Utility of a cognitive-behavioral model to predict fatigue following breast cancer treatment.

Abstract

The objective of the current study was twofold: (a) to determine whether subgroups of breast cancer patients could be identified on the basis of their distinct trajectory or pattern of fatigue following treatment for early stage cancer using growth mixture modeling and (b) to examine whether the subgroups could be distinguished on the basis of a cognitive-behavioral model. Growth mixture modeling and a prospective longitudinal design were used to examine the course of fatigue after treatment for early stage breast cancer. Women (n = 261; mean age = 55.2 years) provided fatigue ratings for 6 months following treatment. A low-fatigue group (n = 85) and a high-fatigue group (n = 176) were extracted. Women who were not married, had a lower income, had a higher body mass index, engaged in greater fatigue catastrophizing, and were lower in exercise participation were more likely to be in the high-fatigue group. Only body mass index and catastrophizing remained significant predictors in multivariate analysis. Findings suggest considerable heterogeneity in the experience of fatigue following treatment and support the utility of a cognitive-behavioral model in predicting the course of posttreatment fatigue. Keywordsfatigue; breast cancer; catastrophizing; exercise; growth mixture modeling Fatigue is one of the most common symptoms reported by women undergoing chemotherapy or radiotherapy for breast cancer and may persist for months and even years following treatment (Andrykowski, Curran, & Lightner, 1998;Bower et al., 2006;Broeckel, Jacobsen, Horton, Balducci, & Lyman, 1998;Jacobsen & Stein, 1999 2002). Evidence for the persistence of fatigue comes primarily from studies comparing breast cancer patients with age-matched women with no history of cancer (Andrykowski et al., 1998;Broeckel et al., 1998;Hann et al., 1998) and with published norms (Bower et al., 2000). On the basis of the research to date, however, it is difficult to draw definitive conclusions about fatigue persistence. This is because of the cross-sectional nature of most previous studies and because the length of time between treatment completion and the assessment of fatigue has varied greatly across previous studies. An additional issue concerns the fact that most studies consider only fatigue scores in the aggregate and do not examine whether there are subgroups of patients who differ in their experience of fatigue after treatment completion. This approach of using aggregate (i.e., group mean) scores may mask meaningful differences among subgroups of patients in the severity, course, and predictors of fatigue. For example, it may be the case that some patients report a reduction in fatigue as time since treatment increases, whereas others report worsening of fatigue; consequently, the overall trajectory of fatigue for the group as a whole would not appear to change.A study of fatigue in breast cancer patients by Bower et al. (2000) partly addressed this issue. In this study, women diagnosed with breast cancer an average of 35 months previously w...

Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy

“…Results suggest a relationship between higher BMI and less robust circadian activity rhythms in breast cancer patients receiving chemotherapy. Breast cancer patients with a higher BMI, lower exercise participation, and greater fatigue catastrophizing have been found to be more likely to be in the high-fatigue group after treatment [18]. These results need to be confirmed in samples that include more participants with higher than normal BMI.…”

Fatigue after treatment for early stage breast cancer

“…With regard to behavioral mechanisms, there is evidence that breast cancer patients exercising less and engaging in more catastrophic coping about fatigue at the end of treatment are more likely to report heightened fatigue over the next 6 months. 28 Additional evidence for the role of exercise includes research demonstrating the benefits of exercise in improving fatigue among breast cancer survivors. 29 With regard to biological mechanisms, there is evidence that, among breast cancer survivors who were at least 1 year postdiagnosis and had completed adjuvant therapy, those who were fatigued show higher levels of proinflammatory cytokine activity than those who were not fatigued.…”

Exploring the differential experience of breast cancer treatment-related symptoms: a cluster analytic approach

“…The research was conducted as part of a larger Institutional Review Board (IRB) approved longitudinal study to investigate the course and correlates of fatigue [24]. Patients were recruited from two oncology practices at university-based institutions, and provided informed consent before participating in the primary study.…”