Physical Activity and Dexamethasone for Cancer-Related Fatigue: A Preliminary Placebo-Controlled, Randomized, Double-Blind Trial

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Sriram Yennurajalingam Division of Cancer, Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX

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Vicente Valero Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

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Brandon G. Smalgo Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

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Michael J. Overman Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

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Aravind Dasari Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

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Robert A. Wolff Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

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Kanwal Pratap Singh Raghav Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

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Carlos H. Barcenas Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

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Naifa L. Busaidy Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX

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Bryan Fellman Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX

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Karen Basen-Engquist Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX

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Kenneth R. Hess Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX

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Debasish Tripathy Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

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Eduardo Bruera Division of Cancer, Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX

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Background: Physical activity (PA) and dexamethasone (Dex) when used independently have modest benefits for cancer-related fatigue (CRF) in patients with advanced cancer. In this study we aimed to determine the feasibility (adherence, safety, and satisfaction) of combining PA with Dex versus PA with placebo (PBO) for CRF, and to explore the effects of PA+Dex and PA+PBO on CRF. Patients and Methods: In this phase II, randomized, double-blind controlled trial, eligible patients had advanced cancer and a CRF score of ≥4 on the Edmonton Symptom Assessment Scale (ESAS) for fatigue (0–10 scale). Patients were randomized to standardized PA for 4 weeks with either 4 mg of Dex (PA+Dex arm) or PBO (PA+PBO arm) twice daily for the first 7 days. Changes in Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) scores from baseline to days 8 and 29 were assessed. Other outcomes included change in quality-of-life scores. Results: A total of 64 (89%) patients were evaluable. Adherence rates for study medication, resistance exercise, and aerobic exercise were 91% and 92% (P=.15), 83% and 70.6% (P=.35), and 82.9% and 78.3% (P=.73), respectively, in the PA+Dex and PA+PBO arms. The satisfaction rates for the PA+Dex and PA+PBO arms were 98% and 79%, respectively. Median (IQR) changes in FACIT-F scores at days 8 and 29 from baseline were 9 (2 to 16; P<.001) and 5.75 (0 to 12.5; P=.015) for the PA+Dex arm, respectively, and 3.5 (−2.1 to 10; P=.054) and 6.5 (2.5 to 15.5; P=.006) for the PA+PBO arm, respectively. We found a significant treatment effect in the PA+Dex arm using exploratory linear mixed model analysis, with treatment showing an improvement of 5.63 units for FACIT-F scores (95% CI, 1.74–9.52; P=.005). We found significant improvement in Functional Assessment of Cancer Therapy-General (FACT-G), Patient-Reported Outcomes Measurement Information System-Fatigue Short Form 7a (PROMIS-Fatigue SF-7a), and Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) totals on days 8 and 29 in the PA+Dex arm. There was no significant difference in grade ≥3 adverse events between the arms (P=.36). Conclusions: Our study found that the use of combination PA+Dex and PA+PBO for CRF was feasible and associated with high rates of satisfaction, adherence to medication and PA intervention, and tolerability. CRF improvement with PA+Dex was clinically significant at days 8 and 29. Further larger studies are justified.

ClinicalTrials.gov identifier: NCT03583255

Submitted April 24, 2024; final revision received July 24, 2024; accepted for publication September 6, 2024. Published online January 7, 2025.

Author contributions: Concept & design: Yennurajalingam, Bruera. Acquisition, analysis, or interpretation of data: Valero, Smalgo, Overman, Dasari, Wolff, Raghav, Barcenas, Busaidy, Fellman, Basen-Engquist, Hess, Tripathy, Bruera, Stanton, Lu. Statistical analysis: Yennurajalingam, Fellman. Administrative, technical, or material support: Yennurajalingam, Bruera. Supervision: Yennurajalingam, Bruera. Writing—original draft: Yennurajalingam, Fellman, Bruera. Writing—review & editing: Yennurajalingam, Fellman, Bruera.

Disclosures: Dr. Yennurajalingam has disclosed receiving grant/research support from Pfizer. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: This work was supported by funding from the National Institute of Nursing Research (NIH 1R21NR016737-01A1; S. Yennurajalingam).

Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7071. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.

Correspondence: Sriram Yennurajalingam, MD, MS, Division of Cancer, Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX 77030. Email: syennu@mdanderson.org

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