Impact of a Multimodal and Combination Therapy on Self-Regulation and Internal Coherence in German Breast Cancer Survivors With Chronic Cancer-Related Fatigue: A Mixed-Method Comprehensive Cohort Design Study

Abstract

<jats:p> Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancer survivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2 multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) on salutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: A total of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, the Cancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81 after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linear model including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of both multimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve self-regulation and patients’ satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P &lt; .05). Compared with AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P &lt; .01). Pearson’s correlations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = −0.60). Qualitative feedback confirmed patients’ benefits in several health-related categories. Conclusions: Self-regulation and internal coherence are manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongside patients’ satisfaction and qualitative feedback they help refine treatment. </jats:p>

Four-year follow-up on fatigue and sleep quality of a three-armed partly randomized controlled study in breast cancer survivors with cancer-related fatigue

“…With the help of psychoeducation, it was intended to improve patients’ knowledge of CRF and self-management capacity regarding the high distress level 46 . Even if, as published in another article, we did not show an improvement in the anxiety and distress in the experimental groups after the intervention 47 and standardized effect sizes of CBT on fatigue are estimated as minor according to meta-analyses 17 , 18 , the patients in the multimodal therapy and combination therapy groups improved in self-regulation and internal coherence 47 . Additional qualitative data suggests that patients felt more competent about handling daily challenges of life 47 .…”

“…This indicates a profound sustainable change in patients’ self-management. In another article the improved self-regulation, e.g., the behavior ‘to reach goals and achieve satisfaction’ and, delayed after 6 months, the internal coherence, including the inner coherence and resilience and thermo-coherence subscales 47 and the improved rest/activity and autonomic regulation in the multimodal treatment group 57 reflect the improved self-management and circadian regulation.…”

Validation of the Internal Coherence Scale (ICS) in Healthy Geriatric Individuals and Patients Suffering from Diabetes Mellitus Type 2 and Cancer

“…It is likely that, similar to metastasized cancer patients, geriatric patients also have a greater variability representing “good” and “bad” days [ 59 ]. In contrast, a sample of breast cancer patients with cancer-related fatigue showed significantly improved ICS scores at a 6 month follow-up when treated with a 10 week multimodal anthroposophic therapy program, compared to a group receiving standard aerobic training [ 60 ], indicating that “coherence” is a trait to be manipulated rather than a static trait like SOC. Similarly, a study by Oei et al (2019) showed improved ICS scores in a group of breast cancer patients who received supportive viscum album treatment [ 61 ].…”