Effectiveness of exercise Programme on Fatigue among Patients Undergoing Cancer Treatment in Selected Hospitals, Mangaluru

 

Mrs. Dona Thomas¹, Dr. Diana Lobo²

¹MSc. Nursing, Medical Surgical Nursing, Laxmi Memorial College of Nursing, A.J Towers, Balmatta, Mangalore, Karnataka,

²HOD, Department of Fundamentals of Nursing, Laxmi Memorial College of Nursing, Mangalore, Karnataka,

 

ABSTRACT:

Background: Cancer-related fatigue (CRF) is the most disturbing symptom associated with cancer diagnosis and its treatment. Fatigue is defined as a persistent, subjective sense of tiredness that is not proportional to activity and not relieved by rest. CRF is reported in over 80% of oncology patients during active treatment. This symptom is not limited to the active treatment phase, with over 30% of cancer survivors reporting CRF lasting at least 5 years. CRF is associated with decreased quality of life (QOL), decreased functional status, and decreased participation in social activities.

Methodology: A quasi experimental approach was adopted to determine the effectiveness of exercise programme on fatigue among patients undergoing cancer treatment in selected hospitals, Mangaluru. Purposive sampling technique was adopted to select the 40 sample and randomly divided 20 each in experimental and control group. Data was collected by using demographic proforma, Visual analogue fatigue scale (VAFS) and Fatigue severity scale (FSS). The data were gathered in master data sheet and analyzed using SPSS 20 software.

Results: There was a significant difference between mean fatigue scores in the different test periods in experimental group on both (VAFS and FSS) [f _{(2, 57)} = 3.18   p<0.05]. In pre test VAFS and FSS scores there was no significant difference in mean fatigue score between experimental and control group (t=0.24),(t=0.53) whereas in post test I& II there was significant difference in mean fatigue scores between experimental and control group (t₁= -8.24, t₂= -12.73, p<0.05), ( t₁= -8.47, t₂= -23.07, p<0.05) respectively.

Conclusion: From the findings of the study it can be concluded that exercise programme significantly reduces fatigue among patients undergoing cancer treatment.

 

 

INTRODUCTION:

The global burden of cancer is shifting dramatically. Worldwide, an estimated 14.1 million new cancer cases and 8.2 million cancer deaths were reported in 2012.¹ Cancers figure among the leading causes of morbidity and mortality worldwide, with approximately 14 million new cases and 8.2 million cancer related deaths in 2012.²  21.7 million of new cancer cases are expected to be diagnosed in 2030. The incidence of cancer in India is 70-90 per 100,000 population and cancer prevalence is established to be around 2,500,000 (2.5 million) with over 800,000 new cases and 5, 50,000 deaths occurring each year.³ An estimate shows that the total cancer burden in India for all sites will increase from 7 lakh new cases per year to 14 lakh by 2026.

 

The treatment options for most of the cancer cases include chemotherapy, radiation therapy and surgery. But the treatments often produce side effects including nausea, pain and fatigue. Fatigue is a serious problem for at least 70 percent of cancer patients.⁴ Cancer treatment–related fatigue generally improves after therapy is completed, but some level of fatigue may persist for months or years following treatment. Cancer treatment–related fatigue is reported in 14% to 96% of patients undergoing cancer treatment and in 19% to 82% of patients post treatment.⁵Cancer treatment related fatigue significantly impairs patients' quality of life and ability to function. Fatigue is reported rarely and treatment options or strategies of management are discussed infrequently. Many physicians consider fatigue a ‘standard norm’ of the treatment or disease, on which nothing can be done, and hence to be endured.⁶

 

A number of studies have looked at the impact of physical activity on cancer recurrence and long-term survival. Exercise has been shown to improve cardiovascular fitness, muscle strength, body composition, fatigue, anxiety, depression, self-esteem, happiness, and several quality of life factors in cancer survivors. Exercise can be individually tailored to the specific needs of each cancer patient or survivor.

 

MATERIALS AND METHOD:

A quasi experimental approach was adopted to determine the effectiveness of exercise programme on fatigue among patients undergoing cancer treatment in selected hospitals, Mangaluru. Quasi experimental repeated measure time series study design was adopted for the study. The present study was conducted in two multi speciality private medical college hospitals namely A.J Hospital and Father Muller Medical College Hospital, Mangaluru. The sample of 40 patients undergoing cancer treatment (20 in the experimental group and 20 in control group) was selected by purposive sampling technique. An official permission for conducting the study was obtained from the director and administrative departments of selected hospitals. Informed consent was obtained from the sample before initiating the study. Data was collected using demographic proforma, Visual analogue fatigue scale (VAFS) and Fatigue severity scale (FSS).   Demographic proforma was used for the assessment of demographic and clinical variables. VAFS and FSS were used to determine the fatigue levels. Exercise programme was taught by the investigator to the experimental group by self demonstration along with a video clipping. Exercises programme was given for 14 days. Collected data will be statistically analyzed and compared to find the effectiveness of exercise programme on fatigue among patients undergoing cancer treatment.

 

RESULTS:

Table 1: Frequency and Percentage Distribution of Patients Undergoing Cancer Treatment According to Baseline Characteristics

 

 

Table 2: Frequency and Percentage Distribution of Patients Undergoing Cancer Treatment According to Clinical Characteristics

Baseline Characteristics	Experimental group (n1=20)		Control group (n2 =20)		c2 Value	Pvalue
	F	%	f	%
1.                    Medical co morbidities a.                    Hypertension b.                    Diabetics mellitus c.                    Anaemia d.                    Respiratory problems e.                    Others	4 1 - - 15	20 5 - - 75	4 2 - - 14	20 10 - - 70	0.368	0.832
2.                    Type of cancer a.                    Head, neck and Oral cancer b.                    Lung cancer c.                    Breast cancer d.                    Prostate cancer e.                    Stomach & intestinal cancer f.                     Colorectal cancer g.                    Cervical  cancer h.                    Others (specify)	8 - 7 - - 1 2 2	40 - 35 -   5 10 10	10 - - - 1 1 - -	50 - - - 20 20 - -	5.00	0.287
3.                    Duration of diagnosis (in years) a.                    Less than 1 b.                    1-5 c.                    5-10 d.                    More than 10	20 - - -	100 - - -	20 - - -	100 - -	0.00	0.00
4.                    Type of treatment a.                    Chemotherapy b.                    Radiation therapy c.                    Combination therapy	- 3 17	- 15 85	- 2 18	- 10 90	0.229	0.633
5.                    Duration of chemo treatment a.                    1-5 cycles b.                    06-10  cycles c.                    11- 15 cycles d.                    ≥16 cycles	12 4 1 -	70.6 23.5 5.9 -	14 4 1 -	77.8 22 -	1.126	0.569
6.                    Duration of radiation treatment a.                    1-5 cycles b.                    06-10 cycles c.                    11-15 cycles d.                    ≥16 cycles	4 10 6 -	20 50 30 -	3 7 10 -	15 35 50 -	1.672	0.433

 

 

Figure3: Bar Diagram Showing Percentage Distribution of Patients Undergoing Cancer Treatment in Terms of Pre-test Fatigue Scores in Experimental and Control Group.

 

 

Figure 4: Bar Diagram Showing Percentage Distribution of Patients Undergoing Cancer Treatment in Terms of Fatigue Scores in Post-test I and Post-test II

 

Figure 5: Ogive Representing the Pre-test and Post-test 1 and Post-test II Average Fatigue Level Scores of Experimental Group Based Visual Analog Scale (VAFS)

 

 

Figure 6: Ogive Representing the Pre-test and Post-test I& II Average Fatigue Level Scores of Control Group Based on Visual Analog Scale (VAFS)

Table 7: Range, Mean, Standard Deviation and Median of Post-test I and Post-test II Fatigue Scores of Patients Undergoing Cancer Treatment in Experimental and Control Group Based on VAFS

 

Table 8: Mean, Standard Deviation and Median of Pre-test, Post-test I and Post-test II Fatigue Scores of Patients Undergoing Cancer Treatment in Experimental and Control Group Based on FSS

 

Table 9: One Way ANOVA Results Showing the Significant Difference in the Mean Fatigue Score during the 3 Test Periods in Experimental Group Based on VAFS and FSS

 

Table 10: Unpaired‘t’ Test Showing the Significant Difference in the Mean Fatigue Scores During the Test Periods in the Experimental and Control Group based on VAFS.

 

Table 11: Unpaired‘t’ Test Showing the Significant Difference  in the Mean Fatigue Scores During the Test Periods in the Experimental and Control Group based on FSS

 

Table 12: Bonferroni t test showing multiple comparisons of pre-test and post-test fatigue score of the experimental group based on VAFS

 

Table 13: Bonferroni t Test Showing Multiple Comparisons of Pre-test and Post-test Fatigue Score of the Experimental Group based on FSS.

Table 14: Association of Pre-test Fatigue Scores of Patients Undergoing Cancer Treatment in the Experimental Group with the Selected Demographic Variables (VAFS)

 

Table 15: Association of Pre-test Fatigue Scores of Patients undergoing cancer treatment in the Control Group with the Selected Demographic Variables (VAFS)

 

Table 16: Association of Pre-Test Fatigue Scores of Patients Undergoing Cancer Treatment in the Experimental Group with the Selected Demographic Variables (FSS)

 

Table 17: Association of Pre-Test Fatigue Scores of Patients undergoing cancer treatment in the Control Group with the Selected Demographic Variables (FSS)                                       n₁=20

 

DISCUSSION:

Description of Demographic Variables of Sample:

In the present study the highest percentage of subjects in experimental group10 (50%) and control group 9(45%) were in the age group of 41-50. Majority 12(60%) of subjects in experimental group were females whereas majority 12(60%) of subjects in control group were males. Most 18(90%) of the subjects in the experimental group and control group 19(95%) were married.  Majority 11(55%) of the subjects of the experimental and control group were having primary education and 6(30%) of experimental group and 5(25%) of control group had secondary schooling. Majority 13(65%) of subjects in experimental group and control group were from nuclear family. Majority 15(75%) of subjects in experimental group and in control group 14(70%) had no co morbidities. Highest percentage 8(40%) of subjects in experimental group and in control group 10(50%) had oral cancer. All 20(100%) of subjects in experimental group and control group were on treatment for less than 1 year. Most 17(85%) of subjects in experimental group and in control group 18(90%) had combined therapy (radiation and chemo therapy).Majority 12(70.6%) of the subjects in experimental group and control group had 1-5 cycles of chemo treatment. Majority 10(50%) of subjects in experimental group had 6-10 cycles of radiation and majority 10(50%) of subjects in control group had 11-15 cycles of radiation. These findings are supported by a study conducted in Germany shows that the mean age of both experimental and control group were 40±11 and 40±10 respectively. Another study conducted shows most cancer survivors (60%), (n=419; 54.2%) belong to female gender

 

Description of Level of Fatigue:

The fatigue levels of the subjects were assessed VAFS and FSS. In pre-test most 18(90%) the subjects in experimental group and 16(80%) of control group had moderate level of fatigue while least percentage 2(10%) of subjects in experimental group and 4(20%) of control group had severe level of fatigue. In the post-test I, all 20(100%) of subjects in the experimental group and most 14(60%) of the subjects of control group had moderate level of fatigue and least percentage 8(40%) of the subjects  of control group had severe level of fatigue whereas in post-test II most 12(60%) of the subjects in the experimental group had moderate level of fatigue and 8(40%) of subjects in experimental group had mild fatigue while in control group most 14(70%) had severe level of fatigue.

 

The study findings are supported by a study conducted on radiotherapy patients shows that at the initiation of treatment, training and comparison groups had moderate fatigue (p=0.632), at the end of the treatment, 44% of patients in the training group had mild fatigue while 57% of the comparison group reported severe fatigue (p=0.011).⁷ Another study shows that in patients who exercised, CRF severity decreases by 4.9% compared to a 29.1% increase in CRF in patients who do not exercise.⁸

 

In the experimental group VAFS post-test I& II fatigue scores ogive lies left of the pre-test fatigue score ogive over the entire range indicates that the post-test fatigue scores were consistently lower than the pre-test fatigue scores. And in the control group post-test II fatigue score ogive lies right of the post-test I and pre-test fatigue score ogive over the entire range indicating that the post-test fatigue scores were consistently higher than the per test and post-test I fatigue score.

Effectiveness of Exercise Programme in Reducing Fatigue:

There was a significant difference between mean fatigue scores in the different test periods in experimental group (VAFS and FSS) [f _{(2, 57)} = 3.18   p<0.05]. Similar supportive study shows that total fatigue level from pre to post intervention was -5.8 with a 95% confidence interval (CI) of (-12.6, 1.1), P=0.098, indicating a beneficial effect on experimental group compared to control group.⁹

 

Significant Difference in the Mean Fatigue Scores during the Test Periods:

The mean post-test I & II VAFS and FSS fatigue scores of the experimental group (4.95±0.60,3.85±0.81) , (50.80±2.09,46.75±1.71)was lower than the mean post-test I & II fatigue scores of control group (6.40±0.50, 6.80±0.67), (55.40±1.23, 56.90±0.97) respectively. In pre-test there was no significant difference in mean fatigue score between experimental and control group (t=0.24), (t=0.53) whereas in post-test I& II there was significant difference in mean fatigue scores between experimental and control group (t₁= -8.24, t₂= -12.73, p<0.05), (t₁=-8.47, t₂= -23.07, p<0.05) respectively. The supportive study shows that the mean score of fatigue intensity were significantly higher in control group than in study group on 14^th day (p=0.024 & 0.015) compared to 1^st day (p=0.012& 0.046).¹⁰

 

Significance of Difference between the Pre-test and Post-test Mean Fatigue Score:

There was a significant difference between the pre-test and post-test VAFS and FSS fatigue scores [post 1(p=0.00) and post 2(p=0.00)], in the experimental group and control group. There was also significant difference between post- test I and post- test II (p=0.00) in experimental group. In FSS fatigue score there was significant difference between pre-test and post-test II (p=0.00), post-test I and post-test II (p=0.005) in control group. A supportive study conducted in Taiwan shows a significant group-by-time interaction effect for fatigue severity and interference (p≤ 0.001); the fatigue severity and interference decreased significantly over time in the intervention group but increased over time in the control group.¹¹

 

Association of the Level of Fatigue with the Selected Demographic Variables:

There was no significant association of pre-test fatigue (VAFS and FSS) scores of experimental group with selected demographic variables. Supportive study conducted in Netherlands shows that there is no association of demographic variables and fatigue level.¹²

 

CONCLUSION:

The current study concluded that exercise programme was effective in reducing fatigue among patients undergoing cancer treatment.

 

LIMITATIONS:

·         There was sample mortality as some participants declined to continue participating in the study. The investigator had to look for additional participants.

 

RECOMMENDATIONS:

Based on the study findings, the following recommendations are stated:

·         Oncology unit should develop exercise programmes for patients undergoing cancer treatment as part of routine care to reduce fatigue.

·         Brochures, study materials can be developed on home based exercise programme and distributed among oncology patients to manage their fatigue even after discharge.

·         A similar study can be done on a larger sample to generalize the findings.

·         A comparative study with more than one intervention can be done.

 

ACKNOWLEDGEMENT:

The author would like to express heartfelt thanks with deep sense of gratitude and respect to guide Dr.Mrs. Diana Lobo, Professor and HOD, Department of Fundamentals of Nursing, Laxmi memorial college of nursing,

 

CONFLICT OF INTEREST:

Nil

 

SOURCE OF FUNDING:

Nil

 

ETHICAL CLEARANCE:

The ethical clearance for the present study was obtained from A.J Ethics Committee, A.J Hospital and Research Centre, Mangaluru.

 

REFERENCES:

1.     Cha AE. Global cancer hotspots: Burden of disease is shifting of developing countries: The Washington Post. [Online] 2014 Dec.

2.     Steward BW, Wild CP. World Cancer Report 2014. [Online]. Available from: URL:http://www.who.i nt/cancer/publications/WRC_2014/en/

3.     Bushan K. Cancer scenario in India. Daily Excelsior.[online] 2014 November 2 [Cited 2015 December 19]

4.     Segal R, Evans W, Johnson D, Smith J, Colletta S, Gayton J. Structured exercise improves functioning in women with stages I and II breast cancer: results of a randomized controlled trial. Journal of Clinical Oncology 2001; 19: 657-66.

5.     Irvine D1, Vincent L, Graydon JE, Bubela N, Thompson L. The prevalence and correlates of fatigue in patients receiving therapy with chemotherapy and radiation therapy: a comparison with the fatigue experienced by healthy individuals. Cancer 1997;17(5):367-78

6.     Dimeo FC, Stieglitz RD, Novelli-Fischer U, Fetscher S, Keul J. Effects of physical activity on fatigue and psychological status of cancer patients during chemotherapy. Cancer 1999;85(10):2273-7.

7.     Aghili M, Farhan F, Rade M. A pilot study of the effects of programmed aerobic exercise on the severity of fatigue in cancer patients during external radiotherapy. European Journal of Oncology Nursing 2007; 11: 179-82.

8.     Wright F, Squires A. Does exercise help reduce cancer-related fatigue? Journal of Clinical Outcomes Management 2014 Apr; 21(4):155-6.

9.     Schmidt ME, Wiskemann J, Armbrust P, Schneeweiss A, Ulrich CM, Steindorf K. Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: A randomized controlled trial. International Journal of Cancer 2015; 137(2):471-80.

10.  Ali WG, Soliman HM. Effects of walking exercise programme on chemotherapy induced fatigue, physical functional status, and symptoms distress among cancer patients. Journal of Nursing and Health Science 2016; 5(1):25-33.

11.  Yang T, Chen M and Li C. Effects of an aerobic exercise programme on fatigue for patients with breast cancer undergoing radiotherapy Journal of Clinical Nursing;24(1-2):202–11.

12.  Weert EV, Hoekstra-Weebers J, Otter R, Postema K, Sanderman R, Schans CVD. Cancer-related fatigue: predictors and effects of rehabilitation. The Oncologist 2006; 11(2):184-96.

 

 

 

 

 

 

 

 

 

Received on 15.10.2017          Modified on 25.10.2017

Accepted on 30.11.2017      ©A&V Publications All right reserved