Cognitive, fatigue, depression and sleep

Introduction
Globally, colorectal cancer (CRC) was the third most common cancer with 1.9 million new cases in 2020, and third common cancer among men and second most in females. The treatment of stage II onwards CRC comprises of surgery and chemotherapy and/or radiation therapy. Chemotherapy is associated with cognitive dysfunction, fatigue, depression and sleep disturbances attributable to factors ranging from structural alteration to the brain to production of pro-inflammatory cytokines. Exercise has been associated with benefits like improved physical function, strength, fatigue, QoL, and possibly survival and reduced recurrence among cancer survivors.
Methods
This randomized controlled study was conducted at Tata Memorial Hospital, Mumbai, and included 64 and 65 participants in the study and control group. The patients aged 18- 58 years, planned to receive 5 FU-based chemotherapy for stage II or Stage III primary CRC and no history of any cancer treatment and psychiatric disorder were eligible to participate. The baseline assessment was done before starting chemotherapy and after 3, 6, 9 and 12 months from baseline assessment. Cognitive function was assessed by using MoCA, fatigue, depression and sleep were evaluated by using FACIT-F, PHQ-9 and PSQI respectively. Serum TNF α was assessed by ELISA method.
Nurse led intervention included 1 week supervised and 12 weeks of unsupervised resistance and aerobic exercises and administration of Vitamin D- 60,000 IU, 8 sachets over 12 weeks. ANOVA, Freidman’s test and Pearson’s correlation was used for hypotheses testing.
Results
There was significantly better cognition, reduced fatigue, depression, and better sleep quality in study group participants compared to control group participants at 1st, 2nd, 3rd and 4th follow-ups (p<0.0001). following administration of nurse led intervention. There was no significant difference in serum TNF α levels.
Conclusions
Resistance and aerobic exercises are effective in improving cognitive function, fatigue, depression and sleep quality in patients receiving chemotherapy for CRC.