Browsing by Subject "Fatigue"
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Item Acceptance and commitment therapy for fatigue interference in advanced gastrointestinal cancer and caregiver burden: protocol of a pilot randomized controlled trial(BMC, 2021-04-20) Mosher, Catherine E.; Secinti, Ekin; Kroenke, Kurt; Helft, Paul R.; Turk, Anita A.; Loehrer, Patrick J., Sr.; Sehdev, Amikar; Al-Hader, Ahmad A.; Champion, Victoria L.; Johns, Shelley A.; Psychology, School of ScienceBackground: Fatigue interference with activities, mood, and cognition is one of the most prevalent and bothersome concerns of advanced gastrointestinal (GI) cancer patients. As fatigue interferes with patient functioning, family caregivers often report feeling burdened by increasing responsibilities. Evidence-based interventions jointly addressing cancer patient fatigue interference and caregiver burden are lacking. In pilot studies, acceptance and commitment therapy (ACT) has shown promise for addressing symptom-related suffering in cancer patients. The current pilot trial seeks to test a novel, dyadic ACT intervention for both advanced GI cancer patients with moderate-to-severe fatigue interference and their family caregivers with significant caregiving burden or distress. Methods: A minimum of 40 patient-caregiver dyads will be randomly assigned to either the ACT intervention or an education/support control condition. Dyads in both conditions attend six weekly 50-min telephone sessions. Outcomes are assessed at baseline as well as 2 weeks and 3 months post-intervention. We will evaluate the feasibility, acceptability, and preliminary efficacy of ACT for improving patient fatigue interference and caregiver burden. Secondary outcomes include patient sleep interference and patient and caregiver engagement in daily activities, psychological flexibility, and quality of life. We will also explore the effects of ACT on patient and caregiver physical and mental health service use. Discussion: Findings will inform a large-scale trial of intervention efficacy. Results will also lay the groundwork for further novel applications of ACT to symptom interference with functioning and caregiver burden in advanced cancer.Item Acceptance and commitment therapy for symptom interference in metastatic breast cancer patients: a pilot randomized trial(Springer Nature, 2018-06) Mosher, Catherine E.; Secinti, Ekin; Li, Ruohong; Hirsh, Adam T.; Bricker, Jonathan; Miller, Kathy D.; Schneider, Bryan; Storniolo, Anna Maria; Mina, Lida; Newton, Erin V.; Champion, Victoria L.; Johns, Shelley A.; Psychology, School of SciencePURPOSE: Breast cancer is the leading cause of cancer mortality in women worldwide. With medical advances, metastatic breast cancer (MBC) patients often live for years with many symptoms that interfere with activities. However, there is a paucity of efficacious interventions to address symptom-related suffering and functional interference. Thus, this study examined the feasibility and preliminary efficacy of telephone-based acceptance and commitment therapy (ACT) for symptom interference with functioning in MBC patients. METHODS: Symptomatic MBC patients (N = 47) were randomly assigned to six telephone sessions of ACT or six telephone sessions of education/support. Patients completed measures of symptom interference and measures assessing the severity of pain, fatigue, sleep disturbance, depressive symptoms, and anxiety. RESULTS: The eligibility screening rate (64%) and high retention (83% at 8 weeks post-baseline) demonstrated feasibility. When examining within-group change, ACT participants showed decreases in symptom interference (i.e., fatigue interference and sleep-related impairment; Cohen's d range = - 0.23 to - 0.31) at 8 and 12 weeks post-baseline, whereas education/support participants showed minimal change in these outcomes (d range = - 0.03 to 0.07). Additionally, at 12 weeks post-baseline, ACT participants showed moderate decreases in fatigue and sleep disturbance (both ds = - 0.43), whereas education/support participants showed small decreases in these outcomes (ds = - 0.24 and - 0.18 for fatigue and sleep disturbance, respectively). Both the ACT and education/support groups showed reductions in depressive symptoms (ds = - 0.27 and - 0.28) at 12 weeks post-baseline. Group differences in all outcomes were not statistically significant. CONCLUSIONS: ACT shows feasibility and promise in improving fatigue and sleep-related outcomes in MBC patients and warrants further investigation.Item Associations between Loneliness and Cancer Patients’ Pain and Fatigue(Office of the Vice Chancellor for Research, 2015-04-17) Stout, Madison E.; Adams, Rebecca N.; Mosher, Catherine E.Introduction: Pain and fatigue occur at higher rates in cancer patients than in the general population. One study found that loneliness predicted both pain and fatigue in cancer patients; however, the study only focused on patients with breast or colon cancer. The goal of the current study is to examine whether loneliness is associated with pain and fatigue in a sample of patients with various cancer types, including more rare diagnoses. We hypothesized that loneliness would be positively correlated with pain and fatigue, controlling for demographic and medical characteristics. Methods: Participants (N=44) were 60 years old (SD=12) on average, 68% Caucasian, and 59% female. All participants had received treatment for cancer at the Indiana University Simon Cancer Center or another Indiana University Hospital since 2013. Participants were recruited from the Indiana Tumor Registry, and after consenting, they were mailed a survey to complete at home that included measures of loneliness, pain, and fatigue. To test our hypothesis, we computed correlations between loneliness and each symptom (i.e., pain and fatigue), controlling for age, gender, and time since diagnosis. Results: As hypothesized, we found a large, positive correlation between loneliness and fatigue (r =0.51, p=0.001), controlling for demographic and medical characteristics. In addition, loneliness was positively correlated with pain, but this result fell just short of statistical significance (r=0.28, p=0.09). Conclusions: Results from this study suggest that greater loneliness is associated with greater fatigue in cancer patients, consistent with the results of one prior study. Although the association between loneliness and pain was more modest, it may reach statistical significance as the study sample size increases. If future longitudinal research shows that greater loneliness predicts cancer patients’ pain and fatigue, it would suggest that interventions to reduce loneliness may also reduce their physical symptoms.Item Automatic analysis of treadmill running to estimate times to fatigue and exhaustion in rodents(PeerJ, 2018-07-06) Zaretsky, Dmitry V.; Kline, Hannah; Zaretskaia, Maria V.; Rusyniak, Daniel E.; Emergency Medicine, School of MedicineIntroduction: The determination of fatigue and exhaustion in experimental animals is complicated by the subjective nature of the measurement. Typically, it requires an observer to watch exercising animals, e.g. rats running on the treadmill, and to identify the time of the event. In this study, we hypothesized that automatic analysis of the time-averaged position of a rat on a treadmill could be an objective way for estimating times to fatigue and exhaustion. To test this hypothesis, we compared these times measured by a human observer to the results of an automated video tracking system. Methods: Rats, previously familiarized to running on the treadmill, ran at a fixed speed with zero incline, until exhaustion. The experiments were performed at either room temperature (24 °C) or in a hot environment (32 °C). Each experiment was video recorded. A trained observer estimated the times to fatigue and exhaustion. Then, video tracking software was used to determine the position of the animals on the treadmill belt. The times to fatigue and exhaustion were determined, based on the position on the treadmill using predefined criteria. Results: Manual scores and the average position on the treadmill had significant correlation. Both the observer and the automated video tracking determined that exercise in a hot environment, compared with the exercise at room temperature, results in shorter times to exhaustion and fatigue. Also, estimates of times made by the observer and the automated video tracking were not statistically different from each other. Discussion: A similarity between the estimates of times to fatigue and exhaustion made by the observer and the automated technique suggests that video tracking of rodents running on a treadmill can be used to determine both parameters in experimental studies. Video tracking technique allows for a more objective measure and would allow for an increased performance in experimentation. The Supplemental information to this manuscript contains an Excel file, which includes the code in Virtual Basic with freeware license, to process and visualize running data and automatically estimate the times to fatigue and exhaustion. Instructions for the software are also included.Item Cancer Treatment-Related Fatigue: Psychometric Testing of the Cancer Treatment-Related Fatigue Representation Scale (CTRFRep) in Patients Undergoing Radiation Treatment for Cancer(2010-02-02T21:24:42Z) Reuille, Kristina M.; Welch, Janet L.; Keck, Juanita F.; Fulton, Janet S.; Friesth, Barbara ManzCancer treatment-related fatigue (CTRF) is recognized as a prevalent and bothersome symptom for patients with cancer. In a model of the CTRF experience, CTRF representation, or the beliefs, thoughts and emotions surrounding the experience of CTRF, is believed to mediate the relationship between CTRF intensity and CTRF distress. To date, there is no reported measure of CTRF representation. The purpose of this descriptive, cross-sectional study guided by Leventhal’s Common Sense Model of Self-Regulation was to evaluate an instrument designed to measure CTRF representation, the CTRF Representation scale (CTRFRep), based on an existing measure, the Illness Perception Questionnaire (IPQ-R). The study included 47 patients (mean age=57.7 years) receiving radiation therapy for cancer interviewed one month post-treatment. 77% of patients had fatigue during treatment. Three content experts and one theory expert assessed content validity of the CTRFRep. The content experts included three behavioral oncology nurse researchers whose focus is on symptom management and/or fatigue. The theory expert was a nurse researcher who is an expert in the area of self-regulation theory. As tested, the CTRFRep consisted of 105 items in 10 subscales addressing beliefs about the Identity, Timeline (Acute vs. Chronic/Cyclical), Consequences (positive/negative), Cause, Control (Treatment/Personal), Symptom Coherence, and Emotional Representation of CTRF. When evaluating psychometrics, the Identity and Cause subscales are analyzed independent of the other subscales. For the Identity subscale, symptoms most reported as related to CTRF were lack of energy, loss of strength, and feeling blue. For the Cause subscale, the most common beliefs regarding causes of CTRF were cancer treatment(s), having cancer, and stress or worry. Results indicate adequate reliability in six of eight remaining subscales (α>=0.70); the item N in those subscales was reduced from 56 to 34. To address construct validity, logistic regression assessed whether CTRFRep mediated the relationship between CTRF intensity and CTRF distress. After controlling for negative affect, the Identity and Consequences subscales were significant mediators – the Acute vs. Chronic Timeline and Emotional Representation scales were partial mediators – of the relationship between CTRF intensity on CTRF distress. These findings indicate fatigue is a problem for people undergoing treatment for cancer, and the CTRFRep may be a reliable and valid measure of CTRF representation for patients undergoing radiation treatment for cancer. Small sample size prevented successful factor analysis of the CTRFRep. Further research of the CTRFRep is warranted.Item Cannabidiol (CBD) Consumption and Perceived Impact on Extrahepatic Symptoms in Patients with Autoimmune Hepatitis(Springer, 2019-07-30) Mathur, Karan; Vuppalanchi, Vahin; Gelow, Kayla; Vuppalanchi, Raj; Lammert, Craig; Medicine, School of MedicineBackground and Aims Utilization and safety of cannabidiol (CBD) in patients with autoimmune hepatitis (AIH) are currently unknown. We aimed to identify the frequency of CBD use, impact on symptoms, and safety profile. Methods An invitation to complete a CBD-specific questionnaire was posted every other day to well-established autoimmune hepatitis Facebook communities (combined membership of 2600 individuals) during a 10-day study period. Age ≥ 18 years and an AIH diagnosis by a physician were the eligibility criteria for participation in the survey. Results In total, 371 AIH patients (median age 49 years, 32% reported advanced fibrosis) completed the questionnaire. Respondents were 91% women, 89% Caucasian, and 89% from North America. Ninety-three (25%) respondents were ever CBD users, with 55 of them (15% of the survey responders) identified as current users. Among ever users, 45.7% reported their treating doctors were aware of their CBD use. The most common reason cited for CBD use was pain (68%), poor sleep (62%), and fatigue (38%). Most respondents using CBD for these symptoms reported a significant improvement in pain (82%), sleep (87%), and fatigue (61%). In ever CBD users, 17.3% were able to stop a prescription medication because of CBD use: pain medication (47%), immunosuppression (24%), and sleep aids (12%). Side effects attributed to CBD use were reported in 3% of CBD users, yet there were no reported emergency department visits or hospitalizations. Conclusion CBD use was not uncommon in patients with AIH, and its use was associated with reports of improvement in extrahepatic symptoms.Item Depression and Cancer-Related Fatigue: A Cross-Lagged Panel Analysis of Causal Effects(2012-07-03) Brown, Linda F.; Bigatti, Silvia M.; Kroenke, Kurt; Rand, Kevin L.; Stewart, Jesse C.Fatigue is one of the most common and debilitating symptoms reported by cancer patients, yet it is infrequently diagnosed or treated. Relatively little is understood about its etiology in the cancer context. Recently, as researchers have begun to focus attention on cancer-related fatigue (CRF), depression has emerged as its strongest correlate. Few longitudinal studies have been done, however, to determine whether causal influences between the two symptoms exist. The aim of the current study was to determine whether depression has a causal influence on CRF and whether reciprocal effects exist. The study used a single-group cohort design of longitudinal data from a randomized controlled trial (N = 405) of an intervention for pain and depression in a heterogeneous sample of cancer patients. To be eligible, participants met criteria for clinically significant pain or depression. A hypothesis that depression would influence change in fatigue after 3 months was tested using latent variable cross-lagged panel analysis, a structural equation modeling technique. A second hypothesis was that fatigue would also influence change in depression over time but at a lesser magnitude. Depression and fatigue were strongly correlated in the sample (i.e., baseline correlation of latent variables was 0.72). Although the model showed good fit to the data, χ2 (66, N = 329) = 88.16, p = 0.04, SRMR = 0.030, RMSEA = 0.032, and CFI = 1, neither cross-lagged structural path was significant. The findings suggest that depression had no causal influence on changes in fatigue in this sample, and fatigue did not influence change in depression. The clinical implication is that depression treatment may not be helpful as a treatment for CRF and therefore interventions specifically targeting fatigue may be needed. Future research should include additional waves of data and larger sample sizes.Item Determinants of Fatigue in the Biceps Brachii During Blood Flow Restriction Training(Office of the Vice Chancellor for Research, 2016-04-08) Meek, Anthony W.; Wilfong, Emily; Streepey, Jefferson W.; Riley, Zachary A.Training loads of 60% - 80% of maximum are traditionally recommended for increasing muscular strength. Lifting lighter loads (~20% of 1RM) with concomitant blood flow restriction (BFR) can also increase muscle strength. It is unknown if adaptation with BFR is limited to the muscle or also due to changes in the nervous system. We examined changes in the output of the motor cortex and the muscle with stimulation, when subjects perform 1.) Training with light loads, 2.) Training with light loads with BFR, and 3.) Training with moderate loads. 5 subjects completed three training sessions with the elbow flexor muscles. Maximal strength was measured before and after each training session. Voluntary activation was tested with cortical stimulation (TMS) and with electrical stimulation of the biceps during additional MVCs. Subjects trained with a block of 4 isometric contractions at 20% MVC (120s, 60s, 60s, 60s durations) or at 60% MVC (40s, 20s, 20s, 20s durations). Fatigue (% decrease in MVC after training) was similar between 20% with BFR and 60% conditions (18.6% and 16%) and less in the 20% without BFR condition (9.7%). Cortical voluntary activation decreased similarly between the 20% BFR and 60% conditions (-3.6% and -3.3%) and showed less change with 20% without BFR (-1.8%). Alternatively, with electrical stimulation of the muscle, both 20% training conditions showed a decline in voluntary activation (-3.1% and -5.15), while voluntary activation increased by 8% after the 60% condition. Similar levels of fatigue occur at different contraction intensities when BFR is applied during the lighter contraction. Both 20% with BFR and 60% loading causes deficits in cortical activation, though the limiting factor in the 20% BFR condition is a decrease in activation of the muscle directly, while in the 60% contraction it is due to an inability to drive the motorneuron pool sufficiently.Item Effects of air-abrasion pressure on the resin bond strength to zirconia: a combined cyclic loading and thermocycling aging study(XMLink, 2017-08) Al-Shehri, Eman Z.; Al-Zain, Afnan O.; Sabrah, Alaa H.; Al-Angari, Sarah S.; Al Dehailan, Laila; Eckert, George J.; Özcan, Mutlu; Platt, Jeffrey A.; Bottino, Marco C.; Biomedical and Applied Sciences, School of DentistryObjectives To determine the combined effect of fatigue cyclic loading and thermocycling (CLTC) on the shear bond strength (SBS) of a resin cement to zirconia surfaces that were previously air-abraded with aluminum oxide (Al2O3) particles at different pressures. Materials and Methods Seventy-two cuboid zirconia specimens were prepared and randomly assigned to 3 groups according to the air-abrasion pressures (1, 2, and 2.8 bar), and each group was further divided into 2 groups depending on aging parameters (n = 12). Panavia F 2.0 was placed on pre-conditioned zirconia surfaces, and SBS testing was performed either after 24 hours or 10,000 fatigue cycles (cyclic loading) and 5,000 thermocycles. Non-contact profilometry was used to measure surface roughness. Failure modes were evaluated under optical and scanning electron microscopy. The data were analyzed using 2-way analysis of variance and χ2 tests (α = 0.05). Results The 2.8 bar group showed significantly higher surface roughness compared to the 1 bar group (p < 0.05). The interaction between pressure and time/cycling was not significant on SBS, and pressure did not have a significant effect either. SBS was significantly higher (p = 0.006) for 24 hours storage compared to CLTC. The 2 bar-CLTC group presented significantly higher percentage of pre-test failure during fatigue compared to the other groups. Mixed-failure mode was more frequent than adhesive failure. Conclusions CLTC significantly decreased the SBS values regardless of the air-abrasion pressure used.Item Effects of Mindfulness-Based Interventions on Fatigue in Cancer Survivors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials(Elsevier, 2021-04) Johns, Shelley A.; Tarver, Will L.; Secinti, Ekin; Mosher, Catherine E.; Stutz, Patrick V.; Carnahan, Jennifer L.; Talib, Tasneem L.; Shanahan, Mackenzie L.; Faidley, Micah T.; Kidwell, Kelley M.; Rand, Kevin L.; Psychology, School of ScienceThis systematic review and meta-analysis was designed to determine the efficacy of mindfulness-based interventions (MBIs) in improving fatigue-related outcomes in adult cancer survivors. Randomized controlled trials (RCTs) were identified from PubMed, MEDLINE, PsycINFO, CINAHL, Web of Science, and EMBASE databases and reference lists of included studies. Separate random-effects meta-analyses were conducted for fatigue and vitality/vigor. Twenty-three studies reporting on 21 RCTs (N=2,239) met inclusion criteria. MBIs significantly reduced fatigue compared to controls at post-intervention (g=0.60, 95% CI [0.36, 0.83]) and first follow-up (g=0.42, 95% CI [0.20, 0.64]). Likewise, MBIs significantly improved vitality/vigor at post-intervention (g=0.39, 95% CI [0.25, 0.52]) and first follow-up (g=0.35, 95% CI [0.03, 0.67]). The evidence grade was low due to risk of bias, substantial heterogeneity, and publication bias among studies. MBIs show promise in improving fatigue and vitality/vigor in cancer survivors. More rigorous trials are needed to address current gaps in the evidence base.