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Many patients with leukemia experience cancer-related fatigue (CRF). However, when patients are admitted for treatment with chemotherapy, clinicians often overlook CRF and interventions that can help to manage it. The purpose of this four-week intervention was to determine whether a nurse-led exercise activity would reduce CRF and increase physical activity compared to current practice. The results suggest that nurse-led exercise programs can immediately decrease CRF and increase activity in admitted patients with leukemia receiving chemotherapy. Including patients in nurse-led exercise activities can support active participation in their own care during and after hospitalization.

Background: Most symptom management takes place in the community, conducted by patient and/or informal carer dyads with guidance from clinicians. Given the prevalence of cancer, there is a critical need for examination of the impact of managing multiple symptoms, particularly those that cluster with fatigue, on informal carers., Objectives: To (1) examine clustering of patient fatigue-related symptom severity and distress in individuals with cancer and (2) test the hypothesis that patient fatigue-related symptom clusters (severity, distress) will be positively associated with carer depressive symptoms., Methods: Secondary analysis of 689 hospice patient/informal carer dyads using exploratory factor analysis and structural equation modeling. Patient symptoms were measured by the Memorial Symptom Assessment Scale, and carer depressive symptoms were measured by the Center for Epidemiological Study-Depression Scale., Results: Patients were 73 (SD, 12) years old, and 43% were female. Carers were 65 years (SD, 14) years old, and 74% were female. For symptom severity, dyspnea, dry mouth, lack of appetite, drowsiness, cough, dizziness, and difficulty swallowing clustered with fatigue. For symptom distress, dyspnea, cough, and dry mouth clustered with fatigue. Structural equation modeling results indicated that the patient fatigue severity cluster was positively related to carer depressive symptoms (b = 0.12, P < .05), but distress was not., Conclusion: Managing multiple symptoms that cluster with fatigue negatively impacts informal carers., Implications for Practice: When patients complain of severe fatigue, clinicians need to explore all causes and ask about other symptoms while exploring whether the informal carer is feeling burdened or depressed.

Objective: The aim of this study was to determine the effect of web-based education and counselling for patients with systemic lupus erythematosus on self-efficacy, fatigue and assessment of care., Methods: The study was conducted as a randomized controlled trial. The study sample consisted of 80 patients divided into two groups: the experimental group ( n  = 40) and a control group ( n  = 40). Randomization was performed by simple random sampling. At the beginning of the study (month 0), data-collection forms were administered to both groups. Web-based education was carried out for the first three months, and counselling and information updates were given for the next three months for the experimental group. In the intervention process, the control group just received standard care. After six months, data-collection forms were administered to both groups again., Results: The mean age of the participants in the experimental and control groups was 35.58 ± 8.40 years and 39.00 ± 12.71 years, respectively. In both groups, 95% of patients were women. Wilcoxon's test was used for within-group comparisons before and after the study. The Mann-Whitney U -test was used to evaluate the difference between the two groups before the intervention and between the two groups after the intervention. We found that there was a significant improvement in fatigue, self-efficacy and assessment of chronic illness care in the experimental group at the end of the study ( p  < 0.05)., Conclusions: The intervention had a positive effect on self-efficacy, fatigue and satisfaction with chronic illness. In accordance with the results, similar studies should be conducted for different patient groups in order to strengthen the results.

Introduction: Fatigue is a prevalent symptom that is associated with various conditions. In patients with chronic heart failure (CHF), fatigue is one of the most commonly reported and distressing symptoms and it is associated with disease progression. Person-centred care (PCC) is a fruitful approach to increase the patient's ability to handle their illness., Aim: The aim of this study was to evaluate the effects of PCC in the form of structured telephone support on self-reported fatigue in patients with CHF., Method: This study reports a subgroup analysis of a secondary outcome measure from the Care4Ourselves randomised intervention. Patients ( n =77) that were at least 50 years old who had been hospitalized due to worsening CHF received either usual care ( n =38) or usual care and PCC in the form of structured telephone support ( n =39). Participants in the intervention group created a health plan in partnership with a registered nurse. The plan was followed up and evaluated by telephone. Self-reported fatigue was assessed using the Multidimensional Fatigue Inventory 20 (MFI-20) at baseline and at 6 months. Linear regression was used to analyse the change in MFI-20 score between the groups., Results: The intervention group improved significantly from baseline to the 6-month follow-up compared with the control group regarding the 'reduced motivation' dimension of the MFI-20 (Δ -1.41 versus 0.38, p =0.046)., Conclusion: PCC in the form of structured telephone support shows promise in supporting patients with CHF in their rehabilitation, improve health-related quality of life and reduce adverse events., Trial Registration: ISRCTN.com ISRCTN55562827.

Background: Cancer-related fatigue (CRF) is considered to be one of the most common symptoms reported by cancer patients. However, little information is available regarding the variables associated with CRF among Jordanian patients., Aims: To assess the prevalence of CRF and explore its predictors among Jordanian patients., Methods: A cross-sectional survey design was used., Findings: Of the 240 patients surveyed, 210 (87.5%) had fatigue at the time of the survey. The total mean fatigue score was 6.2 (SD=1.7) out of a maximum possible score of 10. The results also showed that being unemployed, with longer hospitalisation, low haemoglobin, and having lung cancer seem to predict higher levels of CRF., Conclusion: Several variables and factors associated with CRF were identified. In response to these results, healthcare providers should pay more attention to CRF, which needs to be assessed on a regular basis and to be managed with the available pharmacological and non-pharmacological interventions.

The National Institutes of Nursing Research provides funding via the P20 grant mechanism for research infrastructure and resources to develop nurse scientists with expertise in symptom self-management. The Medical University of South Carolina College of Nursing was awarded a P20 grant in 2016 to build the Symptoms Self-Management Center for technology-enhanced interventions to address pain and fatigue in individuals with chronic health conditions. Resources were derived from three key subcores: bioinformatics, mHealth and eHealth consultative services, and community engagement. This paper describes methods for deriving specific resources within each subcore, the application of subcore resources in two pilot studies, and lessons learned during the early phases of our Symptoms Self-Management Center implementation., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Children undergoing cancer treatment are less active than healthy peers. Inactivity persists into survivorship, negatively influencing health and quality of life. Fatigue is one of the most prevalent symptoms during treatment yet children with increased physical activity (PA) have less fatigue. This pilot study evaluated the impact of coaching on PA and fatigue in children undergoing cancer treatment delivered by pediatric oncology nurse practitioners (NPs) during routine clinic visits. NPs used motivational interviewing during clinic visits to coach children and their families on strategies to increase PA at home. Self-report measures of PA and fatigue were completed at treatment months 2, 4, and 6. PA was also measured using actigraphy. Among 30 children ages 6 to 18 years, 7 had acute lymphoblastic leukemia (ALL), 11 had lymphoma, and 12 had solid tumors. Patterns of fatigue were different by disease group with trends to fatigue decreasing during treatment in the patients with ALL ( p = .09) and lymphoma ( p = .13) but increasing in those with solid tumors ( p = .06). Self-report PA was unchanged. Actigraph measurements remained stable for the group. NPs reported time challenges in implementing coaching during the clinic visit and in providing coaching continuity. The intensive, repeating chemotherapy cycles in solid tumor treatment may contribute to increasing fatigue. Treatment intensity decreases during ALL and lymphoma treatment, which may allow for improvement in fatigue. Inactivity persisted during treatment but did not progress. Future research is needed to evaluate more "dose-intensive" PA interventions in larger samples of specific disease groups.

This report is a secondary analysis of data from a larger study of a nurse-led early therapeutic mobility intervention among patients receiving mechanical ventilation. This analysis evaluated whether intervention frequency or intensity was associated with pain or fatigue. Frequency was defined as once-daily versus twice-daily interventions. Intensity was defined as low (in-bed activities) or moderate (out-of-bed activities). Thirty-nine patients self-reported pain and fatigue immediately before and after the intervention. Neither pain nor fatigue increased significantly (mean increase, <1 [scale of 0-10] for 95% of interventions). Four patients reported decrements in pain; 1 reported a decrease in fatigue. Less than 5% of enrolled patients indicated a score change of +4 to +6 for pain or fatigue, typically with the first intervention that included sitting at the edge of the bed. Future research could examine the distress associated with these symptoms in critically ill adults receiving early therapeutic mobility interventions., (©2019 American Association of Critical-Care Nurses.)

Aim: To explore symptom clusters experienced by patients with oesophageal cancer 3 months after surgery and examine whether symptom clusters are related to demographic, clinical and quality of life variables., Background: There are multiple symptoms in patients with oesophageal cancer after surgery, which seriously affect their quality of life. Exploring the mechanics of concurrent symptoms such as symptom clusters may facilitate the development of strategies to reduce the impact of these symptoms and improve quality of life., Design: Cross-sectional survey. The STROBE Statement was chosen as the EQUATOR checklist., Methods: A convenience sample of 128 oesophageal cancer patients was followed up at 3 months after surgery. Participants completed the demographic questionnaire, the M. D. Anderson Symptom Inventory for Gastrointestinal Cancer, the Functional Assessment of Cancer Therapy-General and the Connor-Davidson Resilience Scale. Exploratory factor analysis, stepwise regression and correlation analysis were applied., Results: Four symptom clusters were identified: dysphagia-psychological, chemoradiotherapy side-effect, digestive tract reconstruction and fatigue-sleep. Gender, stage of disease and resilience influenced the dysphagia-psychological symptom cluster. Gender, stage of disease, resilience and treatment were significant factors affecting the chemoradiotherapy side-effect and fatigue-sleep symptom clusters. Gender, stage of disease, resilience and anastomotic position were significant factors influencing the digestive tract reconstruction symptom cluster. The correlations between symptom clusters and quality of life were significant, with the highest correlation between the dysphagia-psychological cluster and quality of life., Conclusions: Nurses should pay more attention to symptom management in patients with oesophageal cancer 3 months after surgery by focusing on four symptom clusters. It is necessary to implement individualised care depending on the influence factors including gender, stage of disease, resilience, treatment and anastomotic position., Relevance to Clinical Practice: These findings will help develop targeted interventions to facilitate further symptom management for transitional nursing from the peri-operative phase to long-term rehabilitation., (© 2019 John Wiley & Sons Ltd.)

Using Walker and Avant's approach, a concept analysis was performed to develop a working definition of caregiver fatigue. Defining attributes of caregiver fatigue identified were "fell into role" by default, outside the norm of role expectations, excess caregiving demand, and exposure to prolonged period of caregiving. Model, related, and contrary cases were developed. Antecedent, consequences, and empirical referent of caregiver fatigue were also identified. Lastly, a working definition of caregiver fatigue was developed.

Background: Fatigue is a common symptom experienced by people with cancer and other long-term, non-malignant conditions. It can be disease-related or caused by treatments such as chemotherapy or radiotherapy. Patients frequently report this as a distressing symptom and, while some international guidelines for its management exist, evidence suggests that these are not always implemented., Method: This article reviews the evidence basis for fatigue management, looking at exercise, education, psychological interventions, complementary therapies and pharmacological therapy, and finds that a one-size fits all approach to fatigue management is unrealistic., Findings: Research appears to support different interventions at various points in the disease trajectory and this is of importance for service design as palliative care is increasingly introduced earlier in the patient's pathway., Conclusion: Although the body of research is growing, management of fatigue caused by non-malignant conditions remains poorly evidenced, making comprehensive recommendations for these patient groups even more challenging.

Aims and Objectives: To explore nursing interventions used among patients with cancer and summarise the results of their effectiveness. The ultimate goal was to improve the quality of care and provide best evidence for clinicians to refer to while developing effective nursing interventions., Background: Nursing interventions refer to actions that nurses take with the aim of improving the well-being of people with cancer-related health and care needs. A plethora of systematic reviews has been conducted in this research area, although with scattered results. We conducted a comprehensive review to identify and summarise the existing evidence., Methods: This overview of systematic reviews adheres to the PRISMA guidelines. The PubMed, CINAHL, MEDLINE and Scopus databases were searched. Nine reviews reporting findings from 112 original studies published 2007-2017 met the selection criteria. The results of intervention effectiveness were analysed using descriptive quantification and a narrative summary of the quantitative data., Results: The effectiveness of educational nursing interventions was inconsistent on quality of life (QoL), attitudes, anxiety and distress, but positive on level of knowledge, symptom severity, sleep and uncertainty. Psychosocial nursing interventions had a significant effect on spiritual well-being, meaning of life, fatigue and sleep. Psychological nursing interventions reduced cancer-related fatigue. Nursing interventions supporting patients' coping had a significant impact on anxiety, distress, fatigue, sleep, dyspnoea and functional ability. Activity-based interventions may prevent cancer-related fatigue., Conclusions: Nursing interventions achieved significant physical and psychological effects on the lives of patients with cancer. Multidimensional nature of interventions by combining different elements reinforces the effect. Priorities for future research include identifying the most beneficial components of these interventions., Relevance to Clinical Practice: Implementation of these nursing interventions into clinical practice is important to improve patients' knowledge and QoL as well as reducing various symptoms and side effects related to cancer and its treatment., (© 2018 John Wiley & Sons Ltd.)

Background: The integration of palliative care into standard oncology care is supported by research to improve quality of life and symptom distress in patients with advanced cancer. In 2016, the American Society of Clinical Oncology (ASCO) released practice guidelines for oncology palliative care that emphasized interprofessional assessment and management of this patient population., Objectives: The purpose of this study was to evaluate the effect of clinical guidelines on symptom distress in patients with advanced cancer., Methods: In two oncology palliative care clinics, the Edmonton Symptom Assessment Scale (ESAS) scores for pain, fatigue, and anxiety were measured prior to consultation (T1) and at two subsequent visits (T2 and T3). A standardized documentation template was used to measure fidelity for key guideline components., Findings: Pain, fatigue, and anxiety ESAS scores were statistically lower from T1 to T3. The frequency of patients having a decrease of 2 or more points for all symptoms increased compared to baseline data. There was 100% compliance to the documentation template during the guideline implementation.

Objectives: To provide an overview of the symptoms commonly experienced by patients with malignant glioma, and discuss the pathophysiology and interventions associated with those., Data Sources: A review of published scientific literature and clinical literature, and online information from National Comprehensive Cancer Network, Oncology Nursing Society, Epilepsy Foundation of America, and the American Brain Tumor Association., Conclusion: The unique symptom burden associated with a malignant glioma diagnosis often disrupts the lives of patients and their caregivers. Clinical support and interventions addressing malignant glioma-related focal deficits, seizures, headaches, venous thromboembolism, mood disturbances, fatigue, and sleep-wake disturbance can positively impact patient and caregiver experiences while living with malignant glioma., Implications for Nursing Practice: Understanding the pathophysiology of these symptoms and reviewing nursing-led and supported interventions will empower the nurse in providing comprehensive care to patients with malignant glioma and their caregivers., (Copyright © 2018. Published by Elsevier Inc.)

Objectives: This project aimed to identify and promote evidence-based practice in the management of cancer related fatigue (CRF) in the oncology unit of Nanfang Hospital, affiliated with the Southern Medical University in People's Republic of China., Introduction: Cancer-related fatigue is one of the most common symptoms in patients with cancer and significantly affects their functioning and quality of life. However, it is often inadequately addressed and evidence-based practices are not always followed., Methods: The Joanna Briggs Institute (JBI) has a validated audit and feedback tool to assist with best practice implementation audits. The JBI Practical Application of Clinical Evidence System (PACES) was used in this project. A three-phase project was undertaken: i) a pre-implementation audit of current practice against evidence-based audit criteria, ii) identification of barriers and implementation of strategies to improve practice using the JBI Getting Research into Practice (GRiP) tool and iii) a post-implementation audit., Results: The baseline audit results identified non-compliance to best practice in all areas of CRF. Strategies to improve practice involved relevant education for nurses, establishment of a CRF management routine and related documentation systems and displaying and distributing educational materials for the patients. Improved compliance was shown across all audit criteria in post-evaluation., Conclusions: The implementation of institution specific evidence-based resources demonstrated immediate improvement in CRF management and practice. Continuous effort is required to maintain changes and further improve practice. Future projects should focus on measuring the impact of changed practice on patient outcomes.

Purpose: To review how the Multidimensional Assessment of Fatigue (MAF) has been used and evaluate its psychometric properties., Methods: We conducted a database search using "multidimensional assessment of fatigue" or "MAF" as key terms from 1993 to 2015, and located 102 studies., Results: Eighty-three were empirical studies and 19 were reviews/evaluations. Research was conducted in 17 countries; 32 diseases were represented. Nine language versions of the MAF were used. The mean of the Global Fatigue Index ranged from 10.9 to 49.4. The MAF was reported to be easy-to-use, had strong reliability and validity, and was used in populations who spoke languages other than English., Conclusion: The MAF is an acceptable assessment tool to measure fatigue and intervention effectiveness in various languages, diseases, and settings across the world.

Objective: To evaluate the accuracy of the defining characteristics of the nursing diagnosis for "fatigue in women with breast cancer under radiotherapy"., Method: Study of diagnostic accuracy, with cross-sectional design, performed in 130 women with breast cancer under radiation treatment. A data collection instrument was used to evaluate clinical socio-demographics and to investigate the presence or absence of defining characteristics for fatigue. The latent class analysis model was applied to assess accuracy measurements of the characteristics identified., Results: Fatigue diagnosis was present in 21.9% of the women. The characteristic which showed the highest sensitivity was "Impaired capacity in maintaining the usual level of physical activity", while "Impaired capacity in maintaining usual routines" and "Lack of interest about the surrounding environment" presented greater specificity., Conclusion: Accurate diagnostics allow devising an action plan directed to the patients' real needs.

This study aimed to explore an evidence-based nursing practice model of CRF management in hospitalized adult patients using the PARIHS evidence-implementation framework as the theoretical structure to provide guidance for similar nursing practices. The implementation of guideline evidence into clinical practice was conducted on the oncology and radiotherapy wards of a university-affiliated hospital. The process of integrating the guideline into the symptom management system of cancer patients was described. The impact of the evidence implementation was evaluated from three aspects: organizational innovations and outcome measures associated with nurses and with patients pre- and post-evidence implementation. During the implementation of evidence into practice on the wards, a nursing process, health education, a quality control sheet and CRF training courses were established. Through this implementation, compliance with evidence related to CRF increased significantly on the two wards, with that of ward B being higher than that of ward A. Regarding nursing outcomes, nursing knowledge, attitude and behavior scores with respect to CRF nursing care increased substantially after its application on the two wards, and the ward B nurses' scoring was higher than that of the ward A nurses. Qualitative analysis concerning the nurses suggested that leadership, patient concern about CRF management, and the need for professional development were the main motivators of the application, whereas the shortage and mobility of nursing human resources and insufficient communication between doctors and nurses were the main barriers. Additionally, most nurses felt more professional and confident about their work. Regarding patient outcomes, patient knowledge, attitude and behavior scores regarding CRF self-management increased significantly. Patients' post-implementation CRF was alleviated compared with the pre-implementation treatment cycle. The PARIHS framework may provide instructive guidance for the incorporation of evidence into practice, and the process-oriented framework might provide greater operational utility of the application.

Background and Purpose: Postpartum fatigue is one of the most common complaints among women following childbirth. As a postpartum ritual practice, Taiwanese women refrain from taking showers while "doing the month." However, warm showers are the systemic application of moist heat, and they maintain physical hygiene, stimulate blood circulation, mitigate discomfort, and provide relaxation. As Taiwanese society becomes increasingly receptive to scientific and contemporary health care practice, more and more women choose to take warm showers after childbirth. The purpose of this study was to evaluate the efficacy of warm showers on postpartum fatigue among vaginal-birth women in Taiwan., Methods: This was a two-group quasi-experimental design. Women took showers in warm water with temperatures ranging between 40 °C and 43 °C for approximately 20 minutes. Postpartum women's fatigue is measured using the 10-item Postpartum Fatigue Scale (PFS). The intervention effect was analyzed using a generalized estimating equation (GEE) model., Results: The study population consisted of 358 vaginal-birth postpartum Taiwanese women aged 20-43 years. Postpartum women who took warm showers showed improvements from their pretest to posttest mean scores of postpartum fatigue compared to postpartum women who did not take warm showers. Warm showers helped to reduce postpartum fatigue among vaginal-birth women during the study period., Implications for Practice: Nurses have the unique opportunity to provide the intervention to Taiwanese women who have vaginal birth to help them relieve postpartum fatigue with warm showers while "doing the month" without the taboo of no-showering customary practices in the early postpartum period.

Background: Robust research evidence should inform clinical practice of inflammatory bowel disease [IBD] specialist nurses, but such research is currently very limited. With no current agreement on research priorities for IBD nursing, this survey aimed to establish topics to guide future IBD nursing research across Europe., Methods: An online modified Delphi survey with nurse and allied health professional members of the Nurses European Crohn's and Colitis Organisation [n = 303] was conducted. In Round One, participants proposed topics for research. In Round Two, research topics were rated on a 1-9 scale and subsequently synthesised to create composite research questions. In Round Three, participants selected their top five research questions, rating these on a 1-5 scale., Results: Representing 13 European countries, 88, 90 and 58 non-medical professionals, predominantly nurses, responded to Rounds One, Two and Three, respectively. In Round One, 173 potential research topics were suggested. In Rounds Two And Three, responders voted for and prioritised 125 and 44 questions, respectively. Round Three votes were weighted [rank of 1 = score of 5], reflecting rank order. The top five research priorities were: interventions to improve self-management of IBD; interventions for symptoms of frequency, urgency and incontinence; the role of the IBD nurse in improving patient outcomes and quality of life; interventions to improve IBD fatigue; and care pathways to optimise clinical outcomes and patient satisfaction., Conclusions: The prioritised list of topics gives clear direction for future IBD nursing research. Conducting this research has potential to improve clinical practice and patient-reported outcomes., (Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com)

Chest pain and palpitations, non-malignant pain, breathlessness and fatigue often endure despite the receipt of appropriate nursing and medical care. This is distressing for patients, impacts on their quality of life and ability to function and is associated with high healthcare usage and costs. The cognitive behavioural approach offers nurses a model to understand how people's perceptions and beliefs and their emotional, behavioural and physiological reactions are linked. Common 'thinking errors' which can exacerbate symptom severity and impact are highlighted. Understanding of this model may help nurses to help patients cope better with their symptoms by helping them to come up with alternative more helpful beliefs and practices. Many Improving Access to Psychological Therapy services offer support to people with chronic physical symptoms and nurses are encouraged to sign post patients to them.

Objective: This article describes the profound impact of fatigue and the process by which 1 academic medical center assessed fatigue levels, and associated factors, among nursing personnel in their effort to develop a comprehensive fatigue management program., Background: To adequately perform amid high patient acuity and in today's fast paced healthcare environment, nurses must be attentive and react quickly and appropriately with clear judgment and reasoning-abilities that can be greatly impaired by fatigue. Nursing leaders are instrumental in systematically addressing work-related fatigue and implementing processes designed to prevent fatigue and overwork; however, baseline measures are necessary if the efficacy of these initiatives is to be assessed., Methods: The 15-item Occupational Fatigue Exhaustion/Recovery scale was used to assess current fatigue levels among nursing staff at a university medical center. Demographic and schedule-related questions were used to examine the characteristics of the population and identify any associated factors., Results: Work-related fatigue is prevalent among all nursing staff, but differences were noted based on the respondent's position, age, and typical work shift., Conclusions: Nursing administrators and shared governance councils can address the factors contributing to work-related fatigue and negatively impacting nursing personnel's ability to rest and recuperate. Nurse leader involvement is needed to develop comprehensive fatigue reduction strategies.

In recent years, translational research (TR) has become a new approach for bridging basic research and clinical practice. This article examines studies in which the authors used TR to learn more about the underlying causes of selected symptoms, and to discuss these results in the context of cancer nursing and symptom management. A literature review was undertaken, plus critical analysis of the authors. TR conducted by cancer nursing scholars has been relatively limited in the past, but is becoming more common as nurses complete additional academic work in the basic sciences and develop research teams with colleagues of those areas of knowledge. The goal in these studies is to show how a set of variables explains differential interventional effects. The availability of TR provides new evidence for the management of symptoms experienced by individuals with cancer, which could lead to improvements in the care of cancer patients across the world.

Nonpharmacologic interventions for symptom management in patients with rheumatoid arthritis are underinvestigated. Limited data suggest that aromatherapy massage and reflexology may help to reduce pain and fatigue in patients with rheumatoid arthritis. The aim of this study was to examine and compare the effects of aromatherapy massage and reflexology on pain and fatigue in patients with rheumatoid arthritis. The study sample was randomly assigned to either an aromatherapy massage (n = 17), reflexology (n = 17) or the control group (n = 17). Aromatherapy massage was applied to both knees of subjects in the first intervention group for 30 minutes. Reflexology was administered to both feet of subjects in the second intervention group for 40 minutes during weekly home visits. Control group subjects received no intervention. Fifty-one subjects with rheumatoid arthritis were recruited from a university hospital rheumatology clinic in Turkey between July 2014 and January 2015 for this randomized controlled trial. Data were collected by personal information form, DAS28 index, Visual Analog Scale and Fatigue Severity Scale. Pain and fatigue scores were measured at baseline and within an hour after each intervention for 6 weeks. Pain and fatigue scores significantly decreased in the aromatherapy massage and reflexology groups compared with the control group (p < .05). The reflexology intervention started to decrease mean pain and fatigue scores earlier than aromatherapy massage (week 1 vs week 2 for pain, week 1 vs week 4 for fatigue) (p < .05). Aromatherapy massage and reflexology are simple and effective nonpharmacologic nursing interventions that can be used to help manage pain and fatigue in patients with rheumatoid arthritis., (Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Purpose: Fatigue is the third most common "extraintestinal" complaint of patients with irritable bowel syndrome (IBS), but it is still poorly understood. This study aimed to review characteristics of IBS-associated fatigue and to examine pooled frequency, severity of fatigue, and correlations of related factors with fatigue in IBS via meta-analyses., Methods: Publications were searched in eight databases from 1995 to 2014. Random effects meta-analyses were applied with standard error, weighted effect size, and correlation-based measure of effect size., Results: Twenty-four studies were included in systematic review. Seventeen studies were used for meta-analyses (2 studies were excluded in the frequency of fatigue analysis due to data unavailability). Using "tiredness" to define fatigue, and Fatigue Impact Scale to assess fatigue were the most frequently used across the studies. Gastrointestinal symptoms, psychological distress, and health-related quality of life were the most common correlates with fatigue. The pooled frequency of fatigue was 54.2% [95% confidence interval (38.5, 69.4)]. Metaregression on the frequency of fatigue showed positive and significant relations with tertiary care settings, female sex, and younger age. There was a negatively moderate relationship between the severity of fatigue and health-related quality of life score (correlation-based measure of effect size: -.378)., Conclusions: Fatigue is prevalent among patients with IBS and commonly co-occurs with other symptoms. This is the first study to fully examine fatigue in IBS, which shed light on the comprehensive management of fatigue in this patient group. Future research is warranted to further explore fatigue-related factors and underlying mechanisms of fatigue in IBS., (Copyright © 2016. Published by Elsevier B.V.)

This qualitative study describes the temporal patterns of fatigue found as part of a larger study designed to elicit a description of the experience and self-management of fatigue for patients on hemodialysis. Two patterns of fatigue were identified. The first pattern, continuous fatigue, was characterized by participants who experienced fatigue at all times, which was their normal, baseline feeling. Within this group, two subgroups were identified. The second pattern of fatigue, post-dialysis fatigue only, was characterized by participants who experienced fatigue only after their hemodialysis session. This study is unique because it expands our knowledge about hemodialysis and fatigue by describing the patterns that fatigue follows over time from one hemodialysis session to the next. Insight into these phenomena could help ameliorate fatigue and allow nurses to tailor interventions for patients on hemodialysis.

Unlabelled: Post-stroke fatigue (PSF) is a common and one of the most distressing symptoms in stroke survivors. However, little is known about the relationship between severity of fatigue and the overall impact it has on post-stroke disability and burden of care. We aimed to examine the role of PSF in post-stroke disability and burden of care among stroke survivors after their first-ever stroke., Methods: We prospectively recruited 163 subjects (35 females) from patients examined consecutively in a tertiary stroke care center in India, after their first-ever ischemic or hemorrhagic stroke (>3 months after event). In addition to demographic and clinical characteristics, the following assessments were done - SF-36 vitality domain (fatigue), Modified Rankin Scale (functional recovery), Hospital anxiety and depression scale (depression), Functional independence measure (disability and burden of care). We used path analysis to identify a model that will capture the interactions of fatigue, depression, and degree of functional recovery in stroke survivors., Results: The severity of PSF positively correlated with the severity of disability and PSF had significant contribution to disability over and above functional recovery and depression, with all three factors accounting for 43% of the variance. Among the four models that were proposed to explore these relationships, the best fitting model showed that the effect of PSF is mediated through both the direct effect of fatigue on disability and through its interaction with depression, which remained a separate contributor to post-stroke disability and burden of care., Conclusions: PSF, therefore, is an important determinant of post-stroke disability and should be evaluated for successful post-stroke rehabilitation.

Chronic fatigue--an overwhelming subjective feeling of mental or physical exhaustion--impacts patients' everyday functioning and quality of life, delays recovery after hemodialysis, and increases mortality. There are a number of factors that may perpetuate clinically significant fatigue among individuals with chronic kidney disease, including sleep disorders, depression, sedentary lifestyle, anemia, and chronic inflammation. Some of these factors (i.e., anemia and inflammation) are in the forefront of clinical attention, whereas the other contributing factors often remain unrecognized. This article provides a pragmatic overview of the definition, assessment, maintaining factors, and management of fatigue in chronic kidney disease. Given that chronic fatigue is a major determinant of patients' quality of life, nurses can bring about a fundamental improvement in patients' well-being if they recognize the most common fatigue-perpetuating factors and facilitate fatigue management interventions.

Fatigue, one of the most prevalent and underassessed nonmotor symptoms in patients with Parkinson disease (PD), is reported to be a major cause of disability and reduced quality of life. The purpose of this review was to systematically examine the scientific literature and report how fatigue is defined and measured and what interventions are used to treat it. A synthesis of the current literature will expose the current state of the science of fatigue in PD, propose areas for future research, and offer practice implications. An integrative review of the literature was conducted. The electronic databases CINAHL, Psychinfo, and PUBMED were searched using the keywords "Parkinson's disease," "fatigue," "definition," "mental fatigue," "physical fatigue," "measurement," "interventions," "treatment," and "methylphenidate." One hundred fourteen articles were found. Nineteen studies met review criteria. No universal definition of fatigue in PD was found, making it difficult to measure. However, central, physical, mental, and peripheral fatigues were described. Six scales were found that measure fatigue in PD; only one specific to PD, the Parkinson Fatigue Scale, measured physical fatigue. Seven studies reported interventions to treat fatigue and were categorized as medication, exercise, and alternative interventions. None of these interventions had a significant effect on fatigue. Findings showed that (a) there is a lack of a universally accepted definition of fatigue because of its subjective nature, (b) existing fatigue measurement tools do not measure all types of fatigue in PD, and (c) no intervention had a significant effect on fatigue. There is a need to define and explore fatigue further using qualitative methods. Further development of instruments to measure fatigue in women, younger onset, and older adults with PD is needed. A focus on person-centered interventions to reduce fatigue in patients with PD is a research priority.

The aim of this study was to evaluate the pain and fatigue levels of elderly cancer patients and to examine whether pain is an independent variable in fatigue development. A total of 250 elderly cancer patients undergoing treatment in the outpatient chemotherapy units and internal medicine clinic at 2 hospitals were enrolled. A "Patient Information Form," the "McGill Melzack Pain Questionnaire," and the "Brief Fatigue Inventory" were used as data instruments. It was determined that all patients had pain and that the mean present pain intensity score was 2.70 ± 0.99, the mean worst pain intensity score was 4.40 ± 0.86, and the mean least pain intensity score was 1.40 ± 0.66. Whereas the existing fatigue severity score of the patients with fatigue (43.6%) was 6.27 ± 2.06, the mean usual fatigue severity of the patients in the last 24 hours was 6.19 ± 1.63 and that the mean worst fatigue severity score in the last 24 hours was 7.29 ± 1.57. When the regression analysis carried out between the pain and fatigue intensities is examined, it was determined that pain is an independent variable in increasing fatigue and that there is a statistically significant relationship (P < .05). It is important that nurses develop strategies to prevent and determine activities to decrease the pain and fatigue of the patients while planning and implementing their holistic care in a relevant manner.

Background: The effects of home nursing intervention on the quality of life in patients with nasopharyngeal carcinoma (NPC) after radiotherapy and chemotherapy are unclear. According to the characteristics of nursing home patients with nasopharyngeal carcinoma, we should continuously improve the nursing plan and improve the quality of life of patients at home., Materials and Methods: We selected 180 patients at home with NPC after radiotherapy and chemotherapy. The patients were randomly divided into experimental and control groups (90 patients each). The experimental group featured intervention with an NPC home nursing plan, while the control group was given routine discharge and outpatient review. Nursing intervention for patients was mainly achieved by regular telephone follow-up and home visits. We use the quality of life scale (QOL-C30), anxiety scale (SAS) and depression scale (SDS) to evaluate these patients before intervention, and during follow-up at 1 month and 3 months after the intervention., Results: Overall health and quality of life were significantly different between the groups (p<0.05), Emotional function score was significantly higher after intervention (p<0.05), as were cognitive function and social function scores after 3 months of intervention (p<0.05). Scores of fatigue, nausea and vomiting, pain, appetite and constipation were also significantly different between the two groups (p<0.05). Rates of anxiety and depression after 3 months of intervention were 11.1%, 22.2% and 34.4%, 53.3%, the differences being significant (p<0.05)., Conclusions: NPC home nursing plan could effectively improve overall quality of life, cognitive function, social function (after 3 months) of patients, but improvement regarding body function is not suggested. Fatigue, nausea and vomiting, pain, appetite, constipation were clearly improved. We should further pursue a personalized, comprehensive measurements for nursing interventions and try to improve the quality of life of NPC patients at home.

Introduction: Sleepiness during the work shift is common and can be hazardous to workers and, in the case of nurses, to patients under their care. Thus, measuring sleepiness in occupational studies is an important component of workplace health and safety. The Karolinska Sleepiness Scale (KSS) is usually used as a momentary assessment of a respondent's state of sleepiness; however, end-of-shift measurement is sometimes preferred based on the study setting. We assessed the predictive validity of the KSS as an end-of-shift recall measurement, asking for "average" sleepiness over the shift and "highest" level of sleepiness during the shift., Method: Hospital registered nurses (N=40) working 12-h shifts completed an end-of-shift diary over 4 weeks that included the National Aeronautical and Space Administration Task Load Index (NASA-TLX) work intensity items and the KSS (498 shifts over 4 weeks). Vigilant attention was assessed by measuring reaction time, lapses, and anticipations using a 10-min performance vigilance task (PVT) at the end of the shift. The Horne-Ostberg Questionnaire, Epworth Sleepiness Scale, General Sleep Disturbance Scale, and Cleveland Sleep Habits Questionnaire were also collected at baseline to assess factors that could be associated with higher sleepiness. We hypothesized that higher KSS scores would correlate with vigilant attention parameters reflective of sleepiness (slower reaction times and more lapses and anticipations on a performance vigilance task) and also with those factors known to produce higher sleepiness. These factors included the following: (1) working night shifts, especially for those with "morningness" trait; (2) working sequential night shifts; (3) having low physical and mental work demands and low time pressure; (4) having concomitant organic sleep disorders; and (5) having greater "trait" sleepiness (Epworth Sleepiness Scale). Linear mixed models and generalized linear mixed models were used to test associations that could assess the predictive validity of this format of administering the KSS., Results: Greater sleepiness, as measured by higher KSS scores, was found on shifts with nurses working night shift, the third sequential night compared to the first, those with sleep disorder symptoms (especially insomnia), and in nurses with trait sleepiness on the Epworth scale. Less sleepiness (lower KSS scores) was seen in shifts with a high level of time pressure and in nurses with a biologic predisposition to be more alert in the morning (morningness trait) who worked the day shift., Conclusion: We found partial support for using the Karolinska Sleepiness Scale in the recalled format based on our multiple tests of predictive validity.

The goal of the Patient-Reported Outcomes Measurement Information System (PROMIS) is to create efficient, reliable, and valid assessments of adult and child health. The nursing science literature in which PROMIS measures are used is rapidly expanding. Investigators have been encouraged to consider the integration of PROMIS measures into both descriptive studies and clinical trials. Doing this has created opportunities and challenges for investigators. This article highlights three projects to show the perspectives of nurse scientists who incorporated PROMIS measures into their research. The first project describes advantages of PROMIS to allow for comparisons of a study population with a national sample and to compliment legacy measures. The second project examines issues in the translation of tools for region-specific Hispanic populations. The third project provides a perspective on the use of PROMIS measures to capture cancer-related fatigue and to develop new components of a sexual function scale. As indicated by these three examples, nurse scientists can contribute an important role in moving the PROMIS initiative forward. Results from these types of projects also move symptom science forward within a more interdisciplinary approach to common measures of interest., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The purpose of this article was to highlight innovative analytic approaches in symptom science. Complex systems modeling is discussed using fatigue as an example. Fatigue is a common symptom among individuals of any age. It can be acute or chronic, and it can vary across the day and on weekends compared with weekdays. Fatigue can overlap with other symptoms, has many dimensions, and impacts daily function as well as society at large. With the complexities surrounding symptom science, innovative models are needed to advance our understanding of factors within the person, contextual and situational factors, and workplace or health care system factors that impact the symptom experience. Advances in methodologies, such as complex systems modeling, allow for more innovative methods to study the complexities of the symptom experience, design better ways to intervene and manage symptoms, and ultimately improve outcomes related to symptom management, quality of life, and health care utilization., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose/objectives: To examine healthcare providers' (HCPs') perceptions of the supportive care needs of men with advanced prostate cancer (APC)., Research Approach: A qualitative, descriptive study., Setting: Healthcare facilities caring for men with APC in a south-central region of Ontario., Participants: 19 nurses, physicians, and allied health providers who cared for men with APC in outpatient settings., Methodologic Approach: Interviews and focus groups., Findings: HCPs identified four themes related to men's supportive care needs: pain and symptom management, informational needs, emotional needs, and the need for practical assistance. HCPs emphasized issues related to pain, urinary incontinence, and fatigue. They also reported that men continually ask for more information related to treatment, side effects, and prognosis. PARTICIPANTS identified a variety of barriers in meeting supportive care needs, including lack of management strategies, poor knowledge retention, and the "stoic and old-school" nature of men in this population., Conclusions: Supportive care for this population can be improved through more focused implementation of interprofessional care, with clearly defined professional roles and additional specialized roles to address prostate cancer pain, urinary incontinence, and fatigue., Interpretation: Specialized roles in the management of pain, urinary incontinence, and fatigue affecting men with APC could be integrated into interprofessional care to meet supportive care needs.

Purpose/objectives: To explore the symptom experience, coping strategies, and children's descriptions of their quality of life (QOL) after treatment for a brain tumor., Research Approach: An interpretive descriptive qualitative study., Setting: A pediatric hospital setting in Ontario, Canada., Participants: 12 children aged 9-18 years., Methods: Content analysis of semistructured interviews was guided by interpretive description methodology., Findings: Children described symptoms including feeling tired, pain, headaches, emotional problems, difficulty thinking and remembering, problems with sleep, physical problems, and weight changes. Symptoms interfered with physical activity, keeping up with school, maintaining appearances, and communication. Coping strategies included reconditioning, taking breaks, taking medication, challenging themselves, volunteering, maintaining friendships, laughing, and using aids., Conclusions: Survivors experienced multiple symptoms that had an effect on their life, but overall, they described good QOL., Interpretation: Caregivers need to understand the complexity of their patient's symptom experience and its impact on his or her daily life. Coping strategies can be identified to help mitigate potentially negative QOL outcomes.

Purpose/objectives: To explore the symptom trajectory during the first 16 months of childhood leukemia treatment and any associations with the oxidative stress pathway measured by cerebrospinal fluid (CSF) concentration of oxidized phosphatidylcholine (PC), the predominant glycerophospholipid in the brain and cell membranes., Design: Prospective, longitudinal design., Setting: Two cancer centers in the southwestern United States., Sample: 36 children (aged 3-14 years) newly diagnosed with acute lymphoblastic leukemia., Methods: Symptoms were measured using the Memorial Symptom Assessment Scale at six specific time points during treatment. Biochemical changes in oxidative stress were measured by oxidized PC in the CSF., Main Research Variables: Childhood cancer symptoms, oxidized PC., Findings: Significant differences were found in the number of symptoms experienced during the three phases of treatment. Symptom trajectory changes and influence of the oxidative stress pathway on symptom experiences were identified., Conclusions: Symptoms experienced during treatment for childhood leukemia are associated with increased oxidative stress., Implications for Nursing: Children with leukemia experience symptoms throughout treatment. Physiologic measures indicate the influence of oxidative stress on symptoms.

Measures exist to numerically represent degrees of attributes. Quantitative research is based on measurement and is conducted in a systematic, controlled manner. These measures enable researchers to perform statistical tests, analyze differences between groups, and determine the effectiveness of treatments. If something is not measurable, it cannot be tested.

Problem Identification: To summarize the current state of nursing knowledge related to the association of multiple chronic conditions (MCCs) and cancer-related fatigue (CRF) in patients with solid tumors during chemotherapy., Literature Search: A systematic literature search of PubMed, CINAHL®, EMBASE, Cochrane, and ProQuest Dissertations and Theses for primary nursing research from January 2000 to June 2012 that examined the prevalence and/or severity of CRF with MCCs or a single comorbidity.Data Evaluation: The studies were appraised for the clarity and focus of the research question and the appropriateness of the method and research design. A 13-item quality criteria checklist evaluated the data from each article on a 0-2 scale (0 = poor, 1 = fair, 2 = good)., Data Analysis: Of 329 abstracts, 21 studies were included in the analysis. The association of MCC and CRF was mostly reported in aggregate, with a mean of three MCCs per patient.Presentation of Findings: Having one or more other comorbidities was significantly associated with the prevalence and severity of CRF. Specifically, arthritis, hypertension, and cardiac disease, although not consistently or clinically defined across studies, are associated with an increased prevalence and severity of CRF. The association of MCC and CRF prevalence and severity was inconsistent because of the variability in the measures used and the time span identified to measure changes., Implications for Nursing Practice: Awareness of the prevalence of MCCs is essential to support patients experiencing CRF. Holistic nursing assessment of the patient's symptoms-with an awareness of MCCs-would help improve symptom management to limit the effect of CRF.

Aims and Objectives: To determine the incidence of pregnancy-related physical symptoms in healthy pregnant women and their management strategies., Background: In normal progression of pregnancy, many symptoms were experienced. Pregnancy-related physical symptoms may have a negative effect on pregnant women's quality of life. However, pregnant women avoid taking medications from the fear that the medication they use may have a harmful effect on the foetus. Therefore, they practise nonpharmacological methods to help them manage their pregnancy-related physical symptoms., Design: This study used a comparative and descriptive design., Methods: The study population comprised of pregnant women who were visiting for routine check-up and/or examination in the obstetrics gynaecology outpatient clinics of three hospitals in Erzurum, Turkey. The data were collected via a questionnaire including socio-demographic items and questions to identify the pregnancy-related physical symptoms that they experienced and their management strategies., Results: The top three most reported complaints were nausea-vomiting (87·8%), fatigue (77·9%) and breast pain-tenderness (76·2%) during the first trimester, whereas polyuria (79·9%, 88·4%), fatigue (75·6%, 88·4%) and heart burn (71·3%, 81·8%) during the second and third trimesters. Depending on the symptoms, the pregnant women either did nothing or took correct, incorrect or empirical actions to manage their problems. Data revealed that the major source of knowledge was based on their previous experience and that of close relatives. As their education level increased, the percentage of women taking scientifically proven action to correct the problem increased., Conclusions: Various physical symptoms were experienced by women in each trimester of pregnancy. The majority of the women did not do anything to alleviate their physical symptoms., Relevance to Clinical Practice: Midwives and nurses should question the strategies used by pregnant women. In this way, the inappropriate and incorrect practices can be determined, and education on the appropriate practices can be provided., (© 2013 John Wiley & Sons Ltd.)

Background: Exhaustion, a consequence of prolonged stress characterized by unusual fatigue, is associated with increased risk of cardiac morbidity and mortality. In patients recovering from coronary artery bypass (CABG), little is known about the relationship of 1) immune-mediated inflammation and resultant endothelial activation, and 2) cumulative exposure to infectious pathogens (pathogen burden (PB)) implicated in coronary atherosclerosis to exhaustion., Aim: The aim of this exploratory study was to investigate the association of PB, inflammatory markers (interleukin (IL)-6, IL-10) and a marker of endothelial activation (soluble intercellular adhesion molecule-1 (sICAM-1)) to exhaustion., Methods: One to two months post-CABG, 42 individuals who met inclusion criteria were assessed for exhaustion using the Maastricht Interview for Vital Exhaustion. Serum IgG antibodies to herpes simplex virus (HSV)-1, HSV-2, cytomegalovirus, Epstein Barr virus, and inflammatory and endothelial activation markers were measured by enzyme-linked immunosorbent assay. Pathogen burden was defined as the total number of seropositive exposures: low (0-1), moderate (2-3), and high (4)., Results: Prevalence of exhaustion was 40.5%. Relative to non-exhausted patients, exhausted patients demonstrated a higher frequency of moderate PB (h=0.73, p=0.04) but lower frequency of high PB (h=1.05, p=0.03). Exhaustion showed a non-significant trend for positive correlations with IL-6 and sICAM-1 levels, and inverse relation to PB. In subgroup analysis, exhausted patients had stronger correlations with IL-6 and IL-6:IL-10 and a tendency towards higher serum IL-10 concentrations compared with their non-exhausted counterparts., Conclusion: This hypothesis-generating study provides preliminary evidence that elevated post-CABG exhaustion may be associated with PB, inflammation, and endothelial activation.

Background: A calibrated easy-to-use symptom checklist for children who are under treatment for cancer had been developed and reported in Cancer Nursing. The 30-item Therapy-Related Symptom Checklist for Children (TRSC-C) has good measurement and psychometric properties and uses "kid-friendly" terms to monitor symptom occurrence and severity during oncology treatment. A secondary analysis is reported using participants who self-identified as Hispanic., Objective: The objective of this study was to examine among Hispanic pediatric oncology outpatients (a) occurrence and (b) severity of symptoms reported on the TRSC-C, (c) relationships of symptoms to gender and age (<12 vs ≥12), and (d) differences in summated TRSC-C symptom scores between patients with acute lymphoblastic leukemia (ALL) and other diagnoses., Method: This was a cross-sectional analysis using secondary data and descriptive statistics., Sample: The sample was composed of 79 children (55% male) aged 5 to 17 years (mean, 10.3 years) with diagnosis of ALL (52%) or other (48%). Instrument used was TRSC-C by patient/parent report (Cronbach's α = .91)., Results: (a) Symptom occurrence: 15 symptoms on the TRSC-C were reported by 40% or greater. (b) Severity means on 11 symptoms were greater than "a little bit." (c) No gender or age differences were found on mean TRSC-C summated scores. (d) Mean TRSC-C scores (symptom occurrence and severity) were slightly lower but not significantly different (t = 1.71) between ALL (13.71 [SD, 8.06]) and other diagnoses (15.71 [SD, 7.01])., Conclusion: Symptom occurrence and severity reported on the TRSC-C by this Hispanic subsample are consistent with findings in the calibration study and with those of another Hispanic group and other ethnicities., Implications for Practice: Use of the TRSC-C is appropriate during pediatric oncology treatment and diagnoses of Hispanic populations.

The aim of our study was to examine whether a training program for family caregivers of neurological patients has effects on the relatives' depression, prostration, and subjective burden. Fourteen caregivers who participated in a special training program in a German regional neurological rehabilitation hospital and 14 caregivers in the control group were assessed with the Geriatric Depression Scale, the prostration scale of the Giessen Discomfort Questionnaire, and the Caregiver Burden Scale after admission, before discharge, and 1 month after discharge in a telephone interview. Mean depression, prostration, and burden scores were relatively low in both groups. There were no significant variations of depression scores over time within both groups. We found a significant reduction of prostration scores over the three measurement points in the control group. The decrease of the total burden score within the intervention group had a high effect size. Patients in both groups improved remarkably in their Barthel indices. The low psychological complaints in both groups might be associated with a cohort effect. In elderly caregivers, self-disclosure is regarded more negatively compared with younger people. The remarkable improvement of patients in both groups might have been supported by the presence of their caregivers during rehabilitation.

Background: Comparing subgroups with different patterns of change in symptom intensity would assist in sorting out individuals at risk for more severe symptoms and worse functional outcomes., Objectives: The objectives of this study were to identify and compare subgroups of breast cancer patients with different patterns of change in a psychoneurological symptom cluster intensity across the treatment trajectory., Methods: This secondary analysis used the data from 160 breast cancer patients undergoing chemotherapy or radiation treatment. Psychoneurological symptom cluster intensity was a composite score of 5 symptoms (depressed mood, cognitive disturbance, fatigue, insomnia, and pain) in a psychoneurological cluster at each of 3 time points (ie, at baseline and at 2 follow-ups after chemotherapy or radiation treatment)., Results: Five distinct subgroups representing different patterns of psychoneurological symptom cluster intensity during breast cancer treatment were identified: the gradually increasing pattern subgroup (group 1), the constantly low pattern subgroup (group 2), the start low with dramatic increase and decrease pattern subgroup (group 3), the constantly high pattern subgroup (group 4), and the start high with dramatic decrease and leveling pattern subgroup (group 5). Patients without previous cancer treatment experience, with higher level of education, treated with chemotherapy, and/or with more limitations at the baseline were more likely to follow the pattern group 4. Patients in group 4 had the most serious functional limitations measured at the second follow-up time point., Conclusion: The results suggest the need to evaluate interventions for specific subgroups and to examine the causal mechanisms underlying a psychoneurological symptom cluster., Implication: Clinicians should consider these diverse symptom experiences for assessment/management.

Background: Because of a rise in incidence and more effective treatments, the prevalence of patients with metastatic cancer is increasing fast. When palliative treatment is aimed at maintaining or improving patients' quality of life, knowledge about severe fatigue is clinically relevant because of its debilitating effect, but at present this information is lacking., Objective: This study investigated the prevalence of severe fatigue in patients with various incurable cancers and whether severe fatigue increased with further treatment lines and differed between various cancers and treatment modalities. In addition, a relationship between severe fatigue and other symptoms was examined., Methods: Patients were asked to fill in the Checklist Individual Strength, European Organization of Research and Treatment of Cancer-Quality of Life Questionnaire C30, and the McGill Pain Questionnaire during palliative anticancer treatment, and hemoglobin levels were collected., Results: Of all participating patients (n = 137), 47% were severely fatigued. Patients who received first line of treatment were significantly less often severely fatigued (40%) compared with patients who received further lines (60%). Significantly more severe fatigue was observed when patients had more pain, dyspnea, appetite loss, nausea, vomiting, and constipation., Conclusions: During the phase of palliative anticancer treatment, fatigue was the most common symptom, nearly half of the patients had severe fatigue increasing with further treatment lines. Various treatment-related symptoms were related to more severe fatigue., Implications for Practice: As severe fatigue is significantly related to other symptoms of cancer and its treatment, the screening and treatment of these cancer-related symptoms should be more stringent, as they might negatively influence each other.