Cancer-related fatigue (CRF) is a pervasive component of the cancer spectrum that affects patients before, during, and after treatment. For example, as many as 90% of patients who have had a bone marrow transplant or some type of chemotherapy cope with CRF, and the syndrome affects up to 65% of patients undergoing radiation therapy.1 According to the National Comprehensive Cancer Network (NCCN), “Fatigue is by far the most common—and for many the most distressing—symptom affecting people with cancer. At its worst, cancer-related fatigue is a draining, unrelenting exhaustion that impedes the ability to enjoy life and carry out daily activities.”2
EXPLORING HOLISTIC OPTIONS
Oncology clinicians are constantly searching for treatment options that can provide relief for their patients. A number of them are exploring multimodal interventions. One such group investigated the feasibility of using acupuncture combined with holistic education to relieve CRF. The results of their study were published in BMC Complementary and Alternative Medicine.3 The group, at the UCLA Medical School and Center for East-West Medicine, studied breast cancer survivors in a pilot randomized controlled trial. The study was small because the investigators had difficulty recruiting subjects—a challenge the researchers had not anticipated encountering. After attempting several strategies to recruit study participants, the researchers were able to enlist 12 participants: 5 participants for the treatment group and 7 participants for the control group.
The researchers used Integrative Medicine theory to create a protocol comprised of a number of nonpharmacologic modalities for treating the fatigue with a holistic, whole-body approach.4 Eligible study participants were 18 to 65 years (mean age of the participants was 54 years), finished with their primary therapy and free of breast cancer, and experiencing cancer-related fatigue with a score of 4 or greater on the Brief Fatigue Inventory.5 Persons with depression, severe anemia at intake, or severe limitations in physical functioning were excluded; however, persons with other potential causes of fatigue, such as hepatitis or hypothyroidism, were not excluded.
ACUPUNCTURE PLUS WELL-BEING
A strong bond between patient and clinician was essential for the research protocol to be effective. A clinician taught the participants how to enhance their well being with exercise, relaxation techniques, and nutrition and dietary advice in four weekly education sessions.
The treatment group received weekly acupuncture sessions for 8 weeks. The investigators wrote: “… the practitioners oriented patients towards a holistic view of health, built up their self-efficacy through a structured set of progressively challenging mastery experiences, and delivered acupuncture early on to achieve results that would enhance commitment to and confidence in self-care.”3 There were no adverse effects from the acupuncture; there was no bruising, infection, and no incidences of fainting, panic, or disorientation. The control group received standard care. Both patient groups continued to see their personal physicians and receive pharmacologic and nonpharmacologic treatments as before.
The hypothesis proved correct. Fatigue was reduced by 66% among the study participants in the treatment group. The researchers believe that the intervention they used, which included patient education, was more beneficial than a treatment limited to acupuncture alone because effective self-care leads to significantly improved health. The current study was limited by its small sample size. The UCLA group suggests initiating future similar studies while patients are still undergoing treatment to enroll more participants in addition to obtaining input from the treating oncologists. ONA
Bette Kaplan is a medical writer based in Tenafly, New Jersey.
1. Stone P. The measurement, causes and effective management of cancer-related fatigue. Int J Palliat Nurs. 2002;8(3):120-128.
2. Fighting cancer fatigue. National Comprehensive Cancer Network Web site. http://www.nccn.com/life-after-cancer/91-fighting-cancer-fatigue.html. Accessed November 2, 2011.
3. Johnston MF, Hays RD, Subramanian SK, et al. Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study. BMC Complement Altern Med. 2011;11:49.
4. Deng G, Weber W, Sood A, Kemper K. Integrative Medicine Research: Context and Priorities. Commissioned for the IOM Summit on Integrative Medicine and the Health of the Public. February 2009. http://help. senate.gov/old_site/Hearings/2009_02_23/Kemper%20Integrative%20Medicine%20Research%20-%20Context%20and%20Priorities.pdf. Accessed November 2, 2011.
5. Mendoza TR, Wang XS, Cleeland CS, et al. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 1999;85(5):1186-1196.