Investigating Correlates and Therapeutics of Fatigue

National Institute Of Nursing Research

Investigators

Linked publications & trials

Abstract

The activities and approaches of this research program have focused on capturing the symptom experiences and reports of functional challenges reported by cancer survivors and individuals with chronic illnesses. Currently, there are more than 16.9 million cancer survivors living in the United States (US), and that number is expected to increase to over 22.1 million by 2030. The increasing number of cancer survivors is attributed to the declining overall cancer mortality; however, functional challenges such as neurocognitive impairments and physical difficulties continue to burden most cancer survivors, months, even years after completing their primary cancer therapy. These functional challenges often can be overwhelming with self-management responsibilities on patients that extend beyond the healthcare setting. Furthermore, cancer survivors also have a higher incidence of multimordbidity (suffering from multiple chronic health conditions) compared to the general population, stemming from cancer or its treatments. So, this program of research is using a whole-person approach, focusing our efforts on two broad research goals. Goal 1. Identifying biopsychosocial factors of functional health Focus Area 1: Identifying biological determinants of functional health Study 1: This study is a multi-institutional collaboration with several nursing schools across the country investigating the relationships of gut microbiota and cancer-related symptoms. Study 2: Investigating neural correlates of physical fatigue. This project is a collaboration with investigators from NCCIH to identify neural correlates of physical fatigue in individuals with chronic fatigue. Focus Area 2: Exploring psychosocial factors influencing functional outcomes Study 1: Identify psychosocial factors that influence frailty of older, female cancer survivors. Study 2: Social and environmental determinants of functional health of cancer survivors. Both studies identified physical, built, and social environments (Yost index, percent vacant housing, walkability score, rural-urban community area (RUCA) code, location of a National Cancer Institute-designated cancer center) that influence symptom experiences and health outcomes (work ability, frailty, functional limitations, quality of life) of cancer survivors. Study 3: Examine the Effects of Social Isolation on Physical and Mental Health of Senior living in Hampton Roads, Virginia. This study is a collaboration with the Old Dominion School of Nursing. Goal 2. Establishing novel therapeutics to improve functional outcomes Study 1: Anti-fatigue effects of ketamine. This proof-of-concept clinical trial attempts to provide initial evidence that a subanesthetic dose of ketamine (0.5 mg/kg single intravenous dose) has rapid anti-fatigue effects in participants with various chronic conditions. The team's research activities reflect their commitment to significantly improve functional outcomes of cancer survivors with and without chronic illness. Our research activities are purposely sequential to ensure careful translation of findings from bench to bedside to community. The multipronged approach used is appropriate to understand the complex functional challenges of cancer survivors especially those living with chronic illnesses. The support from NINR and the comprehensive collaborative network from my intramural and extramural colleagues will allow the research team to generate and validate hypotheses more quickly. The research program is staffed with dedicated and competent scientists and clinicians. This fiscal year, the team has continued to enroll participants for the collaborative studies with Old Dominion University and NCCIH. The team continues to publish papers in peer-reviewed journals and present findings in professional venues. A list of team accomplishments for this fiscal year are listed below: - One of the team's collaborative projects provides a unique area of work in examining the relationships of gut microbiota and cancer-related symptoms. Findings from this collaborative project will explore social and environmental factors (i.e., age, ethnicity/race, socio-economic status, rurality) that can influence the relationships of the microbiota and cancer-related symptoms. - Another collaborative project with NCCIH has identified potential neural circuits distinct for physical fatigue in patients with chronic fatigue assessed using functional magnetic resonance imaging These findings provide necessary information for other mechanistic investigations and potential innovative interventions. - We are halfway in enrolling participants for our community-based research, in partnership with Old Dominion School of Nursing to explore the effects of social isolation on physical and mental health of seniors living in the Hampton Roads area of Virginia. This research program continues to align with one of the NINR mission areas: prevention and health promotion. The research team has taken advantage of the unique resources and expertise in the NIH intramural and has built robust and sustainable extramural collaborations to conduct multi-level investigations that enhance translation of laboratory discoveries to clinical and community applications.