Answer questions and earn CME/CNE Evidence regarding cancer-related fatigue (fatigue) has accumulated sufficiently such that recommendations for screening, evaluation, and/or management have been released recently by 4 leading cancer organizations. These evidence-based fatigue recommendations are available for clinicians, and some have patient versions; but barriers at the patient, clinician, and system levels hinder dissemination and implementation into practice. The underlying biologic mechanisms for this debilitating symptom have not been elucidated completely, hindering the development of mechanistically driven interventions. However, significant progress has been made toward methods for screening and comprehensively evaluating fatigue and other common symptoms using reliable and valid self-report measures. Limited data exist to support the use of any pharmacologic agent; however, several nonpharmacologic interventions have been shown to be effective in reducing fatigue in adults. Never before have evidence-based recommendations for fatigue management been disseminated by 4 premier cancer organizations (the National Comprehensive Cancer, the Oncology Nursing Society, the Canadian Partnership Against Cancer/Canadian Association of Psychosocial Oncology, and the American Society of Clinical Oncology). Clinicians may ask: Are we ready for implementation into practice? The reply: A variety of approaches to screening, evaluation, and management are ready for implementation. To reduce fatigue severity and distress and its impact on functioning, intensified collaborations and close partnerships between clinicians and researchers are needed, with an emphasis on system-wide efforts to disseminate and implement these evidence-based recommendations.

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21268

Screening, evaluation, and management of cancer‐related fatigue: Ready for implementation to practice?

https://www.jpsmjournal.com/article/S0885-3924(16)00055-5/pdf

Effects of Acupuncture, Tuina, Tai Chi, Qigong, and Traditional Chinese Medicine Five-Element Music Therapy on Symptom Management and Quality of Life for Cancer Patients: A Meta-Analysis

Burden- Cancer Survivorship- The Burden of Cancer Survivorship- Quality of Care- Quality of Life in Long-Term Cancer Survivors- Health Care Disparities- Measuring Quality of Life in Cancer Survivors- Common Problems- Exercise Motivation and Behavior Change- Fatigue- Pain- Depression- Interpersonal Relationships- Adaptation in the Face of Advanced Cancer- Secondary Prevention- Restoring Emotional Well-Being- Physical Activity for Cancer Survivors- Nutrition and Weight Management in Cancer Survivors- Management of Chemotherapy-Related Cognitive Dysfunction- Smoking Cessation and Cancer Survivors- Psychological Distress, Depression, and Anxiety- Managing Daily and Long-Term Stress- Pain and Function- Work- Comprehensive Long-Term Follow-up- Survivor and Provider Perspectives- Survivor Perspectives on Quality Care- Living with Advanced Cancer- International Perspective- Global Considerations- Future Directions- Cancer Survivorship

Handbook of Cancer Survivorship

This study was designed to critically evaluate the effect of acupuncture on cancer-related fatigue (CRF). Seven databases (Cochrane Library, Embase, Medline, Web of Science, CBM, Wanfang, and CNKI) were systematically reviewed from inception to November 2016 for randomized controlled trials (RCTs). Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed form. All analyses were performed with Review Manager 5. Ten RCTs, including 1327 patients (acupuncture, 733; control, 594), meeting the inclusion criteria for the meta-analysis were identified. Acupuncture had a marked effect on fatigue in cancer patients, regardless of concurrent anti-cancer treatment, particularly among breast cancer patients. The meta-analysis also indicated that acupuncture could significantly mitigate CRF compared with sham acupuncture or usual care. Acupuncture for 20–30 min/session three times/week for two or three weeks, twice weekly for two weeks and weekly for six weeks, and weekly for six weeks had substantial effects on CRF. Six RCTs reported the occurrence of adverse events, whereas five reported none. The remaining study reported some manageable events, including spot bleeding and bruising. Acupuncture is effective for CRF management and should be recommended as a beneficial alternative therapy for CRF patients, particularly for breast cancer patients and those currently undergoing anti-cancer treatment.

Effects of acupuncture on cancer-related fatigue: a meta-analysis

Cancer-related fatigue (CRF) has deleterious effects on physical, social, cognitive, and vocational functioning, and causes emotional and spiritual distress for patients and their families; however, it remains under-recognized and undertreated. This article critically reviews and integrates the available empirical evidence supporting the efficacy of pharmacologic and nonpharmacologic treatment approaches to CRF, highlighting new evidence since 2007 and 2009 Putting Evidence Into Practice publications. Interventions that are recommended for practice or likely to be effective in improving fatigue outcomes include exercise; screening for treatable risk factors; management of concurrent symptoms; yoga; structured rehabilitation; Wisconsin ginseng; cognitive-behavioral therapies for insomnia, pain, and depression; mindfulness-based stress reduction; and psychoeducational interventions such as anticipatory guidance, psychosocial support, and energy conservation and activity management. This information can be applied to improve the management of CRF, inform health policy and program development, shape the design of clinical trials of new therapies for CRF, and drive basic and translational research.

Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment.

Background: Faced with highly prevalent and recalcitrant cancer-related fatigue (CRF), together with the absence of any official guidelines on management, numerous groups have been striving to seek and test alternative therapies including acupuncture and moxibustion. However, different patients have various feedbacks, and the many clinical trials have given rise to varied conclusions. In terms of the therapeutic effect of acupuncture and moxibustion, there exist vast inconsistencies. Objective: The aim of the study was to evaluate the auxiliary effectiveness of acupuncture and moxibustion in the treatment of CRF, and to provide more reliable evidence to guide clinical practice. Methods: Randomized controlled trials (RCTs) published before December 2012 were all aggregated, focusing on evaluation of acupuncture or moxibustion for CRF. The quality of the included studies was assessed basing on Cochrane handbook 5.1.0, and the available data were analyzed with RevMan software (version 5.2.0). Descriptive techniques were performed when no available data could be used. Results: A total of 7 studies involving 804 participants were eligible. With real acupuncture versus sham acupuncture, subjects receiving true acupuncture benefited more in the reduction of fatigue. With real acupuncture versus acupressure or sham acupressure, fatigue level appeared 36% improved in the acupuncture group, but 19% in the acupressure group and only 0.6% with sham acupressure. When real acupuncture plus enhanced routine care was compared with enhanced routine care, the combination group improved mean scores for general fatigue, together with physical and mental fatigue. With real acupuncture versus sham acupuncture or wait list controls, the real acupuncture group displayed significant advantages over the wait list controls at 2 weeks for fatigue improvement and better well-being effects at 6 weeks. When moxibustion plus routine care was compared with routine care alone, the meta-analyses demonstrated the combination had a relatively significant benefit in improving severe fatigue and QLQ-C30. Conclusion: Up to the search date, there exist few high quality RCTs to evaluate the effect of acupuncture and moxibustion, especially moxibustion in English. Yet acupuncture and moxibustion still appeared to be efficacious auxiliary therapeutic methods for CRF, in spite of several inherent defects of the included studies. Much more high-quality studies are urgently needed.

https://www.koreascience.or.kr:443/article/JAKO201321251181809.pdf

Acupuncture and Moxibustion for Cancer-related Fatigue: a Systematic Review and Meta-analysis

916 www.thelancet.com/infection Vol 13 November 2013 2 Brassard P, Kezouh A, Suissa S. Antirheumatic drugs and the risk of tuberculosis. Clin Infect Dis 2006; 43: 717–22. 3 Green JA, Tran CT, Farrar JJ, et al. Dexamethasone, cerebrospinal fl uid matrix metalloproteinase concentrations and clinical outcomes in tuberculous meningitis. PLoS One 2009; 4: e7277. 4 Taylor JL, Hattle JM, Dreitz SA, et al. Role for matrix metalloproteinase 9 in granuloma formation during pulmonary Mycobacterium tuberculosis infection. Infect Immun 2006; 74: 6135–44. 5 Walker NF, Clark SO, Oni T, et al. Doxycycline and HIV infection suppress tuberculosis-induced matrix metalloproteinases. Am J Respir Crit Care Med 2012; 185: 989–97.

Corticosteroids for prevention of tuberculosis mortality

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Acupuncture and Moxibustion for Cancer-related Fatigue: a Systematic Review and Meta-analysis

Corticosteroids for prevention of tuberculosis mortality