Cognitive behavioral therapy in breast cancer patients--a feasibility study of an 8 week intervention for tumor associated fatigue treatment.

Christian Eichler,Multhaupt Pia,Multhaupt Sibylle,Mathias Warm,Axel Sauerwald,Wolff Friedrich

doi:10.7314/apjcp.2015.16.3.1063

Christian Eichler, Multhaupt Pia + Show 4 more

Open Access

https://doi.org/10.7314/apjcp.2015.16.3.1063

Copy DOI

Abstract

Tumor associated fatigue (TAF) or cancer related fatigue (CRF) is not a new concept. Nonetheless, no real headway has been made in the quantitative analysis of its successful treatment via cognitive behavioral therapy. Since 20 to 30% of all breast cancer patients suffer from anxiety and/or depression within the first year of their diagnosis, this issue needs to be addressed and a standard treatment protocol has to be developed. This study focused on developing a simple, reproducible and short (8 weeks) protocol for the cognitive behavioral therapy support of tumor associated fatigue patients. Between the year 2011 and 2012, 23 breast cancer patients fulfilled the diagnosis TAF requirements and were introduced into this study. Our method focused on a psycho-oncological support group using a predetermined, highly structured and reproducible, cognitive behavioral therapy treatment manual. Eight weekly, 90 minute sessions were conducted and patients were evaluated before and after this eight session block. Tumor fatigue specific questionnaires such as the multidimensional fatigue inventory (MFI) as well as the hospital anxiety and depression scale (HADS) were used in order to quantitatively evaluate patient TAF. Of the 23 patients enrolled in the study, only 7 patients fulfilled the TAF diagnostic criteria after the psycho-oncological group treatment. This represents a 70% reduction in diagnosable tumor associated fatigue. The HADS analysis showed a 33% reduction in patient anxiety as well as a 57% reduction in patient depression levels. The MFI scores showed a significant reduction in 4 of the 5 evaluate categories. With the exception of the "mental fatigue" MFI category all results were statistically significant. This study showed that a highly structured, cognitive behavioral therapy group intervention will produce significant improvements in breast cancer patient tumor associated fatigue levels after only 8 weeks.

Highlights

Tumor associated fatigue (TAF), known as cancer related fatigue (CRF), emerges to be a largely neglected factor in the treatment of breast cancer patients
This study showed that a highly structured, cognitive behavioral therapy group intervention will produce significant improvements in breast cancer patient tumor associated fatigue levels after only 8 weeks
An ever-growing body of literature is becoming available for breast cancer patients suffering from TAF/ CRF

Summary

Introduction

Tumor associated fatigue (TAF), known as cancer related fatigue (CRF), emerges to be a largely neglected factor in the treatment of breast cancer patients. While a plethora of diagnostic developments and treatment options are under continuous evaluation, the main focus remains on the somatic aspects of this disease, i.e. meeting the oncological challenge by medication, chemotherapy, radiation treatment, surgical intervention and standard clinical care (Schumacher, 2003) Due to this aggressive somatic treatment of breast cancer, tumor associated fatigue is often diagnosed too late in breast cancer therapy (Montazeri et al, 2001; Fafouti et al, 2010; Schleife et al, 2012; Kovacs et al, 2013; Abu-Helalah et al, 2014). Conclusions: This study showed that a highly structured, cognitive behavioral therapy group intervention will produce significant improvements in breast cancer patient tumor associated fatigue levels after only 8 weeks

Methods

Results

Conclusion