Fatigued Cancer Patients Might Benefit From Specialized Counseling

Ruzanna Harutyunyan's picture
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Addressing the psychological, social and behavioral aspects of fatigue during active cancer treatment is “a promising type of intervention,” according to a new systematic review.

Fatigue is one of the most common complaints among people with cancer, and the problem could arise from a complex blend of biological, psychological and behavioral factors.

The review authors, led by Martine Goedendorp, Ph.D., of Radboud University in the Netherlands, analyzed 27 randomized controlled studies. Among these were five studies in which cancer patients received psychosocial treatments that specifically focused on fatigue. The counseling sessions included topics such as understanding fatigue, self-care techniques and activity management.

Because of the small number of studies, the authors could not identify which elements are essential to successful treatment, Goedendorp said.

The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The new review comprises 3,324 adult cancer patients who participated in at least two psychosocial treatment sessions. People with various stages of breast cancer were the focus of 11 studies. The remaining studies included patients with prostate cancer, melanomas, metastatic kidney tumors or various malignancies. The quality of the studies generally was moderate, according to the reviewers.

Twenty-two studies did not focus on fatigue specifically, but rather on broader topics such as symptoms and side effects, depression and anxiety, or quality of life. “Our results showed that psychosocial interventions that were not specifically aimed at fatigue are rarely effective,” Goedendorp said.

In the five studies that focused on fatigue, the interventions consisted of three sessions up to 60 minutes each. All participants learned about fatigue and self-care or coping techniques, and learned how to balance periods of activity and rest.

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The review authors noted some weaknesses in this group of studies. Two revealed a short-term improvement in fatigue, but could not confirm the effect later on. In addition, in the studies where more than one method was used to measure fatigue, the benefits of treatment were not always apparent.

“Even small improvements in fatigue or the ability to cope with it may be associated with decreased suffering and increased quality of life” among cancer patients, said Michael Weitzner, M.D., in a Web cast from the American Psychosocial Oncology Society.

The review authors recommend that clinicians monitor fatigue in cancer patients more frequently and carefully. Steven Passik, Ph.D., a clinical psychologist at Memorial Sloan-Kettering Cancer Center, concurred.

“Patients think that if nobody asks about their fatigue, then it’s ‘just natural,’ and they should accept it,” he said. An important first step is for physicians to identify and treat any underlying physical causes for chronic exhaustion such as anemia or thyroid problems.

After addressing physiological issues, Passik has found that patients have a strong preference for drug-free approaches to improving their energy levels.

“Psychosocial interventions don’t have a lot of side effects, so the door is wide open even if there isn’t a huge database behind them,” he added.

The reviewers note that eight additional studies currently are recruiting patients to participate in psychosocial treatments for fatigue and other cancer-related symptoms. These studies will evaluate cognitive behavior therapy, fatigue support groups, relaxation techniques, various forms of yoga and traditional Chinese qigong.

“One of the single biggest problems we have with studying and managing fatigue is that it’s so multifactorial,” Passik said.

Future studies of psychosocial approaches might recruit participants based on the cause of their fatigue, rather than on the type of cancer or cancer treatment. “If you selected a group whose fatigue was really a result of psychological processes, those people would probably benefit in spades,” he said.

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