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Using Perceived Self-efficacy to Improve Fatigue and Fatigability In Postsurgical Lung Cancer Patients: A Pilot Randomized Controlled Trial

Hoffman, Amy J. PhD, MSN, RN; Brintnall, Ruth Ann PhD, RN, AOCN, APRN-BC; Given, Barbara A. PhD, RN, FAAN; von Eye, Alexander PhD; Jones, Lee W. PhD; Brown, Jean K. PhD, RN, FAAN

doi: 10.1097/NCC.0000000000000378

Background: Fatigue remains a prevalent and debilitating symptom in persons with non–small cell lung cancer (NSCLC). Exercise has been shown to be effective in reducing fatigue, yet interventions are limited for postsurgical NSCLC patients. To date, while surgery is offered as a standard curative treatment for NSCLC, no formal guidelines exist for postsurgical rehabilitation.

Objective: This study focuses on the design and testing of a postsurgical intervention for NSCLC patients to promote perceived self-efficacy for fatigue self-management targeting cancer-related fatigue (CRF) severity and its associated fatigability through exercise.

Methods: A 2-arm randomized controlled trial was used to examine the impact of a 6-week rehabilitative CRF self-management exercise intervention on 37 NSCLC participants compared with 35 control group participants receiving usual care from diagnosis to 6 weeks’ postsurgical hospital discharge.

Results: We exceeded goals for recruitment (66%), retention (97%), adherence (93%), and acceptability. Our 6-week exercise intervention demonstrated preliminary efficacy in significantly reducing CRF severity and fatigability as compared with usual care, with mean CRF levels restored to levels lower than presurgery. Likewise, the exercise group’s functional performance (physical and mental health scores) exceeded usual care. Furthermore, no adverse events were reported; participants had a mean age of 67 years and a mean of 8 comorbid conditions.

Conclusions: An exercise intervention for postsurgical NSCLC patients is feasible, safe, and highly acceptable showing positive changes in CRF self-management.

Implications for Practice: To advance practice, testing of the effectiveness of this health-promoting self-management exercise intervention in a larger-scale randomized controlled trial is needed.

Author Affiliations: College of Nursing, Michigan State University, East Lansing (Drs Hoffman and Given); Kirkhof College of Nursing, Grand Valley State University, Grand Rapids, Michigan (Dr Brintnall); and Psychology Department, Michigan State University, East Lansing (Dr von Eye); and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (Dr Jones); and School of Nursing, University at Buffalo, the State University of New York (Dr Brown).

Each person listed on this article has participated in the study to a significant extent and has adhered to ethical standards of research conduct.

Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under award R21CA164515.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Amy J. Hoffman, PhD, MSN, RN, College of Nursing, Michigan State University, 1355 Bogue St, Office C246, East Lansing, MI 48824 (;

Accepted for publication February 9, 2016.

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