Effects of Exercise and Massage on Sleep and Fatigue in Cancer Patients Undergoing Chemo-Radiation Therapy

Introduction: Sleep disturbance and fatigue are the most common and significant problems in cancer patients during and after treatment of chemo-radiation therapy. Due to the co-occurrence of fatigue, sleep disturbance, and depression in cancer patients, many studies suggest these symptoms may share a common underlying mechanism driven by the activation of the proinflammatory cytokines. Many studies also suggest that exercise has effect on anti-inflammation to ameliorate fatigue as well as on activation of ANS function in enhancing vagal modulation of parasympathetic control to improve sleep. Massage can alleviate symptoms of fatigue in patients with various type of cancer receiving treatment through comforting and relaxing our body. Moreover, circadian timing plays roles to optimize anti-neoplastic effects and minimize toxicity to normal cell during therapy as well as regulating our body systems. Combine exercise and massage as a circadian-based intervention may have robust effect on fatigue and sleep in cancer patients during treatments.

Purpose: This study used a randomized control design to compare the effect of circadian-based exercise and massage intervention, exercise only, and massage only on sleep and fatigue in head and neck patients undergoing chemo-radiotherapy.

Methods: Sixty patients with head and neck carcinoma aged 53.5±9.5 years were randomly allocated to exercise group (EG, n=22), massage group (MG, n=17) or exercise and massage group (EMG, n=21). Exercise was performed at 8-10 am and 14-16 pm for 15 minute for 3 consecutive days. Massage was performed by using a massage cushion before bedtime (20-22 pm) for 15 minutes for 3 consecutive evenings after started chemo-radiation therapy. The Taiwan General Fatigue Scale (TGFS) and the Verramn & Snyder-Halpen scale (VSH) were administered to assess fatigue and sleep quality, respectively, before and after therapy starts for 4 days.

Results: All patients in three groups experienced low fatigue level (TGFS score 23.1~31.6±8.8~13.9), moderate sleep quality (VSH score 74.6~101.6±17.7~27.4). No significant differences at baseline among these three groups. During intervention, the fatigue level is linear decreased in EMG group (F=6.826, p=.017), quadratic decreased in the EG group (F=4.851, p=.039), but no changes in MG group (F=2.160, p=.161). There were no significant changes in sleep quality within and among groups (all p >.05).

Conclusion: A circadian-based intervention combined with exercise and massage may have better effect on decreasing the fatigue level than exercise or massage alone in head and neck cancer patients undergoing chemo-radiation therapies.