Exercise and psychological counseling could ease cancer-related fatigue

October 23, 2007

Cancer patients suffering from symptoms of fatigue might find some relief through regular exercise and psychological counseling to deal with stress, according to a new review.

Fatigue is one of the most common symptoms of patients with cancer and those undergoing treatment with radiation and chemotherapy. According to the American Cancer Society, 90 percent of patients in cancer treatment experience fatigue that can range from "mild lethargy to feeling completely wiped out."

The reviewers, led by Paul Jacobsen of the H. Lee Moffitt Cancer Center in Tampa, Fla., said that fatigue affects patients' quality of life, with one-third feeling that it, "interferes with their ability to work, relationships with others and physical and emotional well-being."

There has been growing interest in helping these patients manage the symptoms of exhaustion with nonpharmacological treatments, and the systematic review aimed to determine the effectiveness of psychological therapy and exercise in meeting the goal.

The review appears in the November issue of the journal Health Psychology. Each evidence-based review in this series centers on a specific psychological assessment or treatment conducted in the context of a physical disease process or risk reduction effort.

The reviewers evaluated 41 studies. Of these, 17 looked at activity-based interventions in which patients either performed supervised or home-based exercises three to five times a week, for exercise periods that ranged from 10 to 26 weeks. Some of these studies included patients undergoing or about to start cancer treatment, while others were comprised only patients who had completed treatment.

Twenty-four studies evaluated psychological interventions. There were a variety of types of interventions, including techniques such as weekly telephone counseling about how to conserve energy and group therapy to teach skills like stress management and relaxation training.

About half of the studies focused on patients who had breast cancer, while others included patients with more than one type of cancer, such as colorectal and prostate.

Jacobsen and his colleagues found that 44 percent of the activity-based trials and 50 percent of the psychological studies that were of good quality reported significant, if not earth shattering, results. Patients who received either of the two types of interventions reported less fatigue than patients in the control groups did, the researchers concluded.

"The overall effects of both psychological and activity-based interventions on fatigue were modest," Jacobsen said. "The effects of psychological interventions were sufficiently large, however, to say that they were unlikely to have occurred by chance alone using conventional definitions of statistical significance."

Jacobsen concluded the results only provide "limited support" for the use of these types of nonpharmacological treatments to manage cancer fatigue.

Steven Passik, associate attending psychologist at the Memorial Sloan-Kettering Cancer Center, said that although there is currently limited research that interventions such as counseling or exercise have a strong benefit on fatigue, patients prefer to try these methods rather than take more medications.

"Some of the main barriers of managing cancer fatigue have proven to be a lack of communication from health care providers to patients about how to battle fatigue, as well as an overall reluctance of many patients to take any more drugs to treat the symptom," Passik said. "So, more research like this study is needed to find what types of interventions work best for patients."

Jacobsen added that if cancer patients do choose to exercise during their treatments, they should take caution.

"Patients should consult with their physicians before initiating an exercise regimen," he said. "They should also let their physician know if they plan to continue to engage in regular exercise while undergoing taxing treatments like chemotherapy."
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FOR MORE INFORMATION

Health Behavior News Service: Lisa Esposito, editor at (202) 387-2829 or www.hbns.org

"Evidence-based Treatment Reviews" is a series within Health Psychology, an official journal of the American Psychological Association. This series of articles is intended to inform health psychology practice, add to teaching and mentoring resources and inspire further evidence-based research and questions. For more information, contact editors Karina Davidson (kd2124@columbia.edu) and Timothy Smith (tim.smith@psych.utah.edu)

Jacobsen P, et al. Systematic review and metal-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychology 26(6), 2007.

Center for Advancing Health

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