Abstract
In this issue, we are pleased to present a set of 4 articles on the topic of integrative interventions for cancer-related fatigue. Up to 90% of cancer patients experience fatigue at some time during their disease, and for many, it is profound, long-lasting, and debilitating. It is not remedied by either sleep or sleep-enhancing medications. The search for more effective interventions for fatigue is thus of major importance, and integrative therapies, with their emphasis on energy and health, seem like an obvious place to look.
Our first article on the topic is by Jennifer Finnegan-John of King’s College London and her colleagues. It is a systematic review of complementary and alternative interventions for fatigue. A wide variety of therapies were examined for potential relevance, including both biologically based and energetically based therapies. Considerations of study quality limit the conclusiveness of the results, but some of these therapies do look promising.
A study by Günther Spahn, Kyung-Eun Choi, and colleagues randomized fatigued breast cancer survivors to a moderate walking intervention versus a multimodal therapy involving physical activity along with a variety of other health practices, emphasizing mindfulness meditation. These authors are to be congratulated for accomplishing a research study with such a multimodal intervention, which can be challenging in itself, in both practical and theoretical ways.
A second multimodal therapy study by Matthias Kroez and colleagues at the Research Institute Havelhöhne piloted a multimodal therapy that had its basis in anthroposophical medicine, with components of art therapy and eurythmics. This therapy was compared with a moderate physical activity intervention in a preference trial, in which patients were allowed to choose which intervention they would follow. This demonstrates another aspect of the difficulties of studies in integrative therapy: Not every patient is willing to make major lifestyle adaptations. Preference trials accommodate this, although their conclusiveness is lowered. An interesting feature of this study is its attention to multiple dimensions of fatigue, including cognitive fatigue and physical fatigue.
A study from Universiti Sains Malaysia by Biswa Biswal examined the impact of ashwagandha (Withania somnifera) on chemotherapy-related fatigue. This nonrandomized comparative trial was conducted in breast cancer patients undergoing chemotherapy. For the biologically based therapies such as herbs, study designs can be more straightforward: ashwagandha extract was administered orally to the patients in the experimental group. This study features attention to multiple dimensions of the EORTC quality-of-life scale.
Laura Rogers and colleagues from Southern Illinois University also studied an exercise intervention in breast cancer patients, although fatigue was not one of their outcomes. Their pilot study examined the effects of exercise on cardiorespiratory fitness, sleep latency, and a variety of inflammatory markers. The examination of biological markers in exercise studies is of great interest because of the potential for multitargeted impacts of exercise in the body. In a lesson that is also relevant to nonpatients, they did find that increasing exercise decreased sleep latency, or the time it takes to fall asleep.
Ellie Chu and colleagues from the University of Hong Kong studied an extract of a traditional Chinese medicine botanical formula, Erxian Decoction. This formula has been used for relief of menopause and for modulating hormonal levels. This suggested to the authors that it might be effective in the treatment of hormonally related cancers. They chose to examine its effect on the metastatic ability of ovarian cancer cells, in a study that included both in vitro and in vivo models. Their research has uncovered a highly multitargeted effect on ovarian cancer, perhaps consistent with use of a multicomponent botanical formula.
Jitender Monga and colleagues examined the extract of Acacia catechu heartwood in breast cancer prevention, in another study featuring both in vitro and in vivo models. This extract is used medicinally and in betel nut chewing in Southeast Asia, under the name “catechu.” This word may seem familiar: It is, in fact, the root of the word “catechin,” familiar to many in the integrative cancer community in the names of compounds such as epigallocatechin gallate from green tea. Catechins were first isolated from this extract. The catechin-rich extract used in this study does show interesting activity in the cancer prevention assays conducted by the authors.