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van Roozendaal AS, Schellekens MPJ, van Woezik RAM, van der Lee ML. Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer-related fatigue. Psychooncology 2023; 32:1876-1884. [PMID: 37902175 DOI: 10.1002/pon.6235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Approximately 25% of cancer patients suffer from cancer-related fatigue (CRF) after cancer treatment. CRF is a multi-factorial condition affected by several interrelated protective and perpetuating factors. As most studies merely assessed bivariate associations, more insight into the complex relationships among these constructs is needed. We applied the multivariate network approach to gain a better understanding of how patients' fatigue, perpetuating and protective factors are dynamically interconnected. METHOD Between February and August 2022, 30 cancer patients filled out a carefully developed ecological momentary assessment questionnaire (EnergyInSight) five times a day for at least 21 days while being on the waitlist for psychological care for CRF. We performed a multi-level vector autoregression analysis to examine the interconnectedness among fatigue, protective factors (allowing rest, acceptance, and self-efficacy) and perpetuating factors (worrying, catastrophizing, and feeling guilty). RESULTS In the contemporaneous network (concurrent associations), higher acceptance and self-efficacy were associated with lower fatigue, whereas all other factors were associated with higher fatigue. The strongest relationships were between worrying and feeling guilty and between acceptance and allowing rest. In the temporal network (lagged associations), fatigue was related to two factors: higher self-efficacy preceded lower fatigue, and higher fatigue preceded increased allowing rest. CONCLUSIONS Taking all included factors into account, the networks identified self-efficacy and allowing rest as key protective factors of CRF. Patients may benefit from psychological interventions that cultivate self-efficacy, as it seems to pave the way to reduced fatigue.
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Affiliation(s)
- Anne S van Roozendaal
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
| | - Melanie P J Schellekens
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
- Tilburg University School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg, The Netherlands
| | - Rosalie A M van Woezik
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
| | - Marije L van der Lee
- Helen Dowling Institute, Centre for Psycho-Oncology, Scientific Research Department, Bilthoven, The Netherlands
- Tilburg University School of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg, The Netherlands
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2
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Schellekens MPJ, Bruggeman-Everts FZ, Wolvers MDJ, Vollenbroek-Hutten MMR, van der Lee ML. What web-based intervention for chronic cancer-related fatigue works best for whom? Explorative moderation analyses of a randomized controlled trial. Support Care Cancer 2022; 30:7885-7892. [PMID: 35726109 PMCID: PMC9512869 DOI: 10.1007/s00520-022-07223-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/11/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Approximately 25% of cancer patients suffer from chronic cancer-related fatigue (CCRF), which is a complex, multifactorial condition. While there are evidence-based interventions, it remains unclear what treatment works best for the individual patient. This study explored whether baseline characteristics moderated the effect of web-based mindfulness-based cognitive therapy (eMBCT) versus ambulant activity feedback (AAF) and a psycho-education control group (PE) on fatigue in patients suffering from CCRF. METHODS In a randomized controlled trial, participant suffering from CCRF participated in either eMBCT, AAF, or PE. Complete data of the treatment-adherent sample (≥ 6 sessions) was used to explore whether sociodemographic, clinical, and psychological characteristics at baseline moderated the intervention effect on fatigue severity at 6 months. RESULTS A trend showed that baseline fatigue severity and fatigue catastrophizing moderated the intervention effect. That is, at low levels of fatigue severity and catastrophizing, patients benefited more from AAF than from eMBCT and at high levels of fatigue severity and catastrophizing, patients benefited more from eMBCT than from PE. CONCLUSIONS This study found some preliminary evidence on what treatment works best for the individual suffering from CCRF. These findings emphasize the potential gain in effectiveness of personalizing treatment. An alternative approach that might help us further in answering the question "what treatment works best for whom?" is discussed.
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Affiliation(s)
- Melanie P J Schellekens
- Scientific Research Department, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, The Netherlands.
- Department of Medical and Clinical Psychology, Tilburg University School of Social and Behavioral Sciences, Tilburg, The Netherlands.
| | - Fieke Z Bruggeman-Everts
- Scientific Research Department, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, The Netherlands
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, The Netherlands
| | - Marije D J Wolvers
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, The Netherlands
| | - Miriam M R Vollenbroek-Hutten
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, The Netherlands
- ZGT Academy, ZiekenhuisGroep Twente, Almelo, The Netherlands
| | - Marije L van der Lee
- Scientific Research Department, Helen Dowling Institute, Centre for Psycho-Oncology, Bilthoven, The Netherlands
- Department of Medical and Clinical Psychology, Tilburg University School of Social and Behavioral Sciences, Tilburg, The Netherlands
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3
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Lingens SP, Hagedoorn M, Zhu L, Ranchor AV, van der Lee M, Garssen B, Schroevers MJ, Sanderman R, Goedendorp MM. Trajectories of fatigue in cancer patients during psychological care. Psychol Health 2021; 37:1002-1021. [PMID: 33985383 DOI: 10.1080/08870446.2021.1916493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Psycho-oncological institutions offer specialized care for cancer patients. Little is known how this care might impact fatigue. This study aimed to identify fatigue trajectories during psychological care, examined factors distinguishing these trajectories and predicted fatigue severity after nine months of psychological care. DESIGN Naturalistic, longitudinal study of 238 cancer patients receiving psycho-oncological care in the Netherlands. Data were collected before initiation of psychological care (T1) and three (T2) and nine months (T3) afterwards. Latent class growth analysis, repeated measure analyses (RMA) and linear regression analysis were performed. MAIN OUTCOME MEASURES Fatigue severity: Checklist Individual Strength. RESULTS Three fatigue trajectories were identified: high- (30%), moderate- (62%) and low-level fatigue (8%). While statistically significant decreases in fatigue were found, this decrease was not clinically relevant. RMA showed main effects for time for fatigue trajectories on depression, anxiety, personal control and illness cognitions. Fatigue severity and physical symptoms at T1, but not demographic or clinical factors, were predictive of fatigue severity at T3. CONCLUSIONS Fatigue is very common during psycho-oncological care, and notably not clinically improving. As symptoms of fatigue, depression, anxiety and physical symptoms often cluster, supplementary fatigue treatment should be considered when it is decided to treat other symptoms first.
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Affiliation(s)
- Solveigh P Lingens
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lei Zhu
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marije van der Lee
- Centre for Psycho-Oncology, Helen Dowling Institute, Bilthoven, The Netherlands
| | - Bert Garssen
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Centre for Psycho-Oncology, Helen Dowling Institute, Bilthoven, The Netherlands
| | - Maya J Schroevers
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Martine M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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4
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Bootsma TI, Schellekens MPJ, van Woezik RAM, Slatman J, van der Lee ML. Forming new habits in the face of chronic cancer-related fatigue: An interpretative phenomenological study. Support Care Cancer 2021; 29:6651-6659. [PMID: 33954822 PMCID: PMC8464573 DOI: 10.1007/s00520-021-06252-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023]
Abstract
Purpose The growing group of patients who suffer from chronic cancer-related fatigue (CCRF) after cancer have helpful and less helpful ways of responding to this long-lasting and disruptive problem. This qualitative study aimed to gain insight in essential elements of how patients respond to CCRF, with a focus on helpful responses to facilitate adaptation. Methods We conducted semi-structured interviews with a purposive sample of 25 participants who experienced severe CCRF for at least 3 months. Participants were recruited via media, patient associations, meetings, and health professionals until data saturation was attained. We used a topic guide with open-ended questions about lived experiences. Interpretative phenomenological analysis (IPA) was used for analysis of the transcripts. Results We identified five interrelated themes of how patients respond to CCRF: (1) discovering physical and emotional boundaries; (2) communicating support needs; (3) reorganizing and planning activities and rest; (4) letting go of one’s habitual identity; and (5) recognizing and accepting CCRF. Conclusion This study highlights the development of new habits and positive beliefs in the face of CCRF and the importance of (social) support in this process. This experiential knowledge on helpful responses can be used to inform patients and their significant others and improve self-efficacy. Health professionals could use these insights to improve recognition of CCRF and personalize treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06252-3.
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Affiliation(s)
- Tom I Bootsma
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB, Bilthoven, the Netherlands. .,Department of Culture Studies, School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands.
| | - Melanie P J Schellekens
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB, Bilthoven, the Netherlands.,Department of Medical and Clinical Psychology, School of Social and Behavioral Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands
| | - Rosalie A M van Woezik
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB, Bilthoven, the Netherlands
| | - Jenny Slatman
- Department of Culture Studies, School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands
| | - Marije L van der Lee
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, 3723 MB, Bilthoven, the Netherlands.,Department of Medical and Clinical Psychology, School of Social and Behavioral Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, the Netherlands
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van Swaay A, Vissers K, Engels Y, Groot M. Haptotherapy for patients with cancer; experience of haptotherapists and reasons for consultation: A survey among haptotherapists. Complement Ther Clin Pract 2021; 43:101352. [PMID: 33761431 DOI: 10.1016/j.ctcp.2021.101352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 02/25/2021] [Accepted: 02/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Haptotherapy is a type of mind-body therapy that makes use of affective touch. This study aims to provide insights in reasons for haptotherapy for patients with cancer, and in experiences of haptotherapists with these patients. MATERIALS AND METHODS In a cross-sectional study, a survey was conducted among 536 Dutch haptotherapists. Multiple-choice and open-ended questions were analyzed both quantitatively and qualitatively. RESULTS Of 272 (50.7%) responding haptotherapists, 167 (61.5%) had experience with treating people with cancer. Most frequently, combinations of emotional problems and a disturbed body experience were reported as reasons for haptotherapy. Haptotherapists emphasized the need for affective touch to restore patients' body connection. CONCLUSION Two-thirds of the respondents treat patients with cancer, addressing the interaction of body and mind. Reasons for consultation cover a wide range of problems in multiple dimensions, in which a disturbed body experience in combination with emotional problems is mentioned most often.
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Affiliation(s)
- Agnes van Swaay
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (717), the Netherlands.
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (717), the Netherlands.
| | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (717), the Netherlands.
| | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, P.O. Box 9101, NL-6500 HB, Nijmegen (717), the Netherlands.
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Schellekens MPJ, Wolvers MDJ, Schroevers MJ, Bootsma TI, Cramer AOJ, van der Lee ML. Exploring the interconnectedness of fatigue, depression, anxiety and potential risk and protective factors in cancer patients: a network approach. J Behav Med 2020; 43:553-563. [PMID: 31435892 PMCID: PMC7366596 DOI: 10.1007/s10865-019-00084-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/17/2019] [Indexed: 01/06/2023]
Abstract
Researchers have extensively studied fatigue, depression and anxiety in cancer patients. Several risk and protective factors have been identified for these symptoms. As most studies address these constructs, independently from other symptoms and potential risk and protective factors, more insight into the complex relationships among these constructs is needed. This study used the multivariate network approach to gain a better understanding of how patients' symptoms and risk and protective factors (i.e. physical symptoms, social withdrawal, illness cognitions, goal adjustment and partner support) are interconnected. We used cross-sectional data from a sample of cancer patients seeking psychological care (n = 342). Using network modelling, the relationships among symptoms of fatigue, depression and anxiety, and potential risk and protective factors were explored. Additionally, centrality (i.e. the number and strength of connections of a construct) and stability of the network were explored. Among risk factors, the relationship of helplessness and physical symptoms with fatigue stood out as they were stronger than most other connections in the network. Among protective factors, illness acceptance was most centrally embedded within the network, indicating it had more and stronger connections than most other variables in the network. The network identified key connections with risk factors (helplessness, physical symptoms) and a key protective factor (acceptance) at the group level. Longitudinal studies should explore these risk and protective factors in individual dynamic networks to further investigate their causal role and the extent to which such networks can inform us on what treatment would be most suitable for the individual cancer patient.
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Affiliation(s)
- Melanie P J Schellekens
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, Postbus 80, 3720 AB, Bilthoven, The Netherlands.
- Department of Methodology and Statistics, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.
| | - Marije D J Wolvers
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, Postbus 80, 3720 AB, Bilthoven, The Netherlands
| | - Maya J Schroevers
- Department of Health Psychology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Tom I Bootsma
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, Postbus 80, 3720 AB, Bilthoven, The Netherlands
- Department of Cultural Studies, School of Humanities and Digital Sciences, Tilburg University, Tilburg, The Netherlands
| | - Angélique O J Cramer
- Department of Methodology and Statistics, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Marije L van der Lee
- Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, Postbus 80, 3720 AB, Bilthoven, The Netherlands
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7
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van Eenbergen MC, Vromans RD, Tick LW, Vreugdenhil G, Krahmer EJ, Mols F, van de Poll-Franse LV. Comparing cancer survivors in population-based samples with those in online cancer communities: Identifying differences in internet use and information needs (Preprint). JMIR Cancer 2020; 8:e19379. [PMID: 35258460 PMCID: PMC8941444 DOI: 10.2196/19379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/07/2020] [Accepted: 01/25/2022] [Indexed: 01/23/2023] Open
Abstract
Background Most Western countries have websites that provide information on cancer and the opportunity to participate in online cancer communities (OCCs). The number of patients with cancer that participate in these OCCs is growing. These patients are relatively easy to approach for research purposes. Objective The objective of this study is to determine the differences and similarities between survivors of cancer in population-based samples and survivors participating in OCCs who use the internet in relation to their illness. Methods In 2017, we drew a sample of 539 population-based patients and 531 OCC patients. The population-based patients were sent a paper-based questionnaire, and the OCC patients were sent the same questionnaire on the web. In the questionnaire, we asked patients about their sociodemographics, internet use, sources of information, media use, and wishes regarding future internet use for health care–related purposes, and the effect of internet use on their health care consumption. Results The response rate of population-based internet users was 47% (233/496), and that of the OCC group was 40.3% (214/531). The OCC group had a significantly higher education level (P<.001), was younger (P<.001), had more survivors that were employed (P<.001), and attached greater importance to the internet (171/214, 79.9% vs 126/233, 54.1%; P<.001) and fellow survivors (107/214, 50% vs 60/233, 25.8%; P<.001). Compared with the population-based group, the OCC group reported more intensive internet use immediately after diagnosis, during treatment, and during follow-up (P<.001 in each case). There were similarities in terms of the relative importance that survivors attach to the various sources of information, the topics on which they seek information, and their wishes for future eHealth possibilities. The OCC group reported a greater need to participate in a web-based class or chat with others (92/214, 43% vs 44/233, 18.9%). Conclusions We conclude that survivors who are members of an OCC are not representative of survivors of cancer in general. There are significant differences in sociodemographic characteristics, internet use during their treatment journey, internet search frequency during their cancer journey, and participation wishes. Using web-based information and communication can support shared decision-making and may facilitate the active participation of patients during their treatment. For research purposes, it is important to take the bias in OCC groups into account.
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Affiliation(s)
- Mies C van Eenbergen
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Ruben D Vromans
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Lidwine W Tick
- Department of Medical Oncology, Maxima Medical Center, Veldhoven, Netherlands
| | - Gerard Vreugdenhil
- Department of Medical Oncology, Maxima Medical Center, Veldhoven, Netherlands
| | - Emiel J Krahmer
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Floortje Mols
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
| | - Lonneke V van de Poll-Franse
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, Netherlands
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Predictors of Returning to Work after Receiving Specialized Psycho-Oncological Care. HEALTH PSYCHOLOGY BULLETIN 2020. [DOI: 10.5334/hpb.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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van Beek FE, Wijnhoven LMA, Jansen F, Custers JAE, Aukema EJ, Coupé VMH, Cuijpers P, van der Lee ML, Lissenberg-Witte BI, Wijnen B, Prins JB, Verdonck-de Leeuw IM. Prevalence of adjustment disorder among cancer patients, and the reach, effectiveness, cost-utility and budget impact of tailored psychological treatment: study protocol of a randomized controlled trial. BMC Psychol 2019; 7:89. [PMID: 31870421 PMCID: PMC6929410 DOI: 10.1186/s40359-019-0368-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/15/2019] [Indexed: 01/01/2023] Open
Abstract
Background Information on the prevalence of adjustment disorders among cancer patients and the value of psychological interventions in this group of patients is limited. This study investigates the prevalence of adjustment disorders among cancer patients as well as the reach, effectiveness, cost-utility and budget impact of a tailored psychological intervention. Method This study consists of two parts. Part 1 is an observational study among a representative group of mixed cancer patients after cancer treatment on the prevalence of adjustment disorder as well as the uptake (i.e. reach) of psychological treatment. In Part 2, patients diagnosed with an adjustment disorder are invited to participate in a randomized controlled trial. Patients will be randomized to the intervention (access to the tailored psychological intervention) or control group (waitlist period of 6 months). The psychological intervention consists of three modules: one module containing psycho-education (3 sessions, all patients) and two additional modules (maximum of 6 sessions per module) provided as continuum, in case needed. Module 2 and 3 can consist of several evidence-based interventions (e.g. group interventions, mindfulness, eHealth) The primary outcome is psychological distress (HADS). Secondary outcomes are mental adjustment to cancer (MAC) and health-related quality of life (EORTC QLQ-C30). To assess the cost-utility and budget impact, quality of life (EQ-5D-5 L) and costs (iMCQ and iPCQ) will be measured. Measures will be completed at baseline and 3 and 6-months after randomization. Discussion This study will provide data of the prevalence of adjustment disorders and the reach, effectiveness, cost-utility and budget impact of a tailored psychological intervention. Trial registration Netherlands Trial Register identifier: NL7763. Registered on 3 June 2019.
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Affiliation(s)
- Florie E van Beek
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lonneke M A Wijnhoven
- Department of Medical Psychology, Radboudumc Nijmegen, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Femke Jansen
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboudumc Nijmegen, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Eline J Aukema
- Ingeborg Douwes Centrum, Centre for Psycho-Oncology, Amsterdam, The Netherlands
| | - Veerle M H Coupé
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ben Wijnen
- Trimbos Institute, Utrecht, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboudumc Nijmegen, Radboud Institute of Health Sciences, Nijmegen, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro & Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. .,Department of Otolaryngology-Head and Neck Surgery, Amsterdam UMC, VUmc, Cancer Center Amsterdam, Amsterdam, The Netherlands.
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Compen F, Bisseling E, Schellekens M, Donders R, Carlson L, van der Lee M, Speckens A. Face-to-Face and Internet-Based Mindfulness-Based Cognitive Therapy Compared With Treatment as Usual in Reducing Psychological Distress in Patients With Cancer: A Multicenter Randomized Controlled Trial. J Clin Oncol 2018; 36:2413-2421. [PMID: 29953304 DOI: 10.1200/jco.2017.76.5669] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose Mindfulness-based cognitive therapy (MBCT) has been shown to alleviate psychological distress in patients with cancer. However, patients experience barriers to participating in face-to-face MBCT. Individual Internet-based MBCT (eMBCT) could be an alternative. The study aim was to compare MBCT and eMBCT with treatment as usual (TAU) for psychological distress in patients with cancer. Patients and Methods We obtained ethical and safety approval to include 245 patients with cancer with psychological distress (≥ 11 on the Hospital Anxiety and Depression Scale) in the study. They were randomly allocated to MBCT (n = 77), eMBCT (n = 90), or TAU (n = 78). Patients completed baseline (T0) and postintervention (T1) assessments. The primary outcome was psychological distress on the Hospital Anxiety and Depression Scale. Secondary outcomes were psychiatric diagnosis, fear of cancer recurrence, rumination, health-related quality of life, mindfulness skills, and positive mental health. Continuous outcomes were analyzed using linear mixed modeling on the intention-to-treat sample. Because both interventions were compared with TAU, the type I error rate was set at P < .025. Results Compared with TAU, patients reported significantly less psychological distress after both MBCT (Cohen's d, .45; P < .001) and eMBCT (Cohen's d, .71; P < .001) . In addition, post-treatment prevalence of psychiatric diagnosis was lower with both MBCT (33% improvement; P = .030) and eMBCT (29% improvement; P = .076) in comparison with TAU (16%), but these changes were not statistically significant. Both interventions reduced fear of cancer recurrence and rumination, and increased mental health-related quality of life, mindfulness skills, and positive mental health compared with TAU (all Ps < .025). Physical health-related quality of life did not improve ( P = .343). Conclusion Compared with TAU, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.
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Affiliation(s)
- Félix Compen
- Félix Compen, Else Bisseling, Melanie Schellekens, Rogier Donders, and Anne Speckens, Radboud University Nijmegen, Nijmegen; Félix Compen, Else Bisseling, and Marije van der Lee, Helen Dowling Institute, Bilthoven, the Netherlands; Linda Carlson, University of Calgary, Calgary, Canada
| | - Else Bisseling
- Félix Compen, Else Bisseling, Melanie Schellekens, Rogier Donders, and Anne Speckens, Radboud University Nijmegen, Nijmegen; Félix Compen, Else Bisseling, and Marije van der Lee, Helen Dowling Institute, Bilthoven, the Netherlands; Linda Carlson, University of Calgary, Calgary, Canada
| | - Melanie Schellekens
- Félix Compen, Else Bisseling, Melanie Schellekens, Rogier Donders, and Anne Speckens, Radboud University Nijmegen, Nijmegen; Félix Compen, Else Bisseling, and Marije van der Lee, Helen Dowling Institute, Bilthoven, the Netherlands; Linda Carlson, University of Calgary, Calgary, Canada
| | - Rogier Donders
- Félix Compen, Else Bisseling, Melanie Schellekens, Rogier Donders, and Anne Speckens, Radboud University Nijmegen, Nijmegen; Félix Compen, Else Bisseling, and Marije van der Lee, Helen Dowling Institute, Bilthoven, the Netherlands; Linda Carlson, University of Calgary, Calgary, Canada
| | - Linda Carlson
- Félix Compen, Else Bisseling, Melanie Schellekens, Rogier Donders, and Anne Speckens, Radboud University Nijmegen, Nijmegen; Félix Compen, Else Bisseling, and Marije van der Lee, Helen Dowling Institute, Bilthoven, the Netherlands; Linda Carlson, University of Calgary, Calgary, Canada
| | - Marije van der Lee
- Félix Compen, Else Bisseling, Melanie Schellekens, Rogier Donders, and Anne Speckens, Radboud University Nijmegen, Nijmegen; Félix Compen, Else Bisseling, and Marije van der Lee, Helen Dowling Institute, Bilthoven, the Netherlands; Linda Carlson, University of Calgary, Calgary, Canada
| | - Anne Speckens
- Félix Compen, Else Bisseling, Melanie Schellekens, Rogier Donders, and Anne Speckens, Radboud University Nijmegen, Nijmegen; Félix Compen, Else Bisseling, and Marije van der Lee, Helen Dowling Institute, Bilthoven, the Netherlands; Linda Carlson, University of Calgary, Calgary, Canada
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11
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Compen FR, Adang EMM, Bisseling EM, Van der Lee ML, Speckens AEM. Exploring associations between psychiatric disorder, psychological distress, and health care utilization in cancer patients. Psychooncology 2018; 27:871-878. [PMID: 29205675 DOI: 10.1002/pon.4591] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The mental burden of cancer might elicit additional health care utilization. However, it is unclear how psychiatric disorder and psychological distress relate to health care utilization. Therefore, this study explores associations between psychiatric disorder, psychological distress, and health care utilization. It was hypothesized that presence of psychiatric disorder and psychological distress was associated with increased health care utilization and costs. METHODS The current study consisted of secondary analyses of baseline data of a larger randomized controlled trial. Two hundred forty-five mixed-cancer patients with at least mild symptoms of psychological distress (Hospital Anxiety and Depression Scale-T ≥ 11) were mainly recruited via online media, participating centers and patient associations. Patients were assessed with Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) for depressive, anxiety, and/or adjustment disorder. Psychological distress was measured by the Hospital Anxiety and Depression Scale. Retrospective self-reported health care utilization in the past 3 months was collected. Associations between predictors and health care utilization in terms of incidence rate ratios (IRR) and costs per category (mental, primary, somatic, and complementary) were assessed by negative binomial, logistic, and gamma regression. RESULTS Eighty-nine (36.3%) patients suffered from psychiatric disorder, which was associated with mental health care utilization (IRR = 1.63) and costs (OR = 3.11). We observed a nonsignificant trend of somatic health care utilization in patients with psychiatric disorder. Psychological distress was associated with mental health care utilization (IRR = 1.09) and costs (OR = 1.09). Psychological distress was also associated with complementary health care utilization (IRR = 1.03). CONCLUSION Psychiatric disorder and psychological distress were associated with mental health care use and costs. Psychological distress was associated with complementary health care use. Adequate assessment and referral to mental health care might prevent unnecessary health care utilization.
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Affiliation(s)
- F R Compen
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
| | - E M M Adang
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, Netherlands
| | - E M Bisseling
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands.,Helen Dowling Institute for Psycho-oncology, Bilthoven, Netherlands
| | - M L Van der Lee
- Helen Dowling Institute for Psycho-oncology, Bilthoven, Netherlands
| | - A E M Speckens
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
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12
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Bruggeman-Everts FZ, Wolvers MDJ, van de Schoot R, Vollenbroek-Hutten MMR, Van der Lee ML. Effectiveness of Two Web-Based Interventions for Chronic Cancer-Related Fatigue Compared to an Active Control Condition: Results of the "Fitter na kanker" Randomized Controlled Trial. J Med Internet Res 2017; 19:e336. [PMID: 29051138 PMCID: PMC5668634 DOI: 10.2196/jmir.7180] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/05/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022] Open
Abstract
Background Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue (CCRF). Effective and easily accessible interventions are needed for these patients. Objective The current paper reports on the results of a 3-armed randomized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition. Methods Severely fatigued cancer survivors were recruited via online and offline channels, and self-registered on an open-access website. After eligibility checks, 167 participants were randomized via an embedded automated randomization function into: (1) physiotherapist-guided Ambulant Activity Feedback (AAF) therapy encompassing the use of an accelerometer (n=62); (2) psychologist-guided Web-based mindfulness-based cognitive therapy (eMBCT; n=55); or (3) an unguided active control condition receiving psycho-educational emails (n=50). All interventions lasted nine weeks. Fatigue severity was self-assessed using the Checklist Individual Strength - Fatigue Severity subscale (primary outcome) six times from baseline (T0b) to six months (T2). Mental health was self-assessed three times using the Hospital Anxiety and Depression Scale and Positive and Negative Affect Schedule (secondary outcome). Treatment dropout was investigated. Results Multiple group latent growth curve analysis, corrected for individual time between assessments, showed that fatigue severity decreased significantly more in the AAF and eMBCT groups compared to the psycho-educational group. The analyses were checked by a researcher who was blind to allocation. Clinically relevant changes in fatigue severity were observed in 66% (41/62) of patients in AAF, 49% (27/55) of patients in eMBCT, and 12% (6/50) of patients in psycho-education. Dropout was 18% (11/62) in AAF, mainly due to technical problems and poor usability of the accelerometer, and 38% (21/55) in eMBCT, mainly due to the perceived high intensity of the program. Conclusions Both the AAF and eMBCT interventions are effective for managing fatigue severity compared to receiving psycho-educational emails. Trial Registration Trialregister.nl NTR3483; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3483 (Archived by WebCite at http://www.webcitation.org/6NWZqon3o)
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Affiliation(s)
- Fieke Z Bruggeman-Everts
- Helen Dowling Instituut, Scientific Research Department, Bilthoven, Netherlands.,Telemedicine Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, Netherlands
| | - Marije D J Wolvers
- Roessingh Research and Development, Telemedicine Group, Enschede, Netherlands.,Telemedicine Group, Faculty of Electrical Engineering Mathematics and Computer Science, University of Twente, Enschede, Netherlands
| | - Rens van de Schoot
- Department of Methods and Statistics, Utrecht University, Utrecht, Netherlands.,North-West University, Vanderbijlpark, South Africa
| | - Miriam M R Vollenbroek-Hutten
- Telemedicine Group, Faculty of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, Netherlands.,Roessingh Research and Development, Telemedicine Group, Enschede, Netherlands
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