The association analysis between fatigue and body composition loss in patients with nasopharyngeal carcinoma during radiotherapy: An observational longitudinal study.

PURPOSE: This study aimed to reveal the association of fatigue with weekly changes in the body composition in patients with nasopharyngeal carcinoma (NPC) and identified the independent strength. METHODS: Four body composition indexes and fatigue were assessed before treatment (T0, baseline) and once a week throughout radiotherapy (T1-T7). Generalized additive mixed models (GAMMs) were used to explore the trajectories and longitudinal relationships of fatigue and weekly changes in body composition. The marginal structural model (MSM) was used to control the effect of depression and anxiety. RESULTS: The trajectories of fatigue in 105 participants reached a peak in the fifth week, and changes in body composition started appearing from the second week. Four body composition indexes, weight, body mass index (BMI), body fat rate, and lean body weight loss weekly were positively associated with fatigue. High magnitude of effects was revealed when anxiety and depression were controlled as time-dependent confounders. The positive associations with fatigue were manifested in patients aged >53 years, those with senior high and above education, no drinking, >5000 Y/month of family inflow, ≥ stage III, or those receiving a dose of ≥70 Gy, ≥3 cycles of induced chemotherapy, and ≤1 cycle of concurrent chemotherapy. CONCLUSIONS: Loss of weight, BMI, body fat rate, and lean body weight could be used to independently evaluate the development of fatigue in patients with NPC during radiotherapy. Positive associations between fatigue and weekly body composition loss were found in patients with certain characteristics.

Effects of Multimodal Exercise on Health-related Physical Fitness and Quality of Life in Patients with Nasopharyngeal Carcinoma during Radiotherapy.

BACKGROUND: The health-related physical fitness of patients with nasopharyngeal carcinoma can decrease significantly during radiotherapy, which can adversely affect their quality of life. AIM: This study was designed to evaluate the potential influence of a multimodal exercise program on the health-related physical fitness and quality of life of patients with nasopharyngeal carcinoma during radiotherapy. METHODS: Forty patients with nasopharyngeal carcinoma undergoing radiotherapy in the First Affiliated Hospital of Fujian Medical University from May to November 2019 were included. The participants in the control group (N=20) received routine nursing, while those in the intervention group (N=20) were also subjected to the multimodal exercise program during radiotherapy. RESULTS: The multimodal exercise program had a positive effect on participants. The step test index in the intervention group was significantly higher as compared to the control group (p < .05). The participants were subjected to 5 times slow speed (60°/s) and 10 times fast (180°/s) speed, and function of some extensor and flexor muscles of the elbow, shoulder, and knee joints in the intervention group was markedly improved (p < .05). In the intervention group, the grip strength of the right hand was observed to be significantly improved (p < .01). Furthermore, the upper limb scratch dorsal test of intervention group was significantly better than that of the control group (p < .05). The scores of physical, emotional, and social functions in the intervention group were found to be significantly higher as compared to the control group (p < .05). CONCLUSIONS: The multimodal exercise program significantly improved the health-related physical fitness and life quality of the patients with nasopharyngeal carcinoma during radiotherapy, though its long-term effects remain to be further analyzed.

The Effectiveness of Yoga on Cancer-Related Fatigue: A Systematic Review and Meta-Analysis.

PROBLEM IDENTIFICATION: The aim of this article is to evaluate the effectiveness of yoga on cancer-related fatigue (CRF) in patients undergoing chemotherapy and/or radiation therapy. LITERATURE SEARCH: Relevant English and Chinese articles were retrieved from medical databases and included in this analysis. Standardized critical appraisal instruments from the Joanna Briggs Institute were adopted for the quality assessment. DATA EVALUATION: 16 randomized controlled trials met the inclusion criteria. SYNTHESIS: Yoga interventions had a positive effect in reducing CRF among patients undergoing chemotherapy and/or radiation therapy, but the adherence to yoga was low. Mixed types of yoga, in addition to supervised and self-practicing strategies, were associated with increased patient adherence and improved CRF. IMPLICATIONS FOR PRACTICE: Yoga appears to be a safe and effective exercise for the management of CRF during chemotherapy and/or radiation therapy; however, additional high-quality studies are needed to define an optimal yoga intervention strategy.

Evaluation of evidence for exercise intervention in patients with cancer-related fatigue during chemoradiotherapy.

AIM AND OBJECTIVES: This systematic review evaluated evidence quality for exercise intervention in patients with cancer-related fatigue (CRF) during chemoradiotherapy to provide evidence-based clinical guidance. BACKGROUND: Cancer-related fatigue is one of the most common symptoms in patients undergoing chemoradiotherapy. There is mounting evidence suggests exercise can relieve CRF and clinical practice guidelines for its management have been published in several countries. However, more specific exercise programmes need to be extracted to guide the clinical practice. DESIGN: The review was presented by PRISMA guidelines. Research questions and strategies were established using evidence-based nursing criteria. Eleven websites and databases were searched. Appraisal of Guidelines for Research and Evaluation II, the JBI literature quality assessment tool, and the JBI evidence pre-classification and evidence recommendation level system were used. RESULTS: Thirteen systematic reviews, four guidelines and one evidence summary were included. The overall guideline quality score was 5.71, indicating high quality, with the following average scores on the six dimensions: scope and purpose, 86.81%; stakeholder group, 71.53%; rigour of the writing, 76.56%; clarity of presentation, 88.19%; applicability, 68.23%; and independence, 72.92%. We summarised 18 pieces of evidence including screening and assessment of CRF and exercise risk, health education, sports programme, sports protection and termination index. There were 12, 1, 1 and 4 pieces of evidence in grades I, II, III and IV, respectively. The evidence recommendation was strong for 15 and weak for three articles. CONCLUSION: Although a normal adult exercise intensity level is considered safe for patients during chemoradiotherapy, our synthesis suggests that 18 pieces of evidence shall be followed. Future research should focus on more cancer types and more targeted exercise programme design. RELEVANCE TO CLINICAL PRACTICE: Cancer-related fatigue status and exercise risk should be screened and evaluated throughout exercise interventions. Interventions should be individualised, initiated at a low intensity and duration, and increased progressively.