Nurse-Guided Symptom Management Improves Fatigue in Advanced Cancers

Fatigue in patients with advanced cancer may be alleviated by systematically managing other physical symptoms, such as pain, nausea, and lack of appetite, according to findings of a new study that examined the impact on fatigue of a nurse-coordinated, patient-tailored treatment (PTT) protocol (J Clin Oncol. 2013;31(6):716-722).

For this trial, 152 patients with a solid malignancy and receiving palliative treatment were randomized evenly to receive either PTT or care as usual (CAU).

PTT patients were monitored by a nurse specialist four times over 10 weeks. They were asked to rate the intensity of nine symptoms, including diarrhea, cough, and dry mouth, but not their fatigue itself. Nurse-coordinated interventions were then devised based on symptom severity; they included education, starting or adjusting symptom-control medications, referral to other specialists, and additional diagnostic assessments.

Treatment decisions for patients in the CAU group were not guided by a specific protocol.

Investigators used the Multidimensional Fatigue Inventory (MFI) to measure the study’s primary outcome, MFI-General Fatigue. Researchers reported a significant difference in that measure in favor of the PTT group on second assessment (effect size, 0.26; P = .007) and third (effect size, 0.35; P = .005), though no significant difference in fatigue scores was found at their last assessment. Significant differences favoring the PTT group were also reported for two other MFI dimensions (reduced anxiety and motivation).

Patients receiving the interventions reported that fatigue interfered less with daily life, while patients in the CAU group said it interfered more. The most bothersome symptoms reported by patients during the intervention sessions were pain, shortness of breath, and lack of appetite.

Researchers, led by Pleun J. de Raaf, MD, said they believe this study marks the first randomized controlled trial to present evidence for the role of optimizing treatment of other symptoms in helping to address cancer fatigue.

Although the study did not reach its aim for a 0.5 medium effect, the researchers recommended that PTT be routinely included in fatigue-management plans for this population.

“Because treatment options for fatigue in patients with advanced cancer are scarce,” they wrote, “we would argue that even small improvements in fatigue should be considered clinically relevant.”