoc comparisons of time at T3: hypnosis group showed decreases in anxiety (p = 0.000), depression (p = 0.000), and fatigue (p = 0.002); yoga group showed decrease in anxiety (p = 0.024).
Self-hypnosis led to improvements in anxiety, depression, and fatigue. Anxiety improved in the yoga group. There were no improvements in the CBT or control groups.
Two of the three interventions may be helpful in reducing anxiety, depression, or fatigue when measured at nine months. Self-hypnosis may help patients improve emotional distress such as depression and anxiety, and may also reduce fatigue; yoga may also help improve anxiety. Larger samples and longer follow-up studies are needed.
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.