Experiencing and responding to chronic cancer‐related fatigue: A meta‐ethnography of qualitative research

Abstract

Objective One of the most prevalent and disrupting symptoms experienced by cancer patients is chronic cancer‐related fatigue (CCRF). A better understanding of the chronic nature of CCRF can provide valuable insights for theory and practice. The purpose of this meta‐ethnography was to derive an overarching interpretative narrative on patients' experiences and responses to CCRF. Methods We conducted a comprehensive systematic literature search in five databases (05‐03‐2018). In addition, papers from reference lists were retrieved. Two researchers independently screened the papers for eligibility and appraised quality (CASP‐criteria). We followed the seven phases of meta‐ethnography to extract, translate, and synthesise first‐order constructs (ie, patients' views) and second‐order constructs (ie, authors' views) from the selected studies into third‐order constructs (ie, new interpretations). Results Of the 1178 collected articles, 16 articles were included. Through synthesis, a new figure of six interrelated third‐order constructs was developed: (1) embodied experience entails the dominating presence of the body; (2) (mis)recognition includes lack of recognition of CCRF by patients, relatives, and health providers; (3) small horizon describes a resultant narrowed world; (4) role change encompasses adopting other life roles; (5) loss of self refers to the impact on one's identity; and (6) regaining one's footing describes the struggle against CCRF, adaptation to CCRF and finally acceptance of a “new normal with CCRF.” Conclusion A new embodiment figure of CCRF with social (eg, (mis)recognition), spatial (eg, small horizon) and temporal dimensions (eg, regaining one's footing) was developed. This figure can help professionals to recognise CCRF, inform patients, and personalise treatment.

United States Utility Algorithm for the EORTC QLU-C10D, a Multiattribute Utility Instrument Based on a Cancer-Specific Quality-of-Life Instrument

“…Problems related to sleep and fatigue were associated with smaller utility decrements. Although problems with sleep and fatigue are also common among the general population, 55 cancer-related fatigue is especially qualitative and quantitively different, 56,57 which might lead the general population to underestimate its impact. Van Gelder et al 58 recently demonstrated varying QLU-C10D utilities by cancer type and noted that physical functioning, pain and nausea, and vomiting had the largest impact on utilities.…”

Fatigue in cancer patients: comparison with the general population and prognostic factors

“…Even though the MFI-20 with its five dimensions already covers a relatively broad spectrum of fatigue, qualitative studies show further characteristics of this issue. A recent metaanalysis of qualitative studies [37] identified six constructs in the sense of new interpretations of fatigue: embodied experience, (mis)recognition, small horizon, role changes, loss of self, and regaining one's footing. Nevertheless, among the existing fatigue scales, the MFI-20 is one of the best at approaching these additional facets of fatigue.…”

Symptom Descriptions in Psychopathology: How Well Are They Working for Us?

“…People with significantly depressed mood commonly describe their fatigue as a feeling of heaviness, such that embarking on even simple tasks requires an enormous amount of effort (Matza et al, 2015). People reporting fatigue in the context of cancer commonly mention decreased physical performance, feelings of weakness, and an excessive need to rest after physical activity (Glaus, Crow, & Hammond, 1996), using phrases that often reference the body (e.g., “heavy limbs,” “legs like jelly/wobbly legs,” “feeling weak,” or “the body is worn out”; Bootsma, Schellekens, van Woezik, van der Lee, & Slatman, 2019). These sorts of qualitative analyses provide some useful clues as to how one might further examine the coherence of this construct at different levels of description.…”