Occurrence of fatigue and associated factors in disease-free breast cancer patients without depression

Trajectory patterns and predictors of cancer-related fatigue in postoperative lung cancer patients receiving chemotherapy

PURPOSE

Cancer-related fatigue (CRF) is a chronic symptom that can affect the overall functioning of lung cancer patients throughout the course of the disease. However, there is limited research on the trajectory and predictors of CRF specifically in lung cancer patients. Furthermore, few studies have investigated the predictive role of positive psychological and social factors in relation to CRF. This study aimed to explore the trajectory of CRF and its predictors in postoperative chemotherapy patients with lung cancer.

METHODS

A total of 202 lung cancer patients who underwent surgery and received adjuvant chemotherapy were recruited for this study. Baseline questionnaires were completed, covering sociodemographic information, disease details, CRF levels, personality traits, psychological resilience, and social support. CRF was assessed at three time points: first chemotherapy (T1), 3 months after chemotherapy (T2), and 6 months after chemotherapy (T3). Latent class growth modeling (LCGM) was used to identify distinct developmental trajectories of CRF. Logistic regression analysis was employed to examine predictors of CRF within different patient groups.

RESULTS

The LCGM analysis revealed three distinct CRF trajectories: persistent high fatigue group (30.7%), rising fatigue group (30.7%), and no fatigue group (38.6%). Cancer stage (OR = 7.563, 95% CI = 2.468-23.182, P < 0.001), melancholic personality (OR = 6.901, 95% CI = 1.261-37.764, P = 0.026), and high psychological resilience (OR = 0.171, 95% CI = 0.041-0.706, P = 0.015) were associated with the CRF trajectory. On the other hand, sanguine personality (OR = 0.254, 95% CI = 0.071-0.916, P = 0.036) and high social support (OR = 0.168, 95% CI = 0.045-0.627, P = 0.008) were associated with the increasing fatigue trajectory.

CONCLUSIONS

This study demonstrated that 60% of lung cancer patients experienced persistent fatigue throughout the assessment period. Moreover, it confirmed the heterogeneity of CRF trajectories among lung cancer patients. The severity of CRF was found to be higher in patients with advanced clinical stages, depressive personality traits, and lower psychological resilience.

The association of personality traits with poststroke fatigue in daily life: An exploratory experience sampling method and cross-sectional study

Fatigue is a frequently occurring and persistent symptom after stroke. Many biological, psychosocial, and behavioural factors are associated with poststroke fatigue, but research into associations with personality traits is relatively sparse. In this study, we explored whether personality traits were related to poststroke fatigue measured with conventional fatigue questionnaires as well as experience sampling methodology (ESM). Twenty-four individuals with stroke completed 10 daily questionnaires about momentary (here-and-now) fatigue for six consecutive days using the mHealth ESM application PsyMate^TM. Further, they completed questionnaires assessing personality (NEO-FFI and LOR-T) and fatigue (FSS). Results showed that higher extraversion (ß = -.44, SE = .12, p = .001; 95% CI = -.67-.19) and optimism (ß = -.18, SE = .06, p = .007; 95% CI = -.30-.05) were associated with lower momentary fatigue. No association was found between neuroticism and momentary fatigue, but higher neuroticism (r = 0.531, p = .008, 95% CI = .160-.759; r = .574, p = .003, 95% CI = .245-.767) was associated with higher scores on the retrospective FSS scales. We conclude that personality traits differentially influence poststroke fatigue, but this also depends on the way fatigue is measured (with retrospective or with momentary measures). When functional gains are not in line with expected progress during the rehabilitation treatment of fatigue, it may be appropriate to take into account how person characteristics are related to momentary fatigue.

A Longitudinal Study of a Multicomponent Exercise Intervention with Remote Guidance among Breast Cancer Patients

Purpose: Breast cancer patients in treatment suffer from long-term side effects that seriously influence their physical and mental health. The aim of this study was to examine effectiveness of a 12-week multicomponent exercise (ME) with remote guidance intervention on health-related outcomes after one year among breast cancer patients. Methods: In phases I–III, 60 patients (51.2 ± 7.9 years) with breast cancer (BC) who completed chemotherapy/postoperative radiotherapy within the previous four months to two years were randomly assigned to (1) multicomponent exercise with remote guidance (ME) and (2) usual care (UC). Eligible participants were approached to assess cancer-related quality of life (QOL), muscle strength, cardiorespiratory endurance, and physical activity (PA) barriers after one year. Results: The results demonstrated that, after one year, the ME group reported higher vitality-related QOL (5.776, 95% confidence interval [CI] 0.987, 10.565, effect size [ES] = 0.360), mental health-related QOL (9.938, 95% CI 4.146, 15.729, ES = 0.512), leg strength and endurance (2.880, CI 1.337, 4.423, ES = 0.557), and strength and endurance of upper extremities (2.745, 95% CI 1.076, 4.415, ES = 0.491) and lower physical activity (PA) hindrance (5.120, 95% CI 1.976, 8.264, ES = 0.486) than the UC group. Conclusions: The ME group observed significant differences from the UC group in QOL, muscle strength, cardiopulmonary endurance, and PA participation. These findings suggested that the multicomponent exercise intervention with remote guidance produced long-term health benefits for breast cancer patients.

Cancer Survivors' Experiences and Explanations of Postcancer Fatigue: An Analysis of Online Blogs

BACKGROUND

Postcancer fatigue (PCF) is a form of chronic fatigue that is very common and can persist for years among disease-free cancer survivors. Despite this, PCF remains underreported and often goes untreated.

OBJECTIVE

The aim of this study is to explore PCF from the perspective of cancer survivors via online blogs, with a focus on their experiences and personal explanations of PCF.

METHODS

An online search identified 15 recent blogs written by cancer survivors who specifically discussed their PCF. Thematic analysis was used to analyze blog content.

RESULTS

Bloggers explained PCF as a severe and unpredictable symptom in their lives. They identified anxiety, emotional trauma, and cancer side effects to be the key causal factors of their PCF. Coping strategies adopted by bloggers included diet, exercise, acceptance and reducing workload to manage their fatigue.

CONCLUSIONS

Online blogs are a rich source of qualitative data that can give unique insight into issues faced by cancer survivors. Bloggers' accounts confirmed that PCF is a complex issue that can be a significant source of frustration in their everyday lives. This study highlighted that bloggers with PCF appear to have some coping strategies and understanding of PCF, yet these are not always consistent with current medical and psychological knowledge.

IMPLICATIONS FOR PRACTICE

This study has demonstrated that blogs can offer valuable information to existing knowledge of cancer survivors' experiences and explanations of PCF. The findings may assist healthcare professionals with educating patients about PCF and with increasing the legitimacy, awareness, and understanding of PCF.

Resilience and positive affect contribute to lower cancer-related fatigue among Chinese patients with gastric cancer

AIMS AND OBJECTIVES

To investigate the prevalence of cancer-related fatigue and explore the relationship between resilience, positive affect, and fatigue among Chinese patients with gastric cancer.

BACKGROUND

Cancer-related fatigue is the most distressing symptom reported frequently by cancer patients during both treatment and survival phases. Resilience and positive affect as vital protective factors against cancer-related fatigue have been examined, but the underlying psychological mechanisms are not well understood.

DESIGN

A cross-sectional study.

METHODS

Two hundred and three gastric cancer patients were enrolled from three hospitals in China. The Cancer Fatigue Scale, the positive affect subscale of the Positive and Negative Affect Schedule and the Connor-Davidson Resilience Scale (CD-RISC10) were administered. Hierarchical linear regression modelling was conducted to examine the association between resilience and cancer-related fatigue, and the mediating effect of positive affect.

RESULTS

The incidence of clinically relevant fatigue among patients with gastric cancer was 91.6%. Regression analysis showed that resilience was negatively associated with cancer-related fatigue, explaining 15.4% of variance in cancer-related fatigue. Mediation analysis showed that high resilience was associated with increased positive affect, which was associated with decreased cancer-related fatigue.

CONCLUSIONS

Cancer-related fatigue is prevalent among patients with gastric cancer. Positive affect may mediate the relationship between resilience and cancer-related fatigue.

RELEVANCE TO CLINICAL PRACTICE

Interventions that attend to resilience training and promotion of positive affect may be the focus for future clinical and research endeavours.

Alexithymia and Cancer-Related Fatigue: A Controlled Cross-Sectional Study

Aims and background

The study aims to investigate the alexithymia construct in patients with a recent or longtime diagnosis of cancer as well as in healthy people, and whether alexithymia and fatigue are linked in the mentioned groups.

Methods

A first group, diagnosed less than 3 months previously (n = 63), and a second group whose cancer diagnosis dated back more than 30 months (n = 53), matched for sex, age, educational level and cancer site were assessed. Matched healthy controls (n = 50) were also evaluated. Alexithymia was assessed with the Toronto Alexithymia Scale-20, while fatigue was assessed with the Brief Fatigue Inventory.

Results

Alexithymia scores were higher in the recently diagnosed group than in the group with a longtime cancer diagnosis (t = 2.18, P <0.05). Both groups had higher scores than controls (t = 4.3, P <0.001; t = 2.01, P <0.05). Alexithymic subjects were 45.6% in the recently diagnosed and 21.4% in the longtime diagnosed group (χ2 = 6.3, P <0.05) and 18% in controls. Fatigue was more severe in patients with a longtime diagnosis compared with recently diagnosed patients (t = 7.079, P = 0.000). A weak but significant association between fatigue and alexithymia was found in recently diagnosed patients (r = 0.27.2; P <0.05).

Conclusions

Our study confirms that alexithymia scores are higher in cancer patients than in controls. The study suggests that alexithymia could be considered a dynamic reaction to illness in recently diagnosed patients, declining during subsequent phases. High fatigue rates in patients with a longtime diagnosis of cancer underline the role of the long course of illness in the perception of fatigue. The association between fatigue and alexithymia was weak in the recently diagnosed group and not significant in patients with a longtime diagnosis, in whom fatigue was an important complaint.

Association of Personality Profiles with Depressive, Anxiety, and Cancer-related Symptoms in Patients Undergoing Chemotherapy

Background

This study identified latent classes of cancer patients based on Big Five personality dimensions and evaluated for differences in demographic and clinical characteristics, depression, anxiety, and cancer-related symptoms.

Methods

Patients (n=1248) with breast, gastrointestinal, gynecological, or lung cancer completed the Center for Epidemiological Studies-Depression scale, Spielberger State-Trait Anxiety Inventories, NEO-Five Factor Inventory (NEO-FFI), and Memorial Symptom Assessment Scale (MSAS). Latent class profile analysis of NEO-FFI scores was used to identify patient subgroups.

Results

Three latent classes were identified. The "Distressed" class (14.3%) scored highest on neuroticism and lowest on extraversion, agreeableness, and conscientiousness. The "Resilient" class (31.9%) scored lowest on neuroticism and highest on extraversion, agreeableness, and conscientiousness. The "Normative" class (53.8%) was intermediate on all dimensions except openness. Compared to the Resilient class, patients in the Distressed class were younger, less educated, more likely to care for another adult, had more comorbidities, and exercised less. The three classes differed by performance status, marital and employment status, and income, but not by gender, time since diagnosis, or type of prior cancer treatment. The classes differed (Distressed > Normative > Resilient) in depression, anxiety, and cancer symptoms.

Conclusions

Personality is associated with psychological and physical symptoms in cancer patients.

Surgical Oncology: Evolution of Postoperative Fatigue and Factors Related to Its Severity

BACKGROUND

Fatigue has been reported by many patients undergoing surgery and is associated with a negative prognosis. The factors associated with postoperative fatigue and its evolution during the postoperative period are unclear. Adequate fatigue measurement instruments are necessary to obtain reliable evaluations and to direct effective care to control fatigue in this patient population.

OBJECTIVES

This article describes the evolution of postoperative fatigue in patients with cancer as well as related factors.

METHODS

A review of the literature using the CINAHL® and PubMed databases was undertaken.

FINDINGS

The prevalence of moderate and severe fatigue varies during the postoperative period, with a reduction in the 12 months after surgery. Various factors (e.g., stress, anxiety, depression, pain, changes in sleep patterns) seem to influence the severity of fatigue. More evidence is needed to explore the relationship between immediate postoperative fatigue and the evolution of fatigue during the period following surgical treatment for cancer.

The association of cognitive fatigue with menopause, depressive symptoms, and quality of life in ambulatory breast cancer patients

BACKGROUND

The causes of cancer-related fatigue, which can influence patients' activities, are multidimensional; however, little is known about the cognitive dimension. We examined the association of cognitive fatigue with menopause, depressive symptoms, and quality of life in ambulatory breast cancer patients after primary treatment.

METHODS

This descriptive, cross-sectional study recruited 20-64-year-old breast cancer patients in an outpatient setting. The patients (N = 93; mean age = 53 years) were divided into low (L-CogF) and high-cognitive fatigue (H-CogF) groups according to their scores on the cognitive fatigue subscale of the Cancer Fatigue Scale. We compared the groups on their sociodemographic and medical characteristics and scores on the Functional Assessment of Cancer Therapy-Breast (FACT-B) [a measure of quality of life (QOL)], Simplified Menopausal Index (SMI), and Self-Rating Questionnaire for Depression (SRQ-D).

RESULTS

The L-CogF (n = 55) and H-CogF (n = 38) patients did not differ in age, years since diagnosis, marital status, educational background, or treatment history. Total and subscale FACT-B scores, except for physical well-being, were significantly lower in H-CogF participants than in L-CogF participants. SMI and SRQ-D scores were significantly higher in H-CogF participants. Employed H-CogF participants were concerned about keeping their jobs (p < 0.05).

CONCLUSIONS

Breast cancer patients with high-cognitive fatigue suffer from severe menopause and depressive symptoms, and deteriorating QOL. Cognitive fatigue should be considered when interpreting patients' cognitive complaints.

Physical activity intensity and health status perception of breast cancer patients undergoing adjuvant chemotherapy

PURPOSE

The aim was to evaluate the physical activity intensity (PAI) of patients receiving adjuvant chemotherapy and investigate the relationship between health status perception and PAI in Japan.

METHODS

Consenting participants of this prospective, descriptive, repeated measures design were 28 women aged 20-64 with stage I-IIIA initial breast cancer whose regimen included anthracycline. Participants wore a triaxial accelerometer and their PAI was measured for a 14-day period at the beginning of chemotherapy. The SF-36 Survey and Cancer Fatigue Scale were administered. The accelerometer was used to calculate the number of steps, physical activity level (PAL) and total minutes of PAI levels of under 1.5 Mets, 1.5-2.9 Mets, and more than 3.0 Mets during the first half (FH; days 2-7) and second half (SH; days 8-14) of the study. Data were analyzed using Pearson's correlation coefficient and multiple regression analysis.

RESULTS

During FH, the mean number of steps was 3841.1 steps/day and mean PAL was 1.43; during SH, the mean number of steps was 4058.4 steps/day, mean PAL was 1.43; participants spent over 70% of the day working quietly in a sitting position. PAL during SH was significantly associated with mean time spent during activities of 1.5-2.9 Mets (β = 0.880, p < 0.0001) and 3.0 Mets (β = 0.268, p < 0.0001).

CONCLUSION

Patients receiving adjuvant chemotherapy had extremely low physical activity. They should be provided useful information of appropriate physical movement and be supported in resolving physical and psychological distress.

The effects of cognitive behavioral therapy for postcancer fatigue on perceived cognitive disabilities and neuropsychological test performance

CONTEXT

After successful cancer treatment, a substantial number of survivors continue to experience fatigue and related concentration and memory problems. Severe fatigue after cancer treatment can be treated effectively with cognitive behavioral therapy (CBT), but it is unclear whether CBT has an effect on cognitive functioning.

OBJECTIVES

We hypothesized that patients would report less cognitive disability after treatment with CBT for cancer-related fatigue. CBT was not expected to affect neuropsychological test performance, as it has been shown that fatigue is not associated with test performance.

METHODS

Data were used from a randomized controlled trial in which 98 severely fatigued cancer survivors, treated at least one year previously, were assessed at baseline (T1) and six months post-baseline (T2). Patients were randomly assigned to receive CBT (n = 50) or to a waiting list (WL) control condition (n = 48). Self-reported cognitive disability was assessed by the Concentration subscale of the Checklist Individual Strength and the Alertness Behavior subscale of the Sickness Impact Profile. Neuropsychological test performance was measured by the symbol digit modalities task and two reaction time tasks.

RESULTS

Patients who received CBT for post-cancer fatigue reported significantly less cognitive disability compared with those in the WL group. CBT also was associated with a clinically relevant reduction in concentration problems (CBT, 32% vs. WL, 2%). There were no significant differences in neuropsychological test performance between the CBT and WL groups.

CONCLUSION

CBT for post-cancer fatigue has already been shown to be an effective therapy. The present study demonstrates that CBT also may lead to a decrease in perceived cognitive disability.

Development of fatigue in cancer survivors: a prospective follow-up study from diagnosis into the year after treatment

CONTEXT

There is a lack of longitudinal studies investigating fatigue from before cancer treatment to long after successful cancer treatment.

OBJECTIVES

This prospective follow-up study aimed to determine the prevalence and predictors of persistent fatigue in cancer survivors in the first year after completion of cancer treatment.

METHODS

Sixty patients with various malignancies were assessed before (T1), shortly after curative cancer treatment (T2), and one year after T2 (T3). Fatigue was assessed monthly between T2 and T3. Fatigue severity was measured using the subscale of the Checklist Individual Strength. Questionnaires were used to measure impaired sleep and rest, physical activity, social support, fatigue catastrophizing, and somatic-related attributions regarding fatigue. Linear regression analyses were performed to identify predictors of persistent fatigue.

RESULTS

In total, 22% of survivors had severe persistent fatigue over the last six months in the first year after cancer treatment. Fatigue at T1, T2, and negative interactions predicted the severity of persistent fatigue. Analyses without fatigue showed that more negative interactions, impaired sleep and rest, fatigue catastrophizing, and lower self-reported physical activity at T2 were associated with the severity of persistent fatigue.

CONCLUSION

Twenty-two percent of the survivors had severe persistent fatigue in the year after cancer treatment. Fatigue and cognitive behavioral factors predicted persistent fatigue in the year after cancer treatment. Diagnosis or cancer treatment did not predict persistent fatigue. The implication is that cognitive behavioral therapy for postcancer fatigue, aimed at the fatigue-perpetuating factors, could be offered from two months after successful cancer treatment.

Combined anxiety and depressive symptoms before diagnosis of breast cancer

PURPOSE

To determine the relationship between pre-diagnosis state anxiety, depressive symptoms, and combined state anxiety and depressive symptoms (CADS) with quality of life (QOL), fatigue, state anxiety and depressive symptoms one and two years after surgery in women with breast cancer.

METHODS

Women with breast problems referred to a Dutch outpatient clinic were recruited for the study. Participants (N=428) completed a set of questionnaires before diagnosis (Time0) and the women with breast cancer subsequently received questionnaires at 12 (Time1) and 24 months (Time2) after surgical treatment. The questionnaire set consisted of questionnaires on demographics, state anxiety, depressive symptoms, fatigue, QOL, neuroticism, and trait anxiety. Chi-square tests, independent samples T-tests, and multivariate linear regression analyses were used to do the analyses.

RESULTS

Before their diagnosis of breast cancer, 111 women (28%) had CADS. Of the CADS-group, a higher percentage had elevated levels of anxiety, depressive symptoms, and CADS at all follow-up moments than of the non-CADS-group. CADS-score at before diagnosis and neuroticism were the most important predictors of outcome measures at Time1 and Time2.

CONCLUSIONS

More than one in four women, who later received the diagnosis breast cancer, had elevated levels of both state anxiety and depressive symptoms (CADS) just before diagnosis. This factor was also a major predictor of QOL, state anxiety, depressive symptoms, and fatigue 12 and 24 months after surgery. This implies that women with a higher score on both state anxiety and depressive symptoms should be identified as soon as possible in the process of diagnosis and treatment of breast cancer using validated questionnaires or screening instruments. Only by identifying this group of patients, tailored psychological care can be accomplished.

The long-term effects after hematopoietic stem cell transplant on leg muscle strength, physical inactivity and fatigue

PURPOSE

The purpose of this study was to analyze the effects of leg muscle strength and fatigue on step-count as a measure of physical activity for people staying at home after hematopoietic stem cell transplantation (HSCT).

METHOD

Nineteen persons receiving HSCT were assessed from hospitalization until about 2 months after discharge. Mean daily step-count was taken as a measure of physical activity. Leg muscle strength was measured in three ways (knee extension, ankle plantar flexion, and ankle dorsiflexion strength) at two points in time (time of hospital discharge and after 2 months). Fatigue and anxiety were assessed using the Japanese Cancer Fatigue Scale and State-Trait Anxiety Inventory. Correlations between the above and factors affecting physical activity were also investigated by multiple regression analysis.

RESULTS

Clinical follow-up measurements in subjects were made an average of 81.0 days after discharge. Subjects with higher mean step-count during hospitalization (β = 0.647, p = 0.000) and greater ankle plantar flexion strength/kg (β = 0.361, p = 0.021) reported higher mean step-count at home (adjusted R(2) = 0.701, p = 0.021). Subjects with body mass index <22.0 kg/m(2) also showed higher step-counts at home compared to other subjects. Mean fatigue score at home was 16.8 (SD = 8.75), a level not associated with clinical problems, and the proportion of physical fatigue was significantly lower than during hospitalization.

CONCLUSION

Mean step-count at home was most strongly affected by ankle plantar flexion strength/kg, and increasing ankle plantar flexion strength/kg was shown to promote recovery of normal physical activities.

Fatigue after treatment in breast cancer survivors: prevalence, determinants and impact on health-related quality of life

PURPOSE

Fatigue is a phenomenon that may persist for years after completion of adjuvant therapy, and is one of the most frequent symptoms associated with breast cancer survivors. The purposes of this study were to investigate the occurrence of fatigue in disease-free breast cancer survivors after treatment, to identify variables associated with fatigue, and to evaluate the impact of fatigue on health-related quality of life.

METHODS

A cross-sectional study was conducted on 202 consecutive women diagnosed with in-situ to Stage III breast cancer attending in outpatient facilities of two large hospitals, one year or more after diagnosis. They completed the Piper Fatigue Scale-Revised and the European Organization for Research and Treatment of Cancer QLQ-C30. Multiple logistic regression models were used to identify predictive factors associated with fatigue. EORTC QLQC-30 scores for fatigued survivors were compared to non-fatigued survivors.

RESULTS

The prevalence of fatigue reported by the breast cancer survivors was 37.6%. Multiple logistic regression analysis revealed that predictive factors for fatigue included younger age (odds ratio [OR]=2.23, 95% confidence interval [CI]=1.11-4.45, p = 0.024); presence of pain (OR = 3.87, 95% CI = 1.88-7.98, p = 0.000); dyspnea (OR = 3.72, 95% CI = 1.46-9.50, p = 0.006); insomnia (OR = 2.40, 95% CI = 1.19-4.86, p = 0.015); and nausea and vomiting (OR = 12.25, 95% CI = 1.18-126.75, p = 0.036). Fatigued women had poorer health-related quality of life than non-fatigued women in all domains.

CONCLUSION

Our results suggest that many disease-free breast cancer survivors after treatment experienced fatigue that compromises their health-related quality of life.

Examining the role of physical activity in reducing postcancer fatigue

Purpose

Persistent fatigue is a long-term adverse effect experienced in about a quarter of patients cured of cancer. It was shown that cognitive behavior therapy (CBT) especially designed for postcancer fatigue is highly effective in reducing severe fatigue. However, it is unclear by what mechanism the fatigue reduction is reached. In many fatigue reduction programs, an increase in physical activity is assumed to reduce fatigue. The purpose of the present study is to determine whether the effect of CBT on fatigue is mediated by an increase in physical activity.

Methods

Data of a previous randomized controlled trial on the efficacy of CBT for postcancer fatigue were reanalyzed (CBT, n = 41; waiting list condition, n = 42). Actigraphy was used to assess the level of objective physical activity. Cancer survivors were assessed prior as well as after the CBT and waiting list period. The mediation hypothesis was tested according to guidelines of Baron and Kenny. A non-parametric bootstrap approach was used to test statistical significance of the mediation effect.

Results

Although CBT effectively reduced postcancer fatigue, no change in level of objective physical activity was found. The mean mediation effect was 1.4% of the total treatment effect. This effect was not significant.

Conclusion

The effect of CBT for postcancer fatigue is not mediated by a persistent increase in objective physical activity.

Impact of walking ability and physical condition on fatigue and anxiety in hematopoietic stem cell transplantation recipients immediately before hospital discharge

PURPOSE

This study analyzed the influence of walking ability and physical condition on fatigue and anxiety at hospital discharge in patients receiving hematopoietic stem cell transplantation (HSCT).

METHOD

A total of 25 subjects were assessed after receiving HSCT until discharge. The Japanese Cancer Fatigue Scale and the State-Trait Anxiety Inventory were used to assess fatigue and anxiety. Relationships of fatigue and anxiety status respective to walking ability variables: leg muscle strength (knee extension, ankle plantar flexion and ankle dorsiflexion strength) and average number of daily steps, and physical condition variables (food intake, febrile days, body mass index, and serum albumin) were examined with correlations and stepwise multiple regression analysis.

RESULTS

Subjects with later achievement of adequate food intake after HSCT (β = 0.62) and weaker knee extension strength per body mass at discharge (β = -0.42) reported higher fatigue (adjusted R(2) = 0.53, p = 0.00). Knee extension strength per body mass at discharge was correlated with an average step-count from 51 to 80 days after HSCT (r = 0.51, p = 0.01). In subjects whose Body Mass Index was above 23.5, weaker ankle dorsiflexion strength per body mass prior to transplantation reported higher fatigue at discharge (adjusted R(2) = 0.97, p = 0.00). Subjects with later achievement of food intake after HSCT (β = 0.59) and more days with fever reported higher anxiety (adjusted R(2) = 0.47, p = 0.00).

CONCLUSION

Post-HSCT fatigue was affected by a delay in adequate food intake and diminished muscle strength. The results of this study show the importance of encouraging walking for maintaining muscle endurance.

Systematic review and meta-analysis of the correlates of cancer-related fatigue

BACKGROUND

Fatigue is one of the most common problems experienced by cancer patients. The factors most frequently reported to correlate with cancer-related fatigue are symptom distress (pain, nausea/vomiting, dyspnea, and lack of appetite) and psychological distress (depression and anxiety).

AIMS

This study was performed to examine the overall association of symptom and psychological distress with cancer-related fatigue using systematic literature review and meta-analysis. This study also aimed to determine which factors have a higher correlation with fatigue, and therefore should receive nursing priority.

METHODS

A meta-analysis of 30 primary studies identified by searching computer databases, which included MEDLINE, PubMed, and CINAHL.

RESULTS

Results showed that all symptoms (pain, dyspnea, nausea/vomiting, and lack of appetite) and psychological distress (depression and anxiety) included had a significant association with cancer-related fatigue with medium-to-large effect sizes, which were estimated using correlation coefficients. The overall correlations of psychological distress with cancer-related fatigue were found to be higher than those of symptom distress. The correlation of nausea/vomiting with cancer-related fatigue was higher than those of pain and dyspnea.

CONCLUSIONS AND IMPLICATIONS

Our findings highlight the importance of psychological distress in dealing with cancer-related fatigue in addition to the need to be attentive to a patient's symptom distress. Of the symptom distress, nausea/vomiting should be prioritized by nurses when managing cancer-related fatigue. This study provides sound empirical evidence that can be used to draft guidelines for the management of cancer-related fatigue.

Mindfulness-based cognitive therapy reduces chronic cancer-related fatigue: a treatment study

INTRODUCTION

About one-third of cancer survivors suffer from severe chronic fatigue. Aim of this study was to evaluate the efficacy of mindfulness-based cognitive group therapy in reducing severe chronic fatigue in cancer survivors with mixed diagnoses.

PATIENTS AND METHODS

Participants (n = 100) were randomly selected from a cohort and allocated to an intervention and a waiting list condition. Analyses were based on 59 participants in the intervention condition and 24 in the waiting-list condition. Fatigue severity (Checklist Individual Strength), functional impairment (Sickness Impact Profile) and well being (Health and Disease-Inventory) were assessed before and after the 9-week intervention. The intervention group had a follow-up 6 months following the intervention.

RESULTS

At post-treatment measurement the proportion of clinically improved participants was 30%, versus 4% in the waiting list condition (χ(2) (1) = 6.71; p = 0.007). The mean fatigue score at post-measurement was significantly lower in the intervention group than in the waiting list group corrected for pre-treatment level of fatigue. The mean well-being score at post-measurement was significantly higher in the intervention group than in the waiting list group corrected for pre-treatment level of well-being. The treatment effect was maintained at 6-month follow-up. No difference between the two conditions was found in functional impairment.

DISCUSSION

Mindfulness-based cognitive therapy is an effective treatment for chronic cancer-related fatigue.

The fatigue experiences of older Taiwanese women with breast cancer

AIMS AND OBJECTIVES

This study explored the fatigue experiences in older Taiwanese women with breast cancer.

BACKGROUND

Cancer is a common disease for older people, and breast cancer ranks second in occurrence among all cancers. Fatigue is the most frequently seen symptom, with more than 90% of cancer patients having such experiences. Fatigue may lead to functional dependence, affecting the care and quality of life for this older population.

DESIGN

A qualitative design was used in this study.

METHODS

In-depth interviews were conducted with participants being treated at the oncology outpatient department in a teaching hospital in northern Taiwan. Data were collected from November 2006-March 2007.

RESULTS

The study included 15 women, aged 65-82, with breast cancer. Analysis of the interviews revealed three themes: factors related to fatigue, interpretation of fatigue and ways to deal with fatigue. The factors related to fatigue arose from treatment, symptom distress and the impact of their emotions. Participants interpreted the fatigue as an inevitable normal reaction, and they were embarrassed to share its occurrence with others. Although fatigue made participants suffer, they found the ways to decrease the feeling of fatigue using psychological adjustments, practical changes and support systems.

CONCLUSIONS

Facing the multilayered influences from treatments and ageing, older women with breast cancer considered fatigue as a physical and psychological expression. By raising the awareness of fatigue, nurses can help this older population manage or relieve fatigue by controlling symptoms, providing emotional support and making related resources available.

RELEVANCE TO CLINICAL PRACTICE

The results of this study can enhance the sensitivity and evaluation abilities of nurses in dealing with the cancer-related fatigue in older women with breast cancer.

Fatigue in gynecological cancer patients during and after anticancer treatment

CONTEXT

Research has indicated that individuals with gynecological cancer experience severe fatigue.

OBJECTIVES

This longitudinal survey aimed to analyze the fatigue experienced over the course of one year by a gynecological cancer population, to determine if the fatigue was more severe than that reported by females without cancer, and to identify variables associated with cancer-related fatigue (CRF).

METHODS

Data were collected over a 12-month period before, during, and after anticancer treatment. Fatigue was assessed using the Multidimensional Fatigue Symptom Inventory-Short Form. Participants with cancer also completed the Rotterdam Symptom Checklist.

RESULTS

Sixty-five cancer patients (mean age = 57.4 years, standard deviation [SD] = 13.9) and 60 control subjects (mean age = 55.4 years, SD = 13.6) participated. Descriptive analysis and repeated measurements modeling indicated that the cancer participants reported worse fatigue than the noncancer individuals before, during, and after anticancer treatment (P < 0.001) and that the level of fatigue in persons with cancer changed with time (P = 0.02). A forward stepwise regression demonstrated that psychological distress level was the only independent predictor of CRF during anticancer treatment (P < 0.00), explaining 44% of the variance in fatigue. After treatment, both psychological distress level (P < 0.00) and physical symptom distress (P = 0.03) were independent predictors of fatigue, accounting for 81% of the variance.

CONCLUSION

Psychological distress level is an important indicator of CRF in gynecological cancer. Interventions focused on the reduction of psychological distress may help alleviate CRF.

Cancer-related fatigue and its associations with depression and anxiety: a systematic review

BACKGROUND

Fatigue is an important symptom in cancer and has been shown to be associated with psychological distress.

OBJECTIVE

This review assesses evidence regarding associations of cancer-related fatigue with depression and anxiety.

METHOD

Database searches yielded 59 studies reporting correlation coefficients or odds ratios.

RESULTS

The combined sample size was 12,103. Almost all studies showed a correlation of fatigue with depression and with anxiety. However, 31 different instruments were used to assess fatigue, suggesting a lack of consensus on measurement.

CONCLUSION

This review confirms the association of fatigue with depression and anxiety. Directionality needs to be better delineated in longitudinal studies.

Personalidade e câncer de mama: produção científica em Psico-Oncologia

O presente estudo se insere no campo da Psico-Oncologia. Objetivou-se empreender uma revisão sistemática da literatura científica dedicada especificamente ao papel da personalidade na evolução da condição clínica e emocional de mulheres acometidas por câncer de mama. Foram consultadas as bases de dados MedLine, PsycINFO, LILACS, SciELO-Brasil e PePSIC. De modo geral, os achados das referências selecionadas apontam que o otimismo enseja uma evolução mais favorável da condição emocional. Além disso, sustentam que pacientes com espírito de luta e manejo apropriado da ansiedade desencadeada por estímulos agressivos tendem a uma melhor condição clínica. Todavia, sugere-se a utilização, em futuras investigações, de escolhas teórico-metodológicas inovadoras para o avanço do conhecimento que atualmente se tem a respeito do assunto em pauta.

Cancer-related fatigue and its associations with depression and anxiety: a systematic review

BACKGROUND

Fatigue is an important symptom in cancer and has been shown to be associated with psychological distress.

OBJECTIVE

This review assesses evidence regarding associations of cancer-related fatigue with depression and anxiety.

METHOD

Database searches yielded 59 studies reporting correlation coefficients or odds ratios.

RESULTS

The combined sample size was 12,103. Almost all studies showed a correlation of fatigue with depression and with anxiety. However, 31 different instruments were used to assess fatigue, suggesting a lack of consensus on measurement.

CONCLUSION

This review confirms the association of fatigue with depression and anxiety. Directionality needs to be better delineated in longitudinal studies.

A pilot study evaluating the safety and efficacy of modafinal for cancer-related fatigue

BACKGROUND

Fatigue is a common symptom that lowers the quality of life of patients with cancer, affecting between 60% and 90% of patients. Relatively few options are available for the treatment of this debilitating condition. Modafinal, a psychostimulant developed for the treatment of narcolepsy, has been used to treat fatigue in other diseases such as multiple sclerosis, but little data support its use in cancer patients.

OBJECTIVE AND DESIGN

The primary objective of this open-label pilot study was to evaluate the safety, and efficacy of modafinil in improving cancer-related fatigue (CRF) as measured by the Brief Fatigue Inventory (BFI). The effect of this agent on depression, quality of life, functional status, and cognitive function was also assessed. Modafinal was self-administered at a dose of 100 mg/d during weeks 1-2, and 200 mg during weeks 3-4. Assessments were performed at baseline, 2, and 4 weeks.

RESULTS

BFI score was improved in 46% of patients at 2 weeks and 75% at 4 weeks (p = 0.025). Hospital Anxiety and Depression Scale scores declined at 2 and 4 weeks (p < 0.001). Most scales for neurocognitive function were unchanged. Score for all Functional Assessment of Cancer Therapy-Brain (FACT-BR) subscales (measuring quality of life), except social/family well-being, were improved (p < 0.05) at 2 and 4 weeks. Significant changes in Eastern Cooperative Oncology Group (ECOG) performance status were noted, with 40% of patients improving at least one level. Modafinil was well-tolerated with only one patient discontinuing treatment due to drug-related toxicity.

CONCLUSION

In this pilot study modafinil was well-tolerated and effective for fatigue in patients with cancer. Improvements were also seen in mood, quality of life, and functional status.

Determinants of fatigue 6 and 12 months after surgery in women with early-stage breast cancer: a comparison with women with benign breast problems

OBJECTIVE

The objective of this study was to examine the predictors of fatigue 6 and 12 months after surgical treatment in women with early-stage breast cancer (BC group) and in women with benign breast problems (BBP group) in a prospective follow-up study.

METHODS

Women entered the study prior to diagnosis and completed questionnaires on personality factors, psychological factors, and social support. Fatigue was assessed 6 and 12 months after diagnosis (BBP group) or surgical treatment (BC group). Clinical data were taken from medical records.

RESULTS

In the BC group (n=117), fatigue at 6 months was predicted by trait anxiety (P<.001) and extraversion (P<.05). Trait anxiety (P<.05), extraversion (P<.05), and depressive symptoms (P<.05) predicted fatigue at 12 months. In the BBP group (n=190), the predictors were trait anxiety (P<.001) for fatigue at 6 months, and trait anxiety (P<.001) and neuroticism (P<.01) for fatigue at 12 months.

CONCLUSION

Many patients who are already fatigued before diagnosis remain tired regardless of diagnosis. Trait anxiety is strongly related to fatigue in both groups.

Study of the prevalence of tumour-related asthenia in Spanish cancer patients

INTRODUCTION

Asthenia is the most prevalent symptom in oncological patients but it is underestimated by the majority of healthcare professionals. The aim of the present study is to estimate the prevalence of tumour-related asthenia in the Spanish population, while defining the associated factors.

METHODS

An epidemiological, multicentre, cross-sectional study was conducted in oncology services from Spain, including 712 cancer patients (58.4+/-13.5 years).

RESULTS

42.5% patients showed asthenia. This prevalence appeared to be tumour-related (p<0.05) and increased among patients with a more advanced stage of disease or with a worsening of performance status (p<0.001). The prevalence of asthenia increased in the presence of the following factors: chemotherapy (in the past: 52.1% vs. 31.0%; at the time of the study: 46.1% vs. 38.2%), symptomatic treatment (in the past: 60.4% vs. 39.8%; at the time of the study: 61.3% vs. 38.6%), present interferon treatment (100%), anaemia (59.7% vs. 31.3%), dehydration/waterelectrolyte imbalance (58.3% vs. 41.6%), respiratory failure (61.4% vs. 39.7%), liver disease (59.5% vs. 41.3%), malnutrition (76.1% vs. 38.7%), pain (57.7% vs. 27.0%), anxiety (56.1% vs. 38.6%), depression (57.9% vs. 40.0%) and sleep disturbances (51.1% vs. 39.4%). A multivariate logistic regression showed that a model including performance status, patient circumstance, chemotherapy, anaemia, pain and anxiety correctly diagnosed asthenia in 70.9% of cases.

CONCLUSIONS

The physiopathology of tumour-related asthenia remains relatively unknown, despite its high prevalence and considerable quality of life impact. Determining factors related to asthenia in clinical practice can favour the use of concrete treatments and improve the conditions of cancer patients.

Chronic cancer-related fatigue in long-term survivors of testicular cancer

OBJECTIVE

High prevalence of cancer-related fatigue (CRF) has been reported among many groups of cancer survivors when compared to the general population. However, this topic has rarely been studied in long-term survivors of testicular cancer (TCSs). The present multi-centre study examines the prevalence of chronic CRF in Norwegian TCSs compared to chronic general fatigue (GF) in the Norwegian general population, and associations between a variety of relevant variables and CRF in TCSs.

METHODS

Participants were 1431 TCSs, aged 18-75, at an average of 11 years posttreatment (range 4.5-21 years), and a sample of 1080 age-matched men from the general Norwegian population (GenPop). The participants responded to a mailed questionnaire that included the Fatigue Questionnaire for the assessment of chronic CRF and chronic GF.

RESULTS

The prevalence of chronic CRF was 17.1% (95% CI 15.2-19.1%) among TCSs compared to 9.7% of chronic GF in GenPop (95% CI 8.0-11.5%). Regression analyses showed that poor quality of life (QOL), various psychosocial and somatic problems, and neuroticism were highly associated with presence of chronic CRF in TCSs.

CONCLUSION

Chronic CRF is far more common among TCSs than chronic GF in the general population and is associated with poor QOL and multiple psychological and somatic health problems. As a consequence, fatigue should be in focus during routine follow-ups as well as later in the general medical care of TCSs.

The course of severe fatigue in disease-free breast cancer patients: a longitudinal study

BACKGROUND

We investigated whether fatigue is a persistent problem, and whether persistent fatigue is related to former treatment modalities. In addition, we studied the predictors of persistent fatigue.

METHODS

At baseline (n=150, mean time since cancer treatment=29 months) patients were asked to fill out several questionnaires on psychological, physical, social, cognitive and behavioral aspects (Ann. Oncol. 2002;13:589-598). During the 2 years after baseline patients were asked to fill out monthly a fatigue questionnaire (CIS-fatigue). Hundred-twenty-one patients completed the study, 10 dropped out and 19 had a disease recurrence.

RESULTS

Twenty-four percent of the patients experienced persistent severe fatigue complaints during the 2-year observation period. Persistent fatigue seemed to be related to the duration of former treatment but unrelated to type of surgery, type of adjuvant therapy and time since treatment finished. High anxiety, high impairment in role functioning and low sense of control over fatigue symptoms at baseline were predictors of persistent fatigue.

CONCLUSION

Fatigue appears to be a persistent problem for a quarter of a sample of disease-free breast cancer patients during a 2-year period. The predictors of persistent fatigue found in this study can be helpful for the development of interventions to reduce post-treatment fatigue.

Cognitive behaviour therapy for fatigued cancer survivors: long-term follow-up

An earlier randomised-controlled trial demonstrated the positive effects of cognitive behaviour therapy (CBT), especially designed for fatigued cancer survivors in reducing fatigue, functional impairments and psychological distress. In the current prospective study, we were able to examine the long-term effect of CBT in patients who completed the therapy. Predictors of fatigue severity at follow-up were exploratory investigated. Sixty-eight patients who completed CBT were assessed at pretreatment, post-treatment and at follow-up (mean follow-up 1.9 years (s.d. 1.0), range: 1–4 years). To analyse possible predictors of treatment outcome a linear regression (enter) was carried out. Improvements on fatigue severity, functional impairment and psychological distress after CBT appeared to remain stable during a follow-up period. Patients who were not fatigued anymore at follow-up were not different from a reference group of non-fatigued cancer survivors. The explorative regression analysis showed that fatigue severity, psychological distress and somatic attributions at pretreatment contributed to persistent fatigue severity at follow-up. Cognitive behaviour therapy, especially designed for post-cancer fatigue, is successful in reducing fatigue and functional impairment in cancer survivors. Moreover, these positive effects were maintained at about 2 years after finishing CBT.

Experience of severe fatigue in long-term survivors of stem cell transplantation

The literature suggests that cancer survivors with more aggressive treatments are more at risk for postcancer fatigue. In this study, we investigated the prevalence of fatigue after completion of stem cell transplantation (SCT). Furthermore, we studied if medical variables are associated with fatigue and if the model of perpetuating factors of postcancer fatigue derived from previous studies in cancer survivors, without SCT, is applicable in SCT survivors. Ninety-eight patients treated with autologous or allogeneic SCT filled out several questionnaires. Medical characteristics were obtained from the medical charts. All patients had to be in persistent complete remission for at least 1 year. Thirty-five per cent of the patients experienced severe fatigue. The percentage of patients with severe fatigue remained stable during the years after transplantation. Several psychosocial factors, but no medical factors, were associated with fatigue. The model of perpetuating factors appeared to be applicable. Contrary to cancer survivors without SCT, we found no decrease in fatigue complaints during the first years after SCT. Cognitive behaviour therapy (CBT) is a general form of psychotherapy directed at changing condition-related cognitions and behaviours. CBT especially designed for postcancer fatigue, aimed at perpetuating factors, can also be used to manage fatigue in cancer survivors treated with SCT.

Personality and fatigue in patients with benign or malignant breast disease

GOALS OF WORK

The aim of the study was to examine the role of five general personality traits in fatigue in a group of patients with breast cancer (BC) and a group with benign breast problems (BBP).

MATERIALS AND METHODS

Of the 304 participating women, 127 patients had BC and 177 BBP. A fatigue scale was completed before diagnosis and 1, 3, and 6 months after diagnosis (benign patients) or surgical treatment (BC patients). A personality questionnaire (NEO-FFI) and a depression scale (CES-D) were completed before diagnosis.

MAIN RESULTS

The BC group was less tired before diagnosis, more tired 1 month after diagnosis, and equally tired 3 and 6 months after diagnosis. In the total group, women were more tired over time when they were more neurotic, less agreeable, or more introverted. After controlling for depressive symptoms, demographics, and medical factors, baseline depressive symptoms (beta = 0.29, p < 0.05), neuroticism (beta = 0.29, p < 0.05), and extraversion (beta = -0.25, p < 0.05) predicted fatigue 6 months later. After also including baseline fatigue, only neuroticism (beta = 0.22, p < 0.05) and baseline fatigue (beta = 0.79, p < 0.001) predicted fatigue.

CONCLUSIONS

Personality is more strongly related to fatigue than demographics, the diagnosis cancer, receiving cancer treatment, and baseline depressive symptoms and fatigue. When replicated, screening and treating women who are at risk to experience high levels of fatigue is recommended.

Effects of Cognitive Behavior Therapy in Severely Fatigued Disease-Free Cancer Patients Compared With Patients Waiting for Cognitive Behavior Therapy: A Randomized Controlled Trial

Purpose

Persistent fatigue is a long-term adverse effect experienced by 30% to 40% of patients cured of cancer. The main objective of this randomized controlled trial was to show the effectiveness of cognitive behavior therapy (CBT) especially designed for fatigue in cancer survivors.

Patients and Methods

A total of 112 cancer survivors with somatically unexplained fatigue were allocated randomly to immediate cognitive behavior therapy or to a waiting list condition for therapy. Both conditions were assessed two times, at baseline and 6 months later. The primary outcome variables were fatigue severity (Checklist Individual Strength) and functional impairment (Sickness Impact Profile). Data were analyzed by intention to treat.

Results

Analyses were based on 50 patients in the intervention condition and 48 patients in the waiting list condition. Patients in the intervention condition reported a significantly greater decrease than patients in the waiting list condition in fatigue severity (difference, 13.3; 95% CI, 8.6 to 18.1) and in functional impairment (difference, 383.2; 95% CI, 197.1 to 569.2). Clinically significant improvement for the CBT group compared with the waiting list group was seen in fatigue severity (54% v 4% of the patients, respectively) and in functional impairment (50% v 18% of the patients, respectively).

Conclusion

Cognitive behavior therapy has a clinically relevant effect in reducing fatigue and functional impairments in cancer survivors.