A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRAMMED AEROBIC EXERCISE ON LEVEL OF FATIGUE IN CANCER PATIENTS DURINGEXTERNAL RADIATION SELECTED
SPECIALITY HOSPITAL IN TUMKUR
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
Mr. ERIC PRAKASH
MEDICAL SURGICAL NURSING
Akshaya College of Nursing,
Tumkur, Karnataka.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate : Mr.ERIC PRAKASH
And address M.Sc Nursing, 1st Year
Akshaya College of Nursing,
Tumkur, Karnataka.
2. Name of the Institution : Akshaya College of Nursing
3. Course of Study : M.Sc. Nursing 1st year,
And Subject MEDICAL SURGICAL NURSING
4. Date of Admission to :
Course
5. Title of the Topic :A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRAMMED AEROBIC EXERCISE ON LEVEL OF FATIGUE IN CANCER PATIENTS DURING EXTERNAL RADIATION SELECTED SPECIALITY HOSPITAL IN TUMKUR
6.1. Introduction
Fatigue is one of the most common complaints of people with cancer. Fatigue exists in 14% to 96% of people with cancer, particularly in individuals actively undergoing treatment. Fatigue is difficult to describe and patients express in a variety of ways, using terms such as tired, weak, exhausted, weary, and worn out, fatigued, heavy or slow. Likewise, health professionals struggle to describe fatigue, using terms such as asthenia, fatigue, lassitude, prostration, exercise intolerance, lack of energy, and weakness. (National cancer institute, 2007).
Fatigue is the most common symptom described by patients with cancer, with reports of prevalence ranging from 60% to more than 90%. Studies of side effects of cancer therapy have noted that 80% to 96% of patients receiving chemotherapy experienced fatigue. Reports concerning radiation treatment have also found fatigue to be present in 60-93% of patients (Virender Suhag, Sunita, 2001).
Research has shown that exercise is not only safe and possible during cancer treatment, but it can improve physical functioning and quality of life. Regular exercise is an effective way to counteract the negative effectiveness of inactivity in chronic illness. Too much rest may result in loss of function, strength and range of motion in the person with a chronic illness. As a result, many health care providers are encouraging their patients to be as physically active as possible during cancer treatment (American cancer society, 2007).
Fatigue has negative impact on various aspects of quality of life, so it is imperative to find non-invasive and nonpharmological solutions for managing it. There is little however known as to which techniques can help alleviate fatigue. Physical exercise has been shown to be effective, convenient and a low cost self care method for reducing anxiety and sleep difficulties and increasing adaption during radiation therapy. Programmed aerobic exercise eg (walking) have been suggested for the rehabilitation of cancer patients affected by energy loss but this is not a fully accepted approach as yet. (Aghili, 2002).
Exercise including light- to moderate-intensity walking programs has potential benefits for people with cancer; in terms of improved physical energy, appetite stimulation, and/or enhanced functional capacity. Exercise schedules may result in improvement in quality of life, and improvements in many aspects of psycho logic state such as improved outlook and sense of well being, enhanced sense of commitment, and the ability to meet the challenges of cancer and cancer treatment (Virender Suhag, Sunita, 2001).
6.2. NEED FOR THE STUDY:
Fatigue is one of the most frequent side effects of cancer treatments. Fatigue has been reported by 60% to 100%of patients undergoing treatment for cancer and has been identified as a research priority by the oncology nursing society for a decade. Cancer related to fatigue differs from normal tiredness by its sudden appearance, its over whelming nature, and its refractory response to rest .While oncology nurses are well aware that fatigue is a prevalent complaint in cancer patients, the best way to assess and treat this depilating symptoms is less clear (oncology nursing society 2001,California).
Cancer continues to cut a deadly swath across the globe, with the American Cancer Society reporting 12 million new cases of malignancy diagnosed worldwide in 2007, with 7.6 million people dying from the disease (Health Day News, 2007). The report, global cancer facts and figures finds that 5.4million of those cancers and 2.9 million deaths are in more affluent, developed nations, while 6.7 million new cancer cases and 4.7 million deaths hit people in developing countries (World Health Organization 2007).
Overall, there were 10.9million new cases, 6.7million deaths and 24.6million persons alive with cancer. The most commonly diagnosed cancers are lung (1.35 million), breast (1.15million), and colorectal (1 million). The most common causes of cancer death are lung cancer (1.18 million deaths).The most prevalent cancer in the world is breast cancer (4.4 million) [2005, American cancer society].
Regular aerobic exercise and relaxation can reduce psychological distress and fatigue in patients treated with high dose of chemotherapy with peripheral stem cell transplantation. therefore, exercise can be offered as an intervention to alleviate fatigue in cancer patients .(Dimeo, et al, 1999).A walking training program is easy to use, with out side effects ; it is inexpensive and thus can be used to prevent or manage fatigue in cancer patients undergoing radiation therapy(Aghili,2002).
During the training period the investigator was posted in International Cancer Centre, Neyyoor. Most of cancer patients after radiation therapy complained of fatigue and the investigator found that cancer patients need effective intervention. This created interest in the investigator to conduct a study. Training of programmed aerobic exercises in cancer patient can reduce fatigue. Through this study the investigator aims to reduce the level of fatigue in cancer patients.
6.3. Review of literature
Review of literature aids the researcher to understand what already is known in relation to the problem of interest and what remains to be known. It helps to plan and conduct in a systematic and systematic manner.
A detailed review of literature relating to different aspect of the problem has been undertaken
Here the review of literature is classified as follows:
a) Studies related to cancer related fatigue
b) Studies related to effectiveness of aerobic exercise
a) Studies related to cancer related fatigue
Nijs, Ellen, et al., (2006) conducted a study on Cancer-related fatigue (CRF) is a common symptom in patients treated for cancer. For patients receiving chemotherapy, the prevalence is 75% to 90%; in those receiving radiation, 65%. A search of the medical (PubMed) and nursing (CINAHL) literature (1995 to February 2005) produced 18 studies. In two-thirds of the studies, the populations were breast cancer patients. Half of the studies had a sample size of less then 30 patients. The studies included dealt with sleep promotion (1), instruction and education (5), exercise (10), and distraction and relaxation (2). Significant effectiveness was found in studies promoting exercise. For interventions on sleep promotion and on education and counseling, a positive result was found, but this was not significant. For distraction and relaxation, only an effect until a few hours after the intervention was found. Given the multidimensional nature of CRF, a combination of interventions is most likely to be effective.
Shin shally, et al., (2002) conducted a study to describe fatigue severity, fatigue interference, and associated factors in hematologic malignancies. Patients being treated for leukemia and non-Hodgkin’s lymphoma (n = 228) completed the Brief Fatigue Inventory to rate fatigue severity and functional interference caused by fatigue. Descriptive statistics, bivariate correlation, and logistic regression were used for data analysis. : Fifty percent of the sample reported severe fatigue, which was defined as a "fatigue worst" rating of 7 or greater. More patients with acute leukemia (61%) reported severe fatigue compared with those with chronic leukemia (47%) and non-Hodgkin’s lymphoma (46%). Increased fatigue severity significantly compromised patients’ general activity, work, and enjoyment of life, mood, walking, and relationships with others. Fatigue severity was strongly associated with performance status, use of opioids, blood transfusions, gastrointestinal symptoms, and sleep disturbance items, as well as with low serum hemoglobin and albumin levels.
Stone P., et al., (2003) conducted a study on Cancer-related fatigue - a difference of opinion. Results of a multicentre survey of healthcare professionals, patients and caregivers. It was a cross-sectional survey, the respondents were patients with cancer and a random selection of Health Care Professionals. The response rates for patients, caregivers and HCPs were 42%, 33% and 34% respectively. Fatigue was reported to affect 56% of patients and to have a considerable impact on quality of life. Caregivers also recognized that fatigue was a common problem, with significant effectiveness on patients' quality of life and impact on themselves. Healthcare professionals recognized that fatigue was a common problem for their patients but overestimated its impact on some aspects of patients' daily lives.
David ,Cella, et al., (2001) conducted a study on Cancer-Related Fatigue: Prevalence of Proposed Diagnostic Criteria in a United States Sample of Cancer Survivors Three hundred seventy-nine individuals who had been treated with chemotherapy, either alone or in combination with radiation therapy, were surveyed. Patients were asked background questions about their current condition, their medical history, and the frequency of fatigue during their chemotherapy. Additionally, patients who reported experiencing fatigue at least a few days each month during treatment were asked a series of questions about the impact of fatigue on their daily functioning. Results show that One hundred forty-one (37%) individuals reported at least 2 weeks of fatigue in the previous month. Of the respondents who had received their last treatment more than 5 years ago, 33% still reported at least a 2-week period of fatigue in the month before the interview. Evaluation of the proposed criteria revealed that 17% of respondents met at least two criteria for Cancer Related Fatigue.
Irvine, Diane, et al., (1998) conducted a study on the clinical course and prognosis of fatigue over the course of radiation therapy. Seventy six patients with breast cancer receiving external radiation therapy were followed longitudinally from the onset of treatment to 6 months post-treatment. Fatigue significantly increased over the course of treatment, was highest at the last week of treatment, and returned to pretreatment levels by 3 months after treatment. The most frequently reported self-relief strategies were sit and sleep. Fatigue had a negative impact on the patient's quality of life. Impairment in quality of life was evident by the end of treatment, with improvement by 3 and 6 months after treatment. The second week through to the last week of radiation therapy is critical times to target interventions for the management of fatigue. Self-help strategies focusing on the cessation of activity and increasing rest were reported as successful by patients.
b) Studies related to effectiveness of aerobic exercise:
Margaret, et al., (2007) conducted a study on effectiveness of exercise on breast cancer patients and survivors: a systematic review and meta-analysis here included only randomized controlled trials that examined exercise interventions for breast cancer patients or survivors with quality of life, cardio respiratory fitness or physical functioning as primary outcomes. We also extracted data on symptoms of fatigue, body composition and adverse effectiveness. Results of 136 studies identified, 14 met all the inclusion criteria. Despite significant heterogeneity and relatively small samples, the point estimates in terms of the benefits of exercise for all outcomes were positive even when statistical significance was not achieved. Exercise led to statistically significant improvements in quality of life as assessed by the Functional Assessment of Cancer Therapy–General (weighted mean difference [WMD] 4.58, 95% confidence interval [CI] 0.35 to 8.80) and Functional Assessment of Cancer Therapy–Breast (WMD 6.62, 95% CI 1.21 to 12.03). Exercise also led to significant improvements in physical functioning and peak oxygen consumption and in reducing symptoms of fatigue.
Kerry S. Courneya, et al.,(2006) conducted a study on Effectiveness of Aerobic and Resistance Exercise in Breast Cancer Patients Receiving Adjuvant Chemotherapy. A randomly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care (n = 82), supervised resistance exercise (n = 82), or supervised aerobic exercise (n = 78) for the duration of their chemotherapy (median, 17 weeks; 95% CI, 9 to 24 weeks). Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy–Anemia scale. The follow-up assessment rate for our primary end point was 92.1%, and adherence to the supervised exercise was 70.2%. Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem (P = .015), aerobic fitness (P = .006), and percent body fat (adjusted P = .076). Resistance exercise was superior to usual care for improving self-esteem (P = .018), muscular strength (P < .001), lean body mass (P = .015), and chemotherapy completion rate (P = .033). Neither aerobic nor resistance exercise significantly improved cancer-specific QOL in breast cancer patients receiving chemotherapy, but they did improve self-esteem, physical fitness, body composition.
Johan, Aulin, et al., (2006) conducted a study on Physical exercise for cytotoxic drug-induced fatigue In total, 89 patients were interviewed about their fatigue and were asked to complete a questionnaire, the Fatigue Symptom Inventory (FSI), once a week over several treatment cycles of cytotoxic drugs. On inclusion, all patients received similar information about fatigue. After randomization, information about the positive effectiveness of exercise was given to half of the patients after one cycle of cytotoxic drugs, and to the remaining patients after two cycles of cytotoxic drugs. Results show that a total of 74 patients completed the study and returned useable questionnaires. The fatigue prevalence was 89% after one cytotoxic drug cycle. According to the FSI ratings, the group who received information about physical exercise after one cycle scored significantly lower ratings than the other group throughout the study (P=0.034). The patient interviews confirmed that physical activity helped them to better battle fatigue. Intensity of other symptoms and side effectiveness from cytotoxic drugs closely paralleled the fatigue ratings.
Courneya K.S et al., (2004) conducting a study on effectiveness of aerobic exercise training in anemic cancer patients receiving deabsorbtion alfa. Conducted a randomized controlled trail in 55 mild to moderately anemic patients with solid tumors. Patients were randomized to either darbepoetin alfa alone (DAL, n = 29) or darbepoetin alfa plus aerobic exercise training (DEX; n = 26). The DEX group performed aerobic exercise training three times per week at 60%-100% of baseline exercise capacity for 12 weeks. The primary endpoint was QoL assessed by the Functional Assessment of Cancer Therapy-Anemia scale. Intention-to-treat analyses indicated significant improvements in QoL and fatigue in both groups over time but there were no between-group differences. The DEX group had a significantly greater VO(2peak) than the DAL group (mean group difference, +3.0 ml/kg per minute; 95% confidence interval, 1.2-4.7; p = .001) and there were borderline significant differences in favor of the DEX group for Hb response and darbepoetin alfa dosing. Aerobic exercise training did not improve Quality of Life or fatigue beyond the established benefits of DAL but it did result in favorable improvements in exercise capacity and a more rapid Hb response with lower dosing requirements. Results shows that aerobic exercise training did not improve quality of life or fatigue beyond the level but it did result in favorable improvements in exercise capacity and more rapid the response with lower dosing requirements.