Cancer-related Fatigue Experiences Research Articles

A holistic profile for cancer-related fatigue for women with breast cancer – a qualitative study

Objective: Cancer- related fatigue (CRF) is one of the most reported long-term effects after breast cancer and severely impacts quality of life. To come towards optimal treatment of multidimensional CRF, the first step is to use a holistic approach to develop a holistic patient profile including the patient’s experience and impact of CRF on their life. Methods and measures: Four semi- structured focus groups with twenty- seven breast cancer patients and fourteen interviews with healthcare professionals (HCPs) were held. Reflexive thematic analysis was used to define (sub)themes for the holistic patient profile. The themes of the interviews and focus groups were compared for validity. Results: Breast cancer patients and HCPs described the same five major themes, consisting of experience of CRF, impact and consequences, coping, personality, and CRF treatment. Experience of CRF consists of cognitive, emotional, and physical aspects. Impact and consequences include work, family, partner relation, social contact and hobbies, body, and misunderstanding. Coping consists of twelve (mal)adaptive strategies. Personality and CRF treatment were summarised as themes. Conclusions: A first holistic patient profile was introduced for CRF for breast cancer. This profile can be conceptualized into a questionnaire to collect information for personalized treatment recommendations and monitoring of CRF over time.

Identification of Distinct Profiles of Cancer-Related Fatigue and Associated Risk Factors for Breast Cancer Patients Undergoing Chemotherapy: A Latent Class Analysis.

Cancer-related fatigue is a complex, multidimensional, subjective experience that affects patients physically, emotionally, and mentally. The interindividual variability in symptoms of cancer-related fatigue merits further exploration. Our objective was to identify distinct profiles of cancer-related fatigue experienced by breast cancer patients undergoing chemotherapy and to evaluate how subgroups vary demographically in clinical characteristics and in modifiable factors such as physical activity, sleep quality, and exercise self-efficacy. Fatigue was assessed with the Chinese Cancer-Related Fatigue Scale, and a latent class analysis was performed to identify subgroups of patients with distinct fatigue profiles. A total of 427 breast cancer patients were included in the data analyses. Five different fatigue profiles were identified: all low-risk fatigue, all high-risk fatigue, high-risk physical fatigue, high-risk emotional fatigue, and high-risk mental fatigue. Patients in different subgroups were characterized by different risk factors. For example, patients in the high-risk emotional fatigue group had less education, lower monthly household incomes, lower exercise self-efficacy scores, less sedentary behavior, poorer sleep, and poorer quality-of-life outcomes compared with those in the all low-risk fatigue group. These findings reveal that breast cancer patients undergoing chemotherapy show significant heterogeneity in their experience of cancer-related fatigue. Characteristics associated with different fatigue profiles, in particular the high-risk profiles, can be used by clinicians to target patients at greater risk of poorer symptom and quality-of-life outcomes to provide interventions tailored to their different needs.

"Honorable Toward Your Whole Self": Experiences of the Body in Fatigued Breast Cancer Survivors.

IntroductionCancer Related Fatigue (CRF) is one of the most common and detrimental side effects of cancer treatment. Despite its increasing prevalence and severity CRF remains dismissed by the majority of clinicians. One reason for the apparent gap between clinical need and clinical undertaking is the penchant toward reductionist accounts of the disorder: a tendency to discount the interface between the lived experience of sufferers and the multi-dimensional etiology of CRF as it manifests adversely on a day-to-day basis.MethodsIn order to better understand the interplay between social, bodily, and emotional components of the disorder we undertook semi-structured interviews with thirteen Breast Cancer survivors suffering from CRF, and then subsequently analyzed their responses using Team Based Qualitative Analysis.ResultsOur analysis revealed multiple dimensions of the social and bodily underpinnings of fatigue. Most relevantly we found a consistent change in the level and quality of attention to bodily signals. This shift in awareness appeared to be directly connected to the experience of CRF and a newfound, “respect,” for the needs of the body. Furthermore, we found that many of the practices that were described as helpful in alleviating fatigue were oriented around eliciting a sense of embodied awareness, examples being: dance, yoga, and shamanic ritual. This relationship with bodily sensations existed in conjunction with the anxiety and trauma that arose as a result of cancer treatment.ConclusionOur analysis suggests that the quality of awareness and relationship to bodily experience in CRF is a functionally relevant component of the disorder and should be considered as an experiential target moving forward.

Cancer-related fatigue in head and neck cancer survivors: Energy and functional impacts

BackgroundSurvivors with head and neck cancer (HNC) report cancer-related fatigue (CRF) as a devastating, prevalent health issue that limits activity engagement and adversely influences quality of life. ObjectiveTo explore HNC survivors' written responses and descriptors regarding CRF, and offer potential healthcare strategies based on findings. MethodologyIn written format, similar to responses on intake forms in outpatient-clinics, 25 HNC survivors provided descriptions of their CRF experiences and their perspectives on its impact. An exploratory descriptive research design was utilized, drawing on social theory for content analysis and thematic development. Results. Two main themes regarding CRF arose from the data: (1) CRF as a barrier to daily function; and (2) uncontrollable and unpredictable energy fluctuations. ConclusionsTo enhance outcomes of CRF symptom management in HNC survivors, a healthcare approach that targets the functional implications of CRF, and utilizes energy cultivation strategies when communicating about the negative impacts of CRF (including limited function and fluctuating energy levels) may be beneficial for HNC survivors. Further research into the effects of CRF on function for HNC survivors is warranted.

The experience of cancer-related fatigue, exercise and exercise adherence among women breast cancer survivors: Insights from focus group interviews.

To identify the experience of breast cancer survivors regarding cancer-related fatigue, exercise and exercise adherence. Cancer-related fatigue is a common symptom among cancer survivors that limits quality of life. Despite exercise being recommended as a viable solution to manage cancer-related fatigue, relatively few research studies on the experience of cancer-related fatigue and exercise adherence have been conducted. This was a qualitative study to identify breast cancer survivors' experience of cancer-related fatigue, exercise and exercise adherence. This paper adhered to the COREQ checklist in reporting. Four focus group interviews were conducted with 16 breast cancer survivors who had fatigue score of 4 out of 10 (moderate fatigue) or greater. Ethical approval was obtained and participants met for focus group interview discussion. The interview guide included questions on cancer-related fatigue, barriers and facilitators of exercising, strategies for exercise adherence and suggestions for a supportive programme. Four themes were identified through thematic analysis: (a) The insidious and overpowering nature of cancer-related fatigue; (b) exercising when experiencing fatigue surrounded by prevailing myths; (c) multiple barriers to exercise; and (d) facilitative factors to continue exercising despite fatigue. Participants' experience of moderate or greater cancer-related fatigue prevented them from exercising, despite knowing its importance, and limited them to passive activities. Misconceptions that exercise is associated with lymphedema and risk of recurrence, poor psychosocial self-image and lack of clear knowledge and exercise programmes for cancer survivors further limited adherence to exercise. In contrast, finding comfort and strength through exercising and interacting with other breast cancer survivors were facilitative factors. The insights shared by breast cancer survivors experiencing cancer-related fatigue can contribute to developing an exercise adherence programme as a way to manage and alleviate fatigue and establish healthy survivorship care.

Cancer-related fatigue stratification system based on patient-reported outcomes and objective outcomes: A cancer-related fatigue ambulatory index.

Although breast cancer mortality is decreasing, morbidity following treatment remains a significant issue, as patients face symptoms such as cancer-related fatigue (CRF). The aim of the present study is to develop a classification system that monitors fatigue via integration of an objective clinical assessment with patient self-report. Forty-three women participated in this research. Participants were post-treatment breast cancer survivors who had been surgically treated for their primary tumour with no evidence of neoplastic disease at the time of recruitment. Self-perceived fatigue was assessed with the Spanish version of the Piper Fatigue Scale-Revised (R-PFS). Objective fatigue was assessed by the 30 second Sit-to-Stand (30-STS) test. Confirmatory factor analysis was done with Maximum Likelihood Extraction (MLE). Internal consistency was obtained by Cronbach's α coefficients. Bivariate correlation showed that 30-STS performance was negatively-inversely associated with R-PFS. The MANOVA model explained 54.3% of 30-STS performance variance. Using normalized scores from the MLE, a classification system was developed based on the quartiles. This study integrated objective and subjective measures of fatigue to better allow classification of patient CRF experience. Results allowed development of a classification index to classify CRF severity in breast cancer survivors using the relationship between 30-STS and R-PFS scores. Future research must consider the patient-perceived and clinically measurable components of CRF to better understand this multidimensional issue.

Defining cancer-related fatigue for biomarker discovery.

Cancer-related fatigue (CRF) is a prominent and distressing symptom for cancer patients that can impair their overall health-related quality of life [1]. CRF is often described as a complex and multidimensional concept consisting of physical, cognitive, affective, spiritual, psychosocial, and environmental factors [1, 2]. Assessment of CRF is obtained from responses on various valid, self-report questionnaires established from several theoretical models of CRF. The complexity of CRF as a concept and the variability in the method of CRF assessment pose a challenge to investigators attempting to understand the etiology of CRF. Establishing a clear definition of a phenomenon, such as CRF, is an essential starting point for phenotypic characterization and biomarker discovery [3]. Therefore, this commentary aims to increase our awareness of the need for better definition and clearer phenotypic characterization of CRF. Several organizations have proposed definitions for CRF such as the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the Pan Canadian Practice Guidelines [2, 4, 5]. However, a recent review conducted by the Multinational Association of Supportive Care in Cancer Fatigue Study Group– Biomarker Working Group found that CRF is defined in various ways [6]. Some studies referenced a specific definition used by national organizations such as the National Comprehensive Cancer Network [2], while other studies defined CRF using specific cancer treatment-related tools, such as the National Cancer Institute Common Toxicity criteria, as well as diagnostic criteria from a proposed ICD-10 definition of CRF [7, 8]. The lack of a consistent operational definition for CRF in the empirical literature makes it challenging to develop a CRF phenotype, which in turn poses a major obstacle for researchers investigating the biological mechanisms of CRF [9]. Therefore, consistent use of an agreed upon definition would be of benefit for biomarker discovery. In addition to the variability in the definition of CRF, numerous questionnaires were reported in the reviewed articles to assess CRF. In fact, 23 different questionnaires were used to assess CRF in the 47 articles reviewed. Even when the same questionnaire was used, different scoring rubrics were often applied to phenotype CRF or to determine its clinical relevance [10, 11]. The significance of this variability when investigating different biologic pathways to determine molecular correlates of CRF is pronounced. For example, we recently assessed genetic correlates of CRF using two different cut-off scores on the Functional Assessment of Cancer TherapyFatigue (FACT-F) questionnaire (http://www.facit.org/ FACITOrg/Questionnaires) in the same group of men with prostate cancer who received radiation therapy. The FACT-F subscale is a 13-item widely-used, readily available questionnaire validated to explore fatigue symptoms in the oncology population. Our unpublished findings revealed that different functional biologic pathways were found when different approaches were utilized to phenotype CRF patients using previously reported FACT-F cut-off scores (Fig. 1). Investigating causal relationships of CRF with specific physiologic mechanisms will remain difficult, unless the complex concept of CRF is better defined, and clearly phenotyped. Perhaps, describing the disease and/or treatment associated with the CRF experience can better define the construct, especially if the intention is for biomarker discovery. CRF is often believed to be induced by the tumor itself and/or the * Leorey N. Saligan saliganl@mail.nih.gov

Interviews with cancer fatigue patients

e17577 Background: Approximately 90% of patients diagnosed with cancer experience fatigue associated with the effects of treatment and/or cancer itself. Despite its high prevalence and negative impact on patients’ lives, there is no consensus on a clinical definition of cancer-related fatigue (CF). Extant qualitative research has methodological limitations, small sample sizes, and varying results regarding CF. A multi-disciplinary research consortium is developing a conceptual model of CF based on 120 qualitative interviews with cancer patients varying by cancer type and stage. Exploratory interviews were conducted to test questions and suggest sensitising concepts for an unbiased interview guide. Methods: Five cancer patients with self-reported CF were purposively sampled and interviewed between September 2007 and March 2008 by a trained interviewer to discuss their CF experiences. Verbatim transcripts were coded by two researchers using qualitative data analysis software and reviewed for consistency and reliability. Data were analyzed using a constant comparison method. Results: Patients were diagnosed with cancer on average 3.5 years ago among the following primary sites: breast (n = 2), lung, colorectal, and prostate/liver. Patients provided 14 terms to describe CF: “tired” and “lack of energy” were the most commonly reported. Patients described CF as a general lack of ability to do anything, a child-like regression, and indicated that current “tiredness” differed from pre-diagnosis tiredness. Patients also described CF in terms of frequency (i.e., duration, onset, recurrence) and intensity and identified treatment as a trigger of fatigue. Patients understood the word “fatigue,” but rarely mentioned it spontaneously. Additionally, patients mentioned that CF was not relieved by rest and impacted several areas of their lives, including activities of daily living and cognitive and emotional functioning. Conclusions: Patients’ experience with CF differs from pre-diagnosis tiredness in terms of intensity, duration, onset, and impact. These results helped to refine the interview guide and provide insight for future interventions. Further research with patients with different cancer types and stages is needed to develop a comprehensive conceptualization and measurement of CF. [Table: see text]

The Experience of Cancer-Related Fatigue and Chronic Fatigue Syndrome: A Qualitative and Comparative Study

Cancer-related fatigue (CRF) is a common and disabling symptom complex reported by survivors. This study aimed to better understand the manifestations of CRF in women treated for breast cancer, and to compare them with those of women diagnosed with chronic fatigue syndrome (CFS). Women with CRF persisting 6 months after treatment for early stage breast cancer, and women with CFS participated in separate, audiotaped focus groups. Transcripts of the sessions were analyzed using the NUD*IST software, and interpreted using grounded theory. Twenty-eight women participated, 16 with CRF and 12 with CFS. Analysis of transcripts from both groups revealed a similar core set of symptoms, featuring fatigue, neurocognitive difficulties, and mood disturbances. Women with CFS reported additional symptoms including musculoskeletal pain and influenza-like manifestations. Both groups suffered disabling behavioral consequences of the symptom complex. Qualitatively, CRF appears closely related to CFS. These findings raise the emergent hypothesis of a conserved neurobehavioral symptom complex, which results from diverse triggering insults.

Association of coping style, pain, age and depression with fatigue in women with primary breast cancer

The purpose of this study was to explore the relative contributions of coping, depression, pain and age, in the experience of cancer related fatigue. A total of 353 women treated for primary breast cancer were assessed within one year of diagnosis using the Profile of Mood States, the Hospital Anxiety and Depression Scale and the mini-Mental Adjustment to Cancer Scale. Fatigue was positively associated with depression and pain, but inversely related to age. In contrast to our expectations, fighting spirit was not associated with less fatigue. A relationship between coping style and cancer-related fatigue was found exclusively for 'positive reappraisal', a combination of fighting spirit and fatalism. Detectable only in multivariate analysis together with depression, the results suggest a weak association between coping and fatigue. The relationship between cancer related fatigue, age and coping styles requires further exploration within longitudinal studies.

Improving the patient’s experience of cancer-related fatigue

Improving the patient’s experience of cancer-related fatigue

Cancer-Related Fatigue: Nursing Assessment and Management

Cancer-Related Fatigue: Nursing Assessment and Management

Cancer-related fatigue. Suffering a different fatigue.

The purpose of this naturalistic inquiry was to understand, from the patient's perspective, the differences between cancer-related fatigue (CRF) and "typical" fatigue and to describe its impact on their lives. The sample consisted of 17 adult patients with cancer who agreed to participate, yielding 23 in-depth audio-taped interviews. Participants included inpatients and outpatients from a dedicated cancer center and a Veterans Affairs Hospital. Symbolic interactionism was the framework used for the interviews to understand how individuals and groups construct and discover the meaning of events. Transcribed data were coded by distress category to classify the textual information and to reduce the text to more relevant and manageable bits of data. Five to 10 representative excerpts from each coding category were chosen and were coded independently by a second coder to evaluate intercoder reliability. CRF was found to be more rapid in onset, more energy draining, more intense, longer lasting, more severe, and more unrelenting when compared with "typical" fatigue. CRF caused distress in the physical, social, spiritual, psychological, and cognitive domains of the participants' lives. All participants agreed that CRF was different than the typical fatigue of everyday life. This study's findings indicate that because of this different fatigue, CRF, participants did not just experience the symptom, but they suffered with it. The current oncology literature and texts do not portray the morbidity of the CRF experience as described by the participants in this study. These data can be used as part of an experiential teaching guide to assist healthcare students and practitioners in understanding the CRF experience. This increased awareness will afford clinicians a better foundation for implementing management strategies. A CRF distress instrument is in development based on these data.