Four-year follow-up on fatigue and sleep quality of a three-armed partly randomized controlled study in breast cancer survivors... 2023 Kröz et al

[Andy]

Full title: Four-year follow-up on fatigue and sleep quality of a three-armed partly randomized controlled study in breast cancer survivors with cancer-related fatigue

Abstract

Cancer-related fatigue (CRF) is a frequent long-term symptom in non-metastasized breast cancer patients (BC). This 4-year follow-up intended to compare the long-term effects of a 10-week multimodal therapy (MT: sleep education, psychoeducation, eurythmy- and painting therapy) and combination therapy [CT: MT plus aerobic training (AT)] to AT-control. BC-patients were randomized or allocated by preference to three arms in a comprehensive cohort study. Primary outcome was a composite score including Pittsburgh Sleep Quality Index (PSQI) and Cancer Fatigue Scale (CFS-D), captured at baseline, after 10 weeks of intervention (T1), 6 months later (T2), and after 4 years (T3). We exploratively tested for superiority of MT and CT versus AT after 4 years (T3) based on the statistical model of the main analysis. Of 126 (65 randomized) BC-patients included, 105 started treatments and 79 were re-assessed for long-term effects (T3). MT and CT were superior over AT after 4 years regarding PSQI/CFS-D and PSQI sum-score, respectively (all p < 0.05), but not for CFS-D. The multimodal and combination treatment for breast cancer patients with CRF indicates sustainable long-term superiority over aerobic training for the outcomes sleep quality and combined sleep quality/fatigue. A confirmative randomized controlled trial is warranted.

Open access, https://www.nature.com/articles/s41598-022-25322-y

 

[Jonathan Edwards]

Suggests that aerobics is useless but I doubt one can conclude anything since it is unblinded.

 

[rvallee]

I missed that part at first: painting therapy. For fatigue. It's said too often these days, but this is completely unserious, to the point of being disrespectful of patients, treating us like we're dumb animals at best. The obsession with simple answers to complex problems is completely out of control, especially about complex problems that aren't even understood.

 

[Hutan]

and then there's Eurythmy:

Eurythmy therapy is a mindfulness-oriented movement therapy expressing sounds and rhythms as movements and gestures29, largely used in both in- and outpatient settings in anthroposophic medicine. To improve cancer-related alterations of rest/activity rhythm, group based exercises were practiced such as I-A-O, clenching–spreading, striding, rhythms/hexameter, the vowel “Ei” and consonants which should achieve a rhythmic stabilization such as L, M and R and O-E-M-L-EI-B-D (the so-called cancer series) was finally introduced and practiced22,23,29.

"O-EM-L-EI-B-D (the so-called cancer series)". Haven't these cancer-survivors been through enough without that? I hate to think what the "clenching-spreading, striding" stuff is. It would be really hard to make stuff up that is more preposterous than this to fix fatigue.

 

[Hutan]

Note the truncated y axis, making the change in fatigue scores (potentially 0 to 60) look more impressive than it is. Participants had to have a score above 24 to participate in this fatigue reduction trial.

Note also the use of 'standard error' error bars. Most studies use a 95% confidence interval. If a study has used standard error in a chart, I reckon they are probably trying to hide how much variation they had in their results. A 95% confidence interval is 1.96 standard errors above and below the mean. So, in order to show a 95% confidence interval, you basically need to double the lines on either side of the mean.

In a fairly long 'Limitations' section, there is not even a nod towards one of the biggest problems with this study, the likelihood of fatigue, or at least the reporting of fatigue, decreasing over time.

Some issues with the Cancer Fatigue Scale asks
9. Do you feel fed up?
15. Do you feel such fatigue that you don’t know what to do with yourself?
Some people have probably rearranged their lives and their expectations in 4 years and feel less fed up and less overwhelmed than they did in earlier years.

7. Do you feel that you more often make errors while speaking?
13. Do you feel that your thinking has become slower?
And then there are questions that have an ambiguous baseline, as does the CFQ. Some people might assume the survey is asking them to make a comparison with the time when they last answered it. This might account for a decrease at T2 that is sustained.

 

[rvallee]

and then there's Eurythmy:

"O-EM-L-EI-B-D (the so-called cancer series)". Haven't these cancer-survivors been through enough without that? I hate to think what the "clenching-spreading, striding" stuff is. It would be really hard to make stuff up that is more preposterous than this to fix fatigue.

I don't see how this is any different from the nonsense in the 70's about cancer personalities. Seems like medicine is badly struggling to learn any lessons when they are to blame.

The entire credibility of scientific medicine is precisely that it's based on medicine. So what credibility does pseudoscience done by MDs have? None at all. In fact it erases the distinction with alternative medicine, and it's not even getting any better over time, just the same absurd ideas over and over again.