Uptake of Recommendations for Posttreatment Cancer-Related Fatigue Among Breast Cancer Survivors

Abstract

Background: Physical activity (PA) and psychosocial interventions are recommended management strategies for cancer-related fatigue (CRF). Randomized trials support the use of mind–body techniques, whereas no data show benefit for homeopathy or naturopathy. Methods: We used data from CANTO (ClinicalTrials.gov identifier: NCT01993498), a multicenter, prospective study of stage I–III breast cancer (BC). CRF, evaluated after primary treatment completion using the EORTC QLQ-C30 (global CRF) and QLQ-FA12 (physical, emotional, and cognitive dimensions), served as the independent variable (severe [score of ≥40/100] vs nonsevere). Outcomes of interest were adherence to PA recommendations (≥10 metabolic equivalent of task [MET] h/week [GPAQ-16]) and participation in consultations with a psychologist, psychiatrist, acupuncturist, or other complementary and alternative medicine (CAM) practitioner (homeopath and/or naturopath) after CRF assessment. Multivariable logistic regression examined associations between CRF and outcomes, adjusting for sociodemographic, psychologic, tumor, and treatment characteristics. Results: Among 7,902 women diagnosed from 2012 through 2017, 36.4% reported severe global CRF, and 35.8%, 22.6%, and 14.1% reported severe physical, emotional, and cognitive CRF, respectively. Patients reporting severe global CRF were less likely to adhere to PA recommendations (60.4% vs 66.7%; adjusted odds ratio [aOR], 0.82; 95% CI, 0.71–0.94; P=.004), and slightly more likely to see a psychologist (13.8% vs 7.5%; aOR, 1.29; 95% CI, 1.05–1.58; P=.014), psychiatrist (10.4% vs 5.0%; aOR, 1.39; 95% CI, 1.10–1.76; P=.0064), acupuncturist (9.8% vs 6.5%; aOR, 1.46; 95% CI, 1.17–1.82; P=.0008), or CAM practitioner (12.5% vs 8.2%; aOR, 1.49; 95% CI, 1.23–1.82; P<.0001). There were differences in recommendation uptake by CRF dimension, including that severe physical CRF was associated with lower adherence to PA (aOR, 0.74; 95% CI, 0.63–0.86; P=.0001) and severe emotional CRF was associated with higher likelihood of psychologic consultations (aOR, 1.37; 95% CI, 1.06–1.79; P=.017). Conclusions: Uptake of recommendations to improve CRF, including adequate PA and use of psychosocial services, seemed suboptimal among patients with early-stage BC, whereas there was a nonnegligible interest in homeopathy and naturopathy. Findings of this large study indicate the need to implement recommendations for managing CRF in clinical practice.

Long-Term Longitudinal Patterns of Patient-Reported Fatigue After Breast Cancer: A Group-Based Trajectory Analysis

“… 23 Substantial evidence shows that long and late effects of cancer treatment are often underaddressed. 24 Therefore, in recent years, the concept of personalized survivorship care has emerged. This concept implies patient stratification on the basis of understanding longitudinal determinants of long‐term and late effects and the development of appropriate care pathways to allow tailored care.…”

Adaptação transcultural e validade de conteúdo do Multidimensional Fatigue Inventory–10 para o português do Brasil

“…Como contribuição, a adaptação transcultural do MFI-10 favorece a assistência de enfermagem na identificação precoce de fadiga em pacientes oncológicos, indicando possíveis alterações passíveis de intervenções direcionadas ao alívio e/ou para redução dos sintomas. Considera-se que a identificação da fadiga e a definição dos possíveis fatores relacionados são preponderantes para o julgamento clínico e a tomada de decisão no cuidado aos pacientes oncológicos [25][26][27][28] Cabe mencionar que o CVC, utilizado na presente investigação para avaliar as evidências de validade relacionadas ao conteúdo, é uma das etapas inerentes à adaptação transcultural. Nesse processo, também cabe avaliar a validade de construto e critério, bem como índices de confiabilidade, verificado com frequência pela estabilidade (realização do teste-reteste), pela consistência interna (para avaliar a homogeneidade) e pela equivalência (para avaliar a confiabilidade interavaliadores) 20,21,29 .…”

The Future of Breast Cancer Research in the Survivorship Field

“…Finally, data from randomized clinical trials support a potential role of acupuncture in relieving CRF [46][47][48][49]. Despite availability of interventions targeting CRF, several barriers, including limited awareness of healthcare professionals and lack of resources and reimbursement for supportive care interventions [50,51], significantly hamper their implementation in routine clinical practice [52].…”