Could nutrition status predict fatigue one week before in patients with nasopharynx cancer undergoing radiotherapy?

BACKGROUND: Patients with nasopharyngeal carcinoma (NPC) undergoing radiotherapy experience significant fatigue, which is frequently underestimated due to the lack of objective indicators for its evaluation. This study aimed to explore the longitudinal association between fatigue and nutrition status 1 week in advance. METHODS: From January 2021 to June 2022, a total of 105 NPC patients who received intensity-modulated radiation therapy were enrolled in the observational longitudinal study. The significant outcomes, including the Piper Fatigue Scale-12 (PFS-12), the Scored Patient-Generated Subjective Global Assessment (PG-SGA), four body composition indices, and the Hospital Anxiety and Depression Scale (HADS), were assessed weekly from pre-treatment until the completion of radiotherapy (T0-T7) to explore their relationship. RESULTS: The trajectories of PFS-12 and all dimensions for 105 participants reached a peak during the fifth week. Sensory fatigue consistently received the highest scores (T0 = 1.60 ± 2.20, T5 = 6.15 ± 1.57), whereas behavior fatigue exhibited the fastest increase over time (T0 = 1.11 ± 1.86, T5 = 5.47 ± 1.70). Higher PG-SGA scores were found to be weakly explainable for aggravating fatigue (ß = 0.02 ~ 0.04). Unlike generalized additive mixed models, marginal structural models (MSM) produced larger effect values (ß = 0.12 ~ 0.21). Additionally, body composition indices showed weakly negative relationships with fatigue in MSMs one week in advance. CONCLUSIONS: The PG-SGA may be a more accurate predictor of future-week fatigue than individual body composition indicators, particularly when HADS is controlled for as a time-dependent confounder.

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.