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 During treatment, relaxation practices had the strongest
fatigue-reducing effect, but after cancer treatments are complete,
yoga provided the biggest benefit.
“During and after cancer therapy, fatigue is one of the most
frequent and distressing symptoms,” said lead author Richard
Hilfiker of the University of Applied Sciences and Arts Western
Switzerland Valais in Leukerbad.
Cancer-related fatigue is considered a “distressing, persistent,
subjective sense of physical, emotional, or cognitive tiredness or
exhaustion related to cancer or cancer treatment that is not
proportional to recent activity and interferes with usual
functioning,” the authors write in British Journal of Sports
Medicine.
Depending on the types of cancer patients have and the treatments
they receive, more than a quarter experience this kind of severe
fatigue, and it can last for five years or more after treatment, the
study team writes.
“Although there is a huge amount of scientific literature on this
topic, it remains one of the symptoms for which cancer patients
express high unmet supportive care needs,” Hilfiker told Reuters
Health by email. “It seems the available research is not yet fully
implemented in clinical practice.”
The researchers reviewed 245 studies published between 1989 and 2017
that evaluated non-pharmaceutical interventions to reduce
cancer-related fatigue during chemotherapy and radiotherapy or
afterward. More than half of the studies involved women with breast
cancer.
The analysis focused on conventional physiotherapy-related
interventions such as movement therapy, relaxation, massage, yoga
and Tai Chi and excluded trials that investigated nutritional
supplements, acupuncture, acupressure, Reiki healing and expressive
writing.
Hilfiker and colleagues found that during cancer treatment,
relaxation exercises such as meditation and stretching were the most
effective, followed by massage, combined exercise and
cognitive-behavioral therapy, and combined aerobic and resistance
training. Healing touch, dance, music, Tai-Chi, and
cognitive-behavioral therapy alone landed at the bottom of the list.
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After cancer treatment, yoga was the most effective, followed by
breathing exercises, combined aerobic and resistance training, dance
and combined exercise and cognitive-behavioral therapy. At the
bottom of the list, massage, relaxation, resistance exercise alone,
aerobic exercise alone and cognitive-behavioral therapy alone were
less effective.
“Relaxation seems to be an important part during cancer treatment,”
Hilfiker said. “This might be very important for patients who are
not motivated or not able to engage in more demanding physical
activities.”
The next step is to look at the intensity, frequency and volume of
exercise to understand what to recommend to patients, said Leorey
Saligan, a principal investigator in the Symptom Management Branch
of the National Institute of Nursing Research in Bethesda, Maryland.
“There’s been a big shift in the paradigm, especially in oncology
research, in looking at treatments for patients,” Saligan, who
wasn’t involved with this study, told Reuters Health. “This
information can empower patients because they know they have
options.”
Saligan is researching cancer-related fatigue and interventions from
a biological perspective, aiming to understand what happens in the
body to reduce the fatigue. If specific types of patients respond to
specific types of therapies, doctors may be able to better recommend
options to their patients.
“If we can predict which patients are at risk for fatigue based on
their biological makeup, we can plan their interventions way ahead
of time,” Saligan said. “We can now tell patients to go out and
exercise, and next we want to be able to tell them how long, how
often and how fast.”
SOURCE: http://bit.ly/2r0diiZ British Journal of Sports Medicine,
online May 13, 2017.
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