Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0043-1766134
Effectiveness of Structured Exercise Intervention in Cancer-Related Fatigue among Oral Cavity Cancer Patients: Randomized Controlled Trial
![](https://www.thieme-connect.de/media/10.1055-s-00050348/202403/lookinside/thumbnails/10-1055-s-0043-1766134_221970863-1.jpg)
Abstract
Introduction In head and neck cancer (HNC) patients, fatigue is present throughout the course of treatment and during follow-up. Cancer-related fatigue (CRF) is a significant treatment-related side effect experienced by oral cancer patients during and after treatment. CRF, when coupled with other side effects of oral cavity cancer, patients who undergo definitive treatment have some of the most dramatic acute side effects, and reduced overall quality of life (QoL). Although there are upcoming intervention strategies to manage CRF, the effect of exercise intervention is explored in this study. The rationale for considering exercise to manage CRF is that it may alleviate the combined effect of toxic treatment and decreased levels of activity during the treatment that reduces the capacity for physical performance.
Objective This study was conducted to investigate the effectiveness of exercise intervention on CRF, and its influence on functional capacity and QoL among patients with oral cavity cancer during and after their primary cancer treatment.
Materials and Methods Oral cavity cancer patients (n = 223), planned for only chemoradiotherapy with curative intent were screened for CRF. Based on the inclusion criteria, 69 patients were grouped randomly into experimental (n = 35) and control (n = 34) groups. Patients in the experimental group were provided structured exercise intervention, while the control group was offered standard and routine care. Structured exercise in this present study comprised moderate-intensity walking and resistance exercises using TheraBand every day for three to five times a week. CRF was assessed using symbolic assessment of fatigue extent and the functional capacity was assessed by 6-minute walk test (6MWT), maximal oxygen uptake (VO2max), and hand dynamometer. QoL was assessed using the European Organization for Research and Treatment for Cancer-QoL (EORTC QLQ-C30) and the Head and Neck Cancer module (HN35), while distress was assessed by the National Comprehensive Cancer Network (NCCN) Distress Thermometer. Randomized patients were assessed at four points.
Result The size effects in fatigue extent (ηp 2 = 0.40) and fatigue impact (ηp 2 = 0.41) were found to be moderate, and a positive correlation between 6MWT, fatigue extent, and fatigue impact was observed.
Conclusion This study suggests that exercise intervention has a significant positive impact on CRF, most aspects of QoL, and the functional capacity of the patients.
Keywords
cancer rehabilitation - cancer-related fatigue - exercise intervention - functional capacity - oral cavity cancer - quality of lifeEthical Approval
The approval for the project was submitted to the Cancer Institute Ethical Committee. This study followed the principles of the Declaration of Helsinki and was approved by the ethical committee meeting dated February 13, 2013. The study was conducted at the Regional Cancer Centre, Chennai.
Publication History
Article published online:
17 May 2023
© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Sung H, Ferlay J, Siegel RL. et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (03) 209-249
- 2 Bossi P, Di Pede P, Guglielmo M. et al. Prevalence of fatigue in head and neck cancer survivors. Ann Otol Rhinol Laryngol 2019; 128 (05) 413-419
- 3 Brown JC, Huedo-Medina TB, Pescatello LS. et al. The efficacy of exercise in reducing depressive symptoms among cancer survivors: a meta-analysis. PLoS One 2012; 7 (01) e30955
- 4 Berger AM, Abernethy AP, Atkinson A. et al. NCCN clinical practice guidelines cancer-related fatigue. J Natl Compr Canc Netw 2010; 8 (08) 904-931
- 5 Curt GA, Breitbart W, Cella D. et al. Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition. Oncologist 2000; 5 (05) 353-360
- 6 Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist 2007; 12 (suppl 1): 4-10
- 7 Satish MS, Vidhubala E. The prevalence of cancer-related fatigue: a review. J Indian Acad Appl Psychol 2022; 48 (02) 375-397
- 8 Janaki MG, Kadam AR, Mukesh S. et al. Magnitude of fatigue in cancer patients receiving radiotherapy and its short term effect on quality of life. J Cancer Res Ther 2010; 6 (01) 22-26
- 9 Posner MR, Hershock DM, Blajman CR. et al; TAX 324 Study Group. Cisplatin and fluorouracil alone or with docetaxel in head and neck cancer. N Engl J Med 2007; 357 (17) 1705-1715
- 10 Vermorken JB, Remenar E, van Herpen C. et al; EORTC 24971/TAX 323 Study Group. Cisplatin, fluorouracil, and docetaxel in unresectable head and neck cancer. N Engl J Med 2007; 357 (17) 1695-1704
- 11 Twomey R, Martin T, Temesi J, Culos-Reed SN, Millet GY. Tailored exercise interventions to reduce fatigue in cancer survivors: study protocol of a randomized controlled trial. BMC Cancer 2018; 18 (01) 757
- 12 Segal RJ, Reid RD, Courneya KS. et al. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 2003; 21 (09) 1653-1659
- 13 Mustian KM, Peppone L, Darling TV, Palesh O, Heckler CE, Morrow GR. A 4-week home-based aerobic and resistance exercise program during radiation therapy: a pilot randomized clinical trial. J Support Oncol 2009; 7 (05) 158-167
- 14 Jeyaram S, Veeraiah S, Elangovan V. Validation of the symbolic assessment of fatigue extent (SAFE)-a cancer fatigue tool with visual response formats. Support Care Cancer 2017; 25 (04) 1111-1119
- 15 Hussey C, Gupta A. Exercise interventions to combat cancer-related fatigue in cancer patients undergoing treatment: a review. Cancer Invest 2022; 40 (09) 822-838
- 16 Jarden M, Baadsgaard MT, Hovgaard DJ, Boesen E, Adamsen L. A randomized trial on the effect of a multimodal intervention on physical capacity, functional performance and quality of life in adult patients undergoing allogeneic SCT. Bone Marrow Transplant 2009; 43 (09) 725-737
- 17 Andersen C, Rørth M, Ejlertsen B. et al. The effects of a six-week supervised multimodal exercise intervention during chemotherapy on cancer-related fatigue. Eur J Oncol Nurs 2013; 17 (03) 331-339
- 18 Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. Cancer treatment-induced alterations in muscular fitness and quality of life: the role of exercise training. Ann Oncol 2007; 18 (12) 1957-1962
- 19 Hwang JH, Chang HJ, Shim YH. et al. Effects of supervised exercise therapy in patients receiving radiotherapy for breast cancer. Yonsei Med J 2008; 49 (03) 443-450
- 20 Patel JG, Bhise AR. Effect of aerobic exercise on cancer-related fatigue. Indian J Palliat Care 2017; 23 (04) 355-361
- 21 Truong PT, Gaul CA, McDonald RE. et al. Prospective evaluation of a 12-week walking exercise program and its effect on fatigue in prostate cancer patients undergoing radical external beam radiotherapy. Am J Clin Oncol 2011; 34 (04) 350-355
- 22 Dimeo FC, Stieglitz RD, Novelli-Fischer U, Fetscher S, Keul J. Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer 1999; 85 (10) 2273-2277
- 23 Wiskemann J, Dreger P, Schwerdtfeger R. et al. Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood 2011; 117 (09) 2604-2613
- 24 Clark JE. Diet, exercise or diet with exercise: comparing the effectiveness of treatment options for weight-loss and changes in fitness for adults (18-65 years old) who are overfat, or obese; systematic review and meta-analysis. J Diabetes Metab Disord 2015; 14: 31
- 25 Adamsen L, Quist M, Andersen C. et al. Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ 2009; 339: b3410
- 26 Vardar Yağlı N, Şener G, Arıkan H. et al. Do yoga and aerobic exercise training have impact on functional capacity, fatigue, peripheral muscle strength, and quality of life in breast cancer survivors?. Integr Cancer Ther 2015; 14 (02) 125-132
- 27 Hsieh CC, Sprod LK, Hydock DS, Carter SD, Hayward R, Schneider CM. Effects of a supervised exercise intervention on recovery from treatment regimens in breast cancer survivors. Oncol Nurs Forum 2008; 35 (06) 909-915
- 28 Moonsammy SH, Guglietti CL, Santa Mina D. et al. A pilot study of an exercise & cognitive behavioral therapy intervention for epithelial ovarian cancer patients. J Ovarian Res 2013; 6 (01) 21
- 29 Thorsen L, Skovlund E, Strømme SB, Hornslien K, Dahl AA, Fosså SD. Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy. J Clin Oncol 2005; 23 (10) 2378-2388
- 30 Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol 2003; 21 (09) 1660-1668
- 31 Musanti R. A study of exercise modality and physical self-esteem in breast cancer survivors. Med Sci Sports Exerc 2012; 44 (02) 352-361
- 32 Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A. Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol 2007; 25 (13) 1713-1721
- 33 Neil-Sztramko SE, Kirkham AA, Hung SH, Niksirat N, Nishikawa K, Campbell KL. Aerobic capacity and upper limb strength are reduced in women diagnosed with breast cancer: a systematic review. J Physiother 2014; 60 (04) 189-200
- 34 Coleman EA, Coon SK, Kennedy RL. et al. Effects of exercise in combination with epoetin alfa during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for multiple myeloma. Oncol Nurs Forum 2008; 35 (03) E53-E61
- 35 Samuel SR, Maiya GA, Babu AS, Vidyasagar MS. Effect of exercise training on functional capacity & quality of life in head & neck cancer patients receiving chemoradiotherapy. Indian J Med Res 2013; 137 (03) 515-520
- 36 Hoffman AJ, Brintnall RA, von Eye A. et al. A rehabilitation program for lung cancer patients during postthoracotomy chemotherapy. OncoTargets Ther 2014; 7: 415-423
- 37 Jones LW, Courneya KS, Mackey JR. et al. Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. J Clin Oncol 2012; 30 (20) 2530-2537
- 38 Mock V, Frangakis C, Davidson NE. et al. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psychooncology 2005; 14 (06) 464-477
- 39 Bourke L, Thompson G, Gibson DJ. et al. Pragmatic lifestyle intervention in patients recovering from colon cancer: a randomized controlled pilot study. Arch Phys Med Rehabil 2011; 92 (05) 749-755
- 40 Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Supervised exercise reduces cancer-related fatigue: a systematic review. J Physiother 2015; 61 (01) 3-9
- 41 Schwartz AL, Thompson JA, Masood N. Interferon-induced fatigue in patients with melanoma: a pilot study of exercise and methylphenidate. Oncol Nurs Forum 2002; 29 (07) E85-E90
- 42 Sprod LK, Hsieh CC, Hayward R, Schneider CM. Three versus six months of exercise training in breast cancer survivors. Breast Cancer Res Treat 2010; 121 (02) 413-419
- 43 Fairey AS, Courneya KS, Field CJ, Bell GJ, Jones LW, Mackey JR. Randomized controlled trial of exercise and blood immune function in postmenopausal breast cancer survivors. J Appl Physiol 2005; 98 (04) 1534-1540
- 44 Jones LW, Eves ND, Peterson BL. et al. Safety and feasibility of aerobic training on cardiopulmonary function and quality of life in postsurgical nonsmall cell lung cancer patients: a pilot study. Cancer 2008; 113 (12) 3430-3439
- 45 Zaleska M, Olszewski WL, Jain P. et al. Pressures and timing of intermittent pneumatic compression devices for efficient tissue fluid and lymph flow in limbs with lymphedema. Lymphat Res Biol 2013; 11 (04) 227-232