Forming new habits in the face of chronic cancer-related fatigue: An interpretative phenomenological study

Resilience in the Face of Cancer: On the Importance of Defining and Studying Resilience as a Dynamic Process of Adaptation

Resilience is defined as the maintenance or relatively quick recovery of mental health during and after adversity. Rather than focusing on psychopathology and its causes, resilience research aims to understand what protective mechanisms shield individuals against developing such disorders and translate these insights to improve psychosocial care. This resilience approach seems especially promising for the field of oncology because patients face stressor after stressor from diagnosis to survivorship. Helping patients to learn how they can best use the resources and abilities available to them can empower patients to handle subsequent stressors. In the past few decades, resilience has increasingly been considered as a dynamic process of adaptation. While researchers use this definition, resilience has not yet been studied as a dynamic process in the field of oncology. As a result, the potential of resilience research to gain insight into what helps protect cancer patients from developing psychopathology is limited. We discuss conceptual and methodological proposals to advance resilience research in oncology. Most importantly, we propose applying prospective longitudinal designs to capture the dynamic resilience process. By gaining insight in how cancer patients engage in protective factors, resilience research can come to its full potential and help prevent psychopathology.

The effect of a fatigue self-management program based on individual and family self-management theory in cancer patients: A single-blinded randomized controlled trial

PURPOSE

This study was conducted to investigate the effect of the Fatigue Self-Management Program based on the Individual and Family Self-Management Theory on fatigue, daily living activities, and well-being in cancer patients.

METHODS

This randomized controlled single-blind experimental study was carried out between November 2020 and April 2022. A total of 94 patients with advanced cancer, 47 in each group, were included in the study, and 57 participants completed the study. Data were collected using the Brief Fatigue Inventory, Katz Index of Independence in Activities of Daily Living, and Well-Being Questionnaire-22. The Fatigue Self-Management Program based on Individual and Family Self-Management Theory was delivered to the intervention group with two face-to-face and two tele-monitoring sessions. No intervention was applied to the control group, who received only routine care.

RESULTS

The mean score of fatigue in the intervention group compared to the control group decreased, and the difference was statistically significant (p < .05); daily living activities mean scores were higher than the control group, but there was no statistically significant difference (p > .05). The mean scores of depression and anxiety in the intervention group were lower than those in the control group; energy, positive well-being, and general well-being mean scores were found to be higher than those in the control group, and the difference was statistically significant (p < .05).

CONCLUSIONS

The Fatigue Self-Management Program effectively reduces the fatigue experienced by cancer patients and increases their well-being but it does not increase their independence in daily living activities.

CLINICAL TRIAL REGISTRY

NCT04822220.

'Life became slow down': A descriptive qualitative study of the experiences of cancer-related fatigue amongst people with advanced lung cancer

BACKGROUND

Cancer-related fatigue is a complex multidimensional concept. However, little is known about the experience of cancer-related fatigue in people with advanced lung cancer. How they emotionally react to and cope with the experience of cancer-related fatigue according to cultural influences has not been extensively explored.

AIM

To explore the experience of cancer-related fatigue, its impacts and emotional reactions to and coping strategies for cancer-related fatigue amongst people with advanced lung cancer in China.

DESIGN

This was a cross-sectional, descriptive qualitative study with face-to-face semi-structured interviews. Data were analysed using content analysis.

SETTING/PARTICIPANTS

Twenty-one people with advanced lung cancer who experienced cancer-related fatigue were recruited in a hospital setting.

RESULTS

Four themes were identified: multifaceted experiences of cancer-related fatigue, impacts of cancer-related fatigue, negative perceptions of cancer-related fatigue and avoiding cancer-related fatigue. The multifaceted experience of cancer-related fatigue had physical, psychological and social impacts along the cancer trajectory. Informants regarded it as a sign of a 'bad ending', searched for root causes and had negative attitudes towards role changes. Avoiding coping strategies included not discussing cancer-related fatigue, refusing encouragement and support, hiding feelings, withdrawing from social life and attempting to control cancer-related fatigue.

CONCLUSION

The findings provide insights into the lack of flexibility of people with advanced lung cancer to adapt to the multidimensional experience of cancer-related fatigue. The reactions and coping towards cancer-related fatigue are profoundly influenced by Chinese culture. Developing psychological interventions based on the cultural background are highly recommended to cultivate the ability to cope flexibly with stressful events and live a meaningful cancer life.

The rhythm of chemotherapy and the felt experience of time: a front-loaded phenomenological retrospective cohort study

It is well-known that chemotherapy brings about various adverse physical effects such as fatigue, nausea, or vomiting, and that it lowers mental well-being. It is less known that it desynchronizes patients with social environment. This study explores the temporal aspects and challenges of chemotherapy. Three groups equal in size and distinguished according to weekly, biweekly, and triweekly treatment schemes, each independently representative in terms of sex and age of the cancer population (total N = 440) were compared. The study found that chemotherapy sessions, regardless of their frequency, patients' age, and the overall length of treatment, have a very large effect on changing the felt pace of time from flying to dragging (Cohen's d = 1.6655). Most patients pay more attention to the passing of time than before treatment (59.3%), which has to do with the disease (77.4%). They also experience the loss of control over time, which they subsequently attempt to regain. The patients' actual activities before and after chemotherapy, however, are mostly the same. All these aspects create a unique 'chemo-rhythm', in which the significance of the type of cancer and demographic variables is negligible, and the mere rhythmic nature of treatment plays a central role. In conclusion, patients find the 'chemo-rhythm' stressful, unpleasant and difficult to control. It is vital to prepare them for it and help to reduce its adverse effects.

Navigating severe chronic cancer-related fatigue: an interpretative phenomenological analysis

OBJECTIVE

This article presents a phenomenological study on the embodied experiences of patients with Chronic Cancer-Related Fatigue (CCRF), aiming to better understand this complex phenomenon.

DESIGN

Data collection consisted of individual interviews with 25 participants who suffered from severe CCRF for at least three months after cancer treatment was finished.

MAIN OUTCOME MEASURES

Against the theoretical background of philosophical phenomenology, we explored embodied experiences, incorporated temporal and spatial aspects of living with CCRF. We applied interpretative phenomenological analysis (IPA) to analyze the transcripts of the interviews.

RESULTS

Using IPA, we identified four themes on how chronic fatigue is experienced post-cancer: (1) Worn out; (2) Diminishment of one's 'I can'; (3) Invisibility; and (4) Regaining one's 'I can'.

CONCLUSION

For clinical practice, these results imply that professionals could focus more on the role of the body and limitations of one's 'I can' when treating CCRF. By studying these embodied CCRF experiences in individual patients, future research could help personalize and optimize treatment.

Using smartphone-based ecological momentary assessment and personalized feedback for patients with chronic cancer-related fatigue: A proof-of-concept study

INTRODUCTION

Chronic cancer-related fatigue (CCRF) is a complex multidimensional problem warranting person-centered care. Providing patients and therapists personalized feedback based on network analysis applied to ecological momentary assessment (EMA) data could facilitate case conceptualization in psycho-oncological care. The aim was to explore patients' and therapists' experiences of using an EMA app and personalized feedback based on network theory to aid case conceptualization in psycho-oncological care.

METHODS

A n = 5 proof-of-concept study was implemented in routine psycho-oncological care. We purposively selected adult cancer patients suffering from severe CCRF who were on the waitlist for psycho-oncological care. During a 3-week period participants filled out the EMA app Energy InSight (fatigue, mood, activity, responding, and context) five times a day. Participants received a descriptive and network feedback report, which they reflected upon during the first therapy sessions. Thematic analysis was used to analyze user experiences.

RESULTS

Patients experienced that filling out the Energy InSight app, as well as receiving descriptive and network-based personalized feedback provided them with insight into their CCRF. Although therapists experienced the discussion of network feedback as challenging, it facilitated the case conceptualization.

DISCUSSION

Using EMA during waitlist for psychological care seemed feasible. Patients experienced beneficial effects from filling out the EMA app and talking over the personalized feedback reports, which in turn aided case conceptualization and personalized care. Based on this evaluation, an improved version of the Energy InSight app and a therapist training for providing network feedback is developed for implementation in psycho-oncological care.

Effect of Somatosensory Interaction Transcutaneous Electrical Acupoint Stimulation on Cancer-related Fatigue and Immunity: A Randomized Controlled Trial

BACKGROUND

This study was intended to evaluate the clinical effect of somatosensory interaction transcutaneous electrical acupoint stimulation (SI-TEAS) on cancer-related fatigue (CRF) and its safety.

METHODS

The study protocol had been registered in China Clinical Trial Registration Center with registration number: ChiCTR2100045655. CRF patients were equally divided into SI-TEAS Group, Acupressure Group and Sham Acupressure Group to receive SI-TEAS, acupressure and sham acupressure treatments 5 times a week. The fatigue levels of patients in the 3 groups were measured by the Piper Fatigue Scale during the baseline period and after 4 and 8 weeks (of treatment). The cell immunity of these patients was determined by detecting the T-lymphocyte subsets and NK cells.

RESULT

Of the 300 participants, 279 have gone through the independent rehabilitation intervention study, including 94 in the SI-TEAS Group, 92 in the Acupressure Group, and 93 in the Sham Acupressure Group. Intergroup comparisons of fatigue degree and cell immunity, namely SI-TEAS Group versus Acupressure Group, Acupressure Group versus Sham Acupressure Group, and SI-TEAS Group versus Sham Acupressure Group, showed that group changes observed during the baseline period and different time points after Week 4 and 8 were statistically different (P<0.05). The SI-TEAS Group had the sharpest decreases in the behavioral, sensory, emotional and cognitive dimensions of fatigue, and the total score, followed by the Acupressure Group, while the Sham Acupressure Group did not show significant changes; the SI-TEAS Group experienced the sharpest increases in the absolute counts of CD3+ T cells, CD4+ T cells, CD8+ T cells, CD4+/CD8+ T cells, and NK cells, followed by the Acupressure Group, while the Sham Acupressure Group did not show significant changes.

CONCLUSION

SI-TEAS could significantly relieve the fatigue of CRF patients and improve their cell immunity, which maybe a useful and effective option for reducing CRF in clinical practice.