Article
Fatigue and Physical Activity in Older Patients With Cancer: A Six-Month Follow-Up Study
Purpose/Objectives: To determine the relationship between fatigue and physical activity in older patients with cancer.
Design: Targeted analysis using data from a prospective longitudinal study.
Setting: A cancer care facility in southeastern Ontario, Canada.
Sample: 440 patients, aged 65 years and older, seeking consultation for cancer treatment at a regional cancer clinic for lymphoma or leukemia or lung, breast, genitourinary, head or neck, gastrointestinal, or skin cancers.
Methods: Self-report questionnaires were mailed to consenting participants and completed at baseline and three and six months after consultation for cancer treatment.
Main Research Variables: Participants rated fatigue and physical activity and reported comorbidities and personal demographic characteristics. Clinical measures of disease and treatment factors were obtained through chart abstraction.
Findings: Fatigue was the most prevalent symptom reported. Higher fatigue was associated with lower physical activity levels. Physical activity level significantly predicted fatigue level, regardless of age.
Conclusions: Physical activity level is a modifiable factor significantly predicting cancer-related fatigue at three and six months following consultation for cancer treatment. The results suggest that physical activity may reduce fatigue in older patients with cancer.
Implications for Nursing: Physical activity interventions should be developed and tested in older patients with cancer.
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Ahlberg, K., Ekman, T., Gaston-Johansson, F., & Mock, V. (2003). Assessment and management of cancer-related fatigue in adults. Lancet, 362(9384), 640-650.
Andrykowski, M. A., Curran, S. L., & Lightner, R. (1998). Off-treatment fatigue in breast cancer survivors: A controlled comparison. Journal of Behavioral Medicine, 21(1), 1-18.
Berger, A. M. (1998). Patterns of fatigue, activity and rest during adjuvant breast chemotherapy. Oncology Nursing Forum, 25(1), 51-62.
Bower, J. E., Ganz, P. A., Desmond, K. A., Bernaards, C., Rowland, J. H., Meyerowitz, B. E., et al. (2006). Fatigue in long-term breast carcinoma survivors: A longitudinal investigation. Cancer, 106(4), 751-758.
Bower, J. E., Ganz, P. A., Desmond, K. A., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18(4), 743-753.
Broeckel, J. A., Jacobsen, P. B., Horton, J., Balducci, L., & Lyman, G. H. (1998). Characteristics and correlates of fatigue after adjuvant chemotherapy. Journal of Clinical Oncology, 16(5), 1689-1696.
Bultmann, U., Kant, I. J., Kasl, S. V., Schroer, K. A., Swaen, G. M., & van den Brandt, P. A. (2002). Lifestyle factors as risk factors for fatigue and psychological distress in the working population: Prospective results from the Maastricht Cohort Study. Journal of Occupational and Environmental Medicine, 44(2), 116-124.
Burnham, T. R., & Wilcox, A. (2002). Effects of exercise on physiological and psychological variables in cancer survivors. Medicine and Science in Sports and Exercise, 34(12), 1863-1867.
Camarillo, M. A. (1991). The oncology patient's experience of fatigue. Quality of Life—A Nursing Challenge, 1(1), 39-44.
Canadian Cancer Society/National Cancer Institute of Canada. (2008). Canadian cancer statistics 2008. Toronto, Canada: Author.
Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Reports, 100(2), 126-131.
Cimprich, B. (1999). Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nursing, 22(3), 185-194.
Courneya, K. S., & Friedenreich, C. M. (1997). Relationship between exercise during treatment and current quality of life among survivors of breast cancer. Journal of Psychosocial Oncology, 15(3/4), 35-57.
Curtis, E. B., Krech, R., & Walsh, T. D. (1991). Common symptoms in patients with advanced cancer. Journal of Palliative Care, 7(2), 25-29.
Dagnelie, P. C., Pijls-Johannesma, M. C., Lambin, P., Beijer, S., DeRuysscher, D., & Kempen, G. I. (2007). Impact of fatigue on overall quality of life in lung and breast cancer patients selected for high-dose radiotherapy. Annals of Oncology, 18(5), 940-944.
de Jong, N., Candel, M. J., Schouten, H. C., Abu-Saad, H. H., & Courtens, A. M. (2006). Course of the fatigue dimension "activity level" and the interference of fatigue with daily living activities for patients with breast cancer. Cancer Nursing, 29(5), E1-E13.
de Jong, N., Courtens, A. M., Abu-Saad, H. H., & Schouten, H. C. (2002). Fatigue in patients with breast cancer receiving adjuvant chemotherapy: A review of the literature. Cancer Nursing, 25(4), 283-297.
Dimeo, F. C. (2001). Effects of exercise on cancer-related fatigue. Cancer, 92(6, Suppl.), 1689-1693.
Dimeo, F. C., Stieglitz, R. D., Novelli-Fischer, U., Fetscher, S., & Keul, J. (1999). Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer, 85(10), 2273-2277.
Donovan, H. S., & Ward, S. (2005). Representations of fatigue in women receiving chemotherapy for gynecologic cancers. Oncology Nursing Forum, 32(1), 113-116.
Duthie, E. H. (2004). Physiology of aging: Relevance to symptoms, perceptions, and treatment tolerance. In L. Balducci, G. H. Lyman, W. B. Ershler, & M. Extermann (Eds.), Comprehensive geriatric oncology (2nd ed., pp. 207-222). New York: Taylor and Francis.
Esbensen, B. A., Osterlind, K., & Hallberg, I. R. (2006). Quality of life of elderly persons with cancer: A three-month follow-up. Cancer Nursing, 29(3), 214-224.
Ferrell, B. R., Grant, M., Dean, G. E., Funk, B., & Ly, J. (1996). "Bone tired": The experience of fatigue and its impact on quality of life. Oncology Nursing Forum, 23(10), 1539-1547.
Galvao, D. A., & Newton, R. U. (2005). Review of exercise intervention studies in cancer patients. Journal of Clinical Oncology, 23(4), 899-909.
Given, C. W., Given, B., Azzouz, F., Kozachik, S., & Stommel, M. (2001). Predictors of pain and fatigue in the year following diagnosis among elderly cancer patients. Journal of Pain and Symptom Management, 21(6), 456-466.
Glaus, A. (1993). Assessment of fatigue in cancer and noncancer patients and in healthy individuals. Supportive Care in Cancer, 1(6), 305-315.
Groll, D. L., Heyland, D. K., Caeser, M., & Wright, J. G. (2006). Assessment of long-term physical function in acute respiratory distress syndrome (ARDS) patients: Comparison of the Charlson Comorbidity Index and the Functional Comorbidity Index. American Journal of Physical Medicine and Rehabilitation, 85(7), 574-581.
Groll, D. L., To, T., Bombardier, C., & Wright, J. G. (2005). The development of a comorbidity index with physical function as the outcome. Journal of Clinical Epidemiology, 58(6), 595-602.
Harada, N. D., Chiu, V., King, A. C., & Stewart, A. L. (2001). An evaluation of three self-reported physical activity instruments for older adults. Medicine and Science in Sports and Exercise, 33(6), 962-970.
Headley, J. A. (1997). Chemotherapy-induced ovarian failure in women with breast cancer. Dissertation Abstracts International, 58, 4139.
Hotopf, M. (2004). Definitions, epidemiology, and models of fatigue in the general population and in cancer. In J. Armes, M. Krishnasamy, & I. J. Higginson (Eds.), Fatigue in cancer (pp. 3-27). New York: Oxford University Press.
Hutchins, L. F., Unger, J. M., Crowley, J. J., Coltman, C. A., & Albain, K. S. (1999). Under-representation of patients 65 years of age or older in cancer-treatment trials. New England Journal of Medicine, 341(27), 2061-2067.
Irvine, D., Vincent, L., Graydon, J. E., Bubela, N., & Thompson, L. (1994). The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy: A comparison with the fatigue experienced by healthy individuals. Cancer Nursing, 17(5), 367-378.
Irvine, D. M., Vincent, L., Bubela, N., Thompson, L., & Graydon, J. (1991). A critical appraisal of the research literature investigating fatigue in the individual with cancer. Cancer Nursing, 14(4), 188-199.
Irwin, M. L., Crumley, D., McTiernan, A., Bernstein, L., Baumgartner, R., Gilliland, F. D., et al. (2003). Physical activity levels before and after a diagnosis of breast carcinoma: The health, eating, activity and lifestyle (HEAL) study. Cancer, 97(7), 1746-1757.
Jacobsen, P. B., & Stein, K. (1999). Is fatigue a long-term side effect of breast cancer treatment? Cancer Control, 6(3), 256-263.
Janda, M., Gerstner, N., Obermair, A., Fuerst, A., Wachter, S., Dieckmann, K., et al. (2000). Quality-of-life changes during conformal radiation therapy for prostate carcinoma. Cancer, 89(6), 1322-1328.
Jean-Pierre, P., Figueroa-Moseley, C. D., Kohli, S., Fiscella, K., Palesh, O. G., & Morrow, G. R. (2007). Assessment of cancer-related fatigue: Implications for clinical diagnosis and treatment. Oncologist, 12(Suppl. 1), 11-21.
Kenefick, A. L. (2006). Patterns of symptom distress in older women after surgical treatment for breast cancer. Oncology Nursing Forum, 33(2), 327-335.
Knols, R., Aaronson, N. K., Uebelhart, D., Fransen, J., & Aufdemkampe, G. (2005). Physical exercise in cancer patients during and after medical treatment: A systematic review of randomized and controlled clinical trials. Journal of Clinical Oncology, 23(16), 3830-3842.
Kurtz, M. E., Kurtz, J. C., Stommel, M., Given, C. W., & Given, B. (1999). The influence of symptoms, age, comorbidity, and cancer site on physical functioning and mental health of geriatric women patients. Women and Health, 29(3), 1-12.
Lawrence, D. P., Kupelnick, B., Miller, K., Devine, D., & Lau, J. (2004). Evidence report on the occurrence, assessment, and treatment of fatigue in cancer patients. Journal of the National Cancer Institute. Monographs, 32, 40-50.
Loge, J. H., Abrahamsen, A. F., Ekeberg, O., & Kaasa, S. (1999). Hodgkin disease survivors more fatigued than the general population. Journal of Clinical Oncology, 17(1), 253-261.
Loge, J. H., Abrahamsen, A. F., Ekeberg, O., & Kaasa, S. (2000). Fatigue and psychiatric morbidity among Hodgkin disease survivors. Journal of Pain and Symptom Management, 19(2), 91-99.
Luctkar-Flude, M. F., Groll, D., Tranmer, J. E., & Woodend, K. (2007). Fatigue and physical activity in older adults with cancer: A systematic review of the literature. Cancer Nursing, 30(5), E35-E45.
Mast, M. (1998). Correlates of fatigue in survivors of breast cancer. Cancer Nursing, 21(2), 136-142.
McMillan, S. C., & Weitzner, M. A. (2003). Methodologic issues in collecting data from debilitated patients with cancer near the end of life. Oncology Nursing Forum, 30(1), 123-129.
McNeely, M. L., Campbell, K. L., Rowe, B. H., Klassen, T. P., Mackey, J. R., & Courneya, K. S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. Canadian Medical Association Journal, 175(1), 34-41.
Mitchell, S. A., Beck, S. L., Hood, L. E., Moore, K., & Tanner, E. R. (2007). Putting Evidence Into Practice®: Evidence-based interventions for fatigue during and following cancer and its treatment. Clinical Journal of Oncology Nursing, 11(1), 99-113.
Mitka, M. (2003). Too few older patients in cancer trials: Expert says disparity affects research results and care. JAMA, 290(1), 27-28.
Mock, V. (2001). Fatigue management: Evidence and guidelines for practice. Cancer, 92(6, Suppl.), 1699-1707.
Mock, V., Hassey Dow, K., Meares, C. J., Grimm, P. M., Dienemann, J. A., Haisfield-Wolfe, M. E., et al. (1997). Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncology Nursing Forum, 24(6), 991-1000.
Mock, V., McCorkle, R., & Krumm, S. (2003). Clinical excellence through evidence-based practice: Fatigue management as a model. Oncology Nursing Forum, 30(5), 787-796.
Morrow, G. R., Andrews, P. L., Hickok, J. T., Roscoe, J. A., & Matteson, S. (2002). Fatigue associated with cancer and its treatment. Supportive Care in Cancer, 10(5), 389-398.
Moser, D. K., Dracup, K., & Doering, L. V. (2000). Factors differentiating dropouts from completers in a longitudinal, multicenter clinical trial. Nursing Research, 49(2), 109-116.
Mostert, S., & Kesselring, J. (2002). Effects of a short-term exercise training program on aerobic fitness, fatigue, health perception, and activity level of subjects with multiple sclerosis. Multiple Sclerosis, 8(2), 161-168.
Nail, L. M., & Jones, L. S. (1995). Fatigue as a side effect of cancer treatment: Impact on quality of life. Quality of Life—A Nursing Challenge, 4(1), 8-13.
National Comprehensive Cancer Network. (2003). Clinical Practice Guidelines in Oncology™: Cancer-related fatigue. Journal of the National Comprehensive Cancer Network, 1(3), 308-331.
Neumark, D. E., Stommel, M., Given, C. W., & Given, B. A. (2001). Research design and subject characteristics predicting nonparticipation in a panel survey of older families with cancer. Nursing Research, 50(6), 363-368.
Norman, G. R., & Streiner, D. L. (2000). Biostatistics: The bare essentials. Hamilton, Canada: B. C. Decker.
Oldervoll, L. M., Kaasa, S., Knobel, H., & Loge, J. H. (2003). Exercise reduces fatigue in chronic fatigued Hodgkin disease survivors—Results from a pilot study. European Journal of Cancer, 39(1), 57-63.
Payne, J. K. (2002). The trajectory of fatigue in adult patients with breast and ovarian cancer receiving chemotherapy. Oncology Nursing Forum, 29(9), 1334-1340.
Pedersen, B. K., & Saltin, B. (2006). Evidence for prescribing exercise as therapy in chronic disease. Scandinavian Journal of Medicine and Science in Sports, 16(Suppl. 1), 3-63.
Penedo, F. J., Schneiderman, N., Dahn, J. R., & Gonzalez, J. S. (2004). Physical activity interventions in the elderly: Cancer and comorbidity. Cancer Investigation, 22(1), 51-67.
Portenoy, R. K., & Itri, L. M. (1999). Cancer-related fatigue: Guidelines for evaluation and management. Oncologist, 4(1), 1-10.
Portenoy, R. K., Thaler, H. T., Kornblith, A. B., Lepore, J. M., Friedlander-Klar, H., Kiyasu, E., et al. (1994). The Memorial Symptom Assessment Scale: An instrument for the evaluation of symptom prevalence, characteristics, and distress. European Journal of Cancer, 30A(9), 1326-1336.
Schwartz, A. L. (2000). Daily fatigue patterns and effect of exercise in women with breast cancer. Cancer Practice, 8(1), 16-24.
Sidani, S. (2003). Symptom management. In D. M. Doran (Ed.), Nursing-sensitive outcomes (pp. 115-175). Mississauga, Canada: Jones and Bartlett Publishers Canada.
Skalla, K. A., & Rieger, P. T. (1995). Fatigue. In P. T. Rieger (Ed.), Biotherapy: A comprehensive review (pp. 221-242). Sudbury, MA: Jones and Bartlett.
Stasi, R., Abriani, L., Beccaglia, P., Terzoli, E., & Amadori, S. (2003). Cancer-related fatigue: Evolving concepts in evaluation and treatment. Cancer, 98(9), 1786-1801.
Stone, P., Richards, M., A'Hern, R., & Hardy, J. (2001). Fatigue in patients with cancers of the breast or prostate undergoing radical radiotherapy. Journal of Pain and Symptom Management, 22(6), 1007-1015.
Tavio, M., Milan, I., & Tirelli, U. (2002). Cancer-related fatigue. International Journal of Oncology, 21(5), 1093-1099.
Tranmer, J. E., Heyland, D., Dudgeon, D., Groll, D., Squires-Graham, M., & Coulson, K. (2003). Measuring the symptom experience of seriously ill cancer and noncancer hospitalized patients near the end of life with the Memorial Symptom Assessment Scale. Journal of Pain and Symptom Management, 25(5), 420-429.
Truong, P. T., Berthelet, E., Lee, J. C., Petersen, R., Lim, J. T., Gaul, C. A., et al. (2006). Prospective evaluation of the prevalence and severity of fatigue in patients with prostate cancer undergoing radical-external beam radiotherapy and neoadjuvant hormone therapy. Canadian Journal of Urology, 13(3), 3139-3146.
U. S. Department of Health and Human Services. (1996). Physical activity and health: A report of the Surgeon General (Rep. No. S/N 017-023-00196-5). Atlanta, GA: U. S. Department of Health and Human Services, Centers for Disease Control and Prevention, and National Center for Chronic Disease Prevention and Health Promotion.
Visovsky, C., & Schneider, S. M. (2003). Cancer-related fatigue. Online Journal of Issues in Nursing, 8(3).
Washburn, R. A., & Ficker, J. L. (1999). Physical Activity Scale for the Elderly (PASE): The relationship with activity measured by a portable accelerometer. Journal of Sports Medicine and Physical Fitness, 39(4), 336-340.
Washburn, R. A., McAuley, E., Katula, J., Mihalko, S. L., & Boileau, R. A. (1999). The Physical Activity Scale for the Elderly (PASE): Evidence for validity. Journal of Clinical Epidemiology, 52(7), 643-651.
Washburn, R. A., Smith, K. W., Jette, A. M., & Janney, C. A. (1993). The Physical Activity Scale for the Elderly (PASE): Development and validation. Journal of Clinical Epidemiology, 46(2), 153-162.
Wengstrom, Y., Haggmark, C., Strander, H., & Forsberg, C. (2000). Perceived symptoms and quality of life in women with breast cancer receiving radiation therapy. European Journal of Oncology Nursing, 4(2), 78-88.
Whedon, M., Stearns, D., & Mills, L. E. (1995). Quality of life of long-term adult survivors of autologous bone marrow transplantation. Oncology Nursing Forum, 22(10), 1527-1537.
Yancik, R., Wesley, M. N., Ries, L. A. G., Havlik, R. J., Edwards, B. K., & Yates, J. W. (2001). Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA, 285(7), 885-892.
Yun, Y. H., Kim, S. H., Lee, K. M., Park, S. M., & Kim, Y. M. (2007). Age, sex, and comorbidities were considered in comparing reference data for health-related quality of life in the general and cancer populations. Journal of Clinical Epidemiology, 60(11), 1164-1175.