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Nurses' Study Finds Energy Conservation Better than General Education In Controlling Cancer-Related Fatigue

PHILADELPHIA (March 12, 2004) -- Cancer patients describe fatigue as the most frequent and distressing problem of cancer treatment. Yet, the best way to help patients cope had not been evaluated until now. In a new study, lead by Fox Chase Cancer Center's director of nursing research, Andrea M. Barsevick, D.N.Sc., conserving energy is better for controlling cancer-related fatigue than general education focused on nutrition and a healthy diet. The results are published in the March 15th issue of the journal, Cancer (Vol. 100, No. 6, pp. 1302-1310).

While diminishing the overall quality of life, fatigue can also strip patients of their ability to function in normal everyday activities. According to Barsevick, patients often rest more and assume that less activity will help battle the symptom of fatigue during their treatment. Yet, less or over-activity is not the root of cancer-related fatigue.

"There are many factors that can cause or contribute to fatigue including cancer therapy, medications taken to relieve other symptoms, sleep disturbance and pain," said Barsevick. "Unlike fatigue that accompanies extreme activity and lack of sleep, cancer-related fatigue is not aided simply by adding rest or sleep."

While much of Barsevick's research has examined the profound effects fatigue had on patients, the effectiveness of energy conservation and activity management (ECAM) for fatigue reduction and maintenance of functional performance had never been evaluated in adults with cancer undergoing treatment.

Energy conservation is a "common sense" activity involving the deliberate planned management of one's energy. The objective of energy conservation is to balance rest and activity during times of high fatigue so valued activities and goals can be maintained. Taking additional rest periods is one energy-conservation activity. Other strategies include priority setting, delegation, pacing oneself, and planning high-energy activities at times of peak energy.

In this randomized clinical trial, the ECAM intervention was compared to a nutrition-focused control intervention. Participants of the study took part in three telephone sessions with an oncology nurse during the first five weeks of their chemotherapy, radiation or concurrent therapy. Researchers gathered information on the patients' fatigue and functionality before treatment began and at two points during their treatment that would normally coincide with times of high fatigue.

The control group was similar to the ECAM group in the attention and time spent with participants, but nurses delivered information on nutrition and maintaining a healthy diet. Topics such as vitamins and minerals were discussed and participants were asked to keep a dietary journal.

At the conclusion of the study, Barsevick noted "the ECAM group experienced a greater decrease in fatigue over a period of time." However, the intervention did not change overall performance in functionality.

"Further research will need to be done to achieve a stronger clinical benefit for patients," said Barsevick. "It may be necessary to identify and manage other key symptoms in addition to fatigue."

The results are a combination of the outcomes reached at both Fox Chase Cancer Center and the University of Utah. Barsevick worked in collaboration Susan Beck, PhD, RN, and William Dudley, PhD at the University of Utah, Kyra Whitmer, PhD at the University of Cincinnati and Lillian Nail, Ph.D., at the Oregon Health and Science University. Also contributing to the study at Fox Chase was radiation oncology nurse, Carole Sweeney, MSN.

Fox Chase Cancer Center, part of the Temple University Health System, is one of the leading cancer research and treatment centers in the United States. Founded in 1904 in Philadelphia as one of the nation’s first cancer hospitals, Fox Chase was also among the first institutions to be designated a National Cancer Institute Comprehensive Cancer Center in 1974. Fox Chase researchers have won the highest awards in their fields, including two Nobel Prizes. Fox Chase physicians are also routinely recognized in national rankings, and the Center’s nursing program has received the Magnet recognition for excellence four consecutive times. Today, Fox Chase conducts a broad array of nationally competitive basic, translational, and clinical research, with special programs in cancer prevention, detection, survivorship, and community outreach.  For more information, call 1-888-FOX CHASE or (1-888-369-2427).

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