Factors Related to Persistent Fatigue Following Completion of Breast Cancer Treatment

Céline Gélinas

Lise Fillion

ONF 2004, 31(2), 269-278. DOI: 10.1188/04.ONF.269-278

Purpose/Objectives: To verify the predictive capacity of the stress-process theory to explain persistent fatigue following completion of breast cancer treatments; to verify the relationship between interleukin-1b and fatigue.

Design: Correlational.

Setting: Tertiary medical center in Quebec City, Canada.

Sample: A systematic sample of 103 women in remission from breast cancer was recruited. The mean age was 54 years. Participants with a depressive mood, insomnia, or stage IV cancer were excluded.

Methods: Participants were met during their follow-up appointment after the end of radiation therapy. Questionnaires on fatigue, stress variables, and other confounding variables were completed by telephone interview. Blood samples also were collected to measure the serum level of interleukin-1b.

Main Research Variables: Fatigue, several variables from the stress-process theory, pain, menopausal symptoms, and demographic and medical variables.

Findings: Fatigue was related theoretically and coherently to many stress-process variables. By controlling for pain, the final regression model included cancer stressors and passive and active coping as predictors, which accounted for 41% of the variance in fatigue. No relationship was found between fatigue and interleukin-1b.

Conclusions: The results supported the relevance of the stress-process theory for explaining cancer-related fatigue.

Implications for Nursing: Nursing interventions based on this theoretical framework could be developed. In addition, further clinical research that tests the efficacy of these psycho-educative interventions in preventing persistent fatigue and improving the quality of life of women with breast cancer is recommended.

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    References

    Akechi, T., Kugaya, A., Okamura, H., Yamawaki, S., & Uchitomi, Y. (1999). Fatigue and its associated factors in ambulatory cancer patients: A preliminary study. Journal of Pain and Symptom Management, 17, 42-48.

    American Psychological Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Andrykowski, M.A., Curran, S.L., & Lightner, R. (1998). Off-treatment fatigue in breast cancer survivors: A controlled comparison. Journal of Behavioral Medicine, 21(1), 1-18.

    Berglund, G., Bolund, C., Fornander, T., Rutqvist, L.E., & Sjöden, P.O. (1991). Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients. Cancer, 27, 1075-1081.

    Born, J., Lange, T., Hansen, K., Mölle, M., & Fehm, H.L. (1997). Effects of sleep and circadian rhythm on human circulating immune cells. Journal of Immunology, 158, 4454-4464.

    Bower, J.E., Ganz, P.A., Desmond, K.A., Rowland, J.H., Meyerowitz, B.E., & Belin, T.R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18, 743-753.

    Broeckel, J.O., Jacobsen, P.B., Horton, J., Balducci, L., & Lyman, G.H. (1998). Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 16, 1689-1696.

    Cella, D. (1998). Factors influencing quality of life in cancer patients: Anemia and fatigue. Seminars in Oncology, 25(Suppl. 7), 43-46.

    Cimprich, B. (1992). Attentional fatigue following breast cancer surgery. Research in Nursing and Health, 15, 199-207.

    Couzi, R.J., Helzlsouer, K.J., & Fetting, J.H. (1995). Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy. Journal of Clinical Oncology, 13, 2737-2744.

    Daut, R.L., Cleeland, C., & Flanery, R.C. (1983). Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain, 17, 197-210.

    Draper, N.R., & Smith, H. (1998). Applied regression analysis (3rd ed.). New York: Wiley.

    Endler, N.S., Courbasson, C.M.A., & Fillion, L. (1998). Coping with cancer: The evidence for the temporal stability of the French-Canadian version of the Coping With Health Injuries and Problems (CHIP). Personality and Individual Differences, 25, 711-717.

    Endler, N.S., Parker, J.D.A., & Summerfeldt, L.J. (1993). Coping with health problems: Conceptual and methodological issues. Canadian Journal of Behavioural Science, 25, 384-399.

    Ferrell, B.R., Dow, K.H., Leigh, S., Ly, J., & Gulasekaram, P. (1995). Quality of life in long-term cancer survivors. Oncology Nursing Forum, 22, 915-922.

    Ferrell, B.R., Grant, M.M., Funk, B.M., Otis-Green, S.A., & Garcia, N.J. (1998). Quality of life in breast cancer survivors: Implications for developing support services. Oncology Nursing Forum, 25, 887-895.

    Fillion, L., & Gagnon, P. (1998, August). Stress as a predictor of fatigue among breast cancer and prostate cancer patients receiving radiotherapy. Paper presented at the 24th International Congress of Applied Psychology, San Francisco, CA.

    Fillion, L., & Gagnon, P. (1999). French adaptation of the shortened version of the Profile of Mood States. Psychological Reports, 84, 188-190.

    Fillion, L., Gélinas, C., Simard, S., Savard, J., & Gagnon, P. (2003). Validation evidence for the French Canadian version of the Multidimensional Fatigue Inventory (MFI) as a measure of cancer-related fatigue. Cancer Nursing, 26, 143-154.

    Fillion, L., Hurwitz, B.P., Milanovich, J.R., Motivals, S.J., Graves, J., & Schneiderman, N. (1998). Reliability and concurrent and predictive validity of the subjective appraisal rating scale in HIV-infected men and women. Research Report, 249, 1-19.

    Fillion, L., Kohn, P., Gagnon, P., Van Wijk, M., & Cunningham, A. (1999). The Inventory of Recent Life Experiences for Cancer Patients (IRLE-C): A decontamined measure of cancer-based hassles. Toronto, Canada: York University.

    Fillion, L., Lemyre, L., Mandeville, R., & Piché, R. (1996). Cognitive appraisal, stress state, and cellular immunity responses before and after diagnosis of breast tumor. International Journal of Rehabilitation and Health, 2, 169-187.

    Foltz, A.T., Gaines, G., & Gullatte, M. (1996). Recalled side effects and self-care actions of patients receiving inpatient chemotherapy. Oncology Nursing Forum, 23, 679-683.

    Fortin, M.F. (1996). Le processus de la recherche de la conception à la réalisation. [Research process: From conception to completion]. Ville Mont-Royal, Canada: Decarie Éditeur.

    Gaston-Johansson, P., Fall-Dickson, J., Bakos, A.B., & Kennedy, M.J. (1999). Fatigue, pain, and depression in pre-autotransplant breast cancer patients. Cancer Practice, 7, 240-247.

    Greenberg, D.B., Gray, J.L., Mannix, C.M., Eisenthal, S., & Carey, M. (1993). Treatment-related fatigue and serum interleukin-1 levels in patients during external beam irradiation for prostate cancer. Journal of Pain and Symptom Management, 8, 196-200.

    Greenberg, D.B., Sawicka, J., Eisenthal, S., & Ross, D. (1992). Fatigue syndrome due to localized radiation. Journal of Pain and Symptom Management, 7, 38-45.

    Hack, T.F., Cohen, L., Katz, J., Robson, L.S., & Goss, P. (1999). Physical and psychological morbidity after axillary lymph node dissection for breast cancer. Journal of Clinical Oncology, 17, 143-149.

    Herbert, T.B., & Cohen, S. (1996). Measurement issues in research on psychosocial stress. In H.B. Kaplan (Ed.), Psychosocial stress: Perspective on structuring theory, life-course, and methods (pp. 295-332). San Diego, CA: Academic Press.

    Hilditch, J.R., Lewis, J., Peter, A., van Maris, B., Ross, A., Franssen, P., et al. (1996). A menopause-specific quality of life questionnaire: Development and psychometric properties. Maturitas Journal of the Climacteric and Postmenopause, 24, 161-175.

    Hilfinger, D.A., Yeager, K.A., Dibble, S.L., & Dodd, M.J. (1997). Patients' perspectives of fatigue while undergoing chemotherapy. Oncology Nursing Forum, 24, 43-48.

    Hoskins, C.N. (1997). Breast cancer treatment-related patterns in side effects, psychological distress, and perceived health status. Oncology Nursing Forum, 24, 1575-1583.

    International Union Against Cancer. (1997). TNM: Classification of malignant tumours (5th ed.). New York: Wiley-Liss.

    Irvine, D., Vincent, L., Graydon, J.E., & Bubela, N. (1998). Fatigue in women with breast cancer receiving radiation therapy. Cancer Nursing, 21, 127-135.

    Irvine, D., Vincent, L., Graydon, J.E., Bubela, N., & Thompson, L. (1994). The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy: A comparison with the fatigue experienced by healthy individuals. Cancer Nursing, 14, 367-378.

    Jacobsen, P.B., Hann, D.M., Azzarello, L.M., Horton, J., Balducci, L., & Lyman, G.H. (1999). Fatigue in women receiving adjuvant chemotherapy for breast cancer: Characteristics, course, and correlates. Journal of Pain and Symptom Management, 18, 233-242.

    Jacobsen, P.B., & Stein, K. (1999). Is fatigue a long-term side effect of breast cancer treatment? Cancer Control, 6, 256-263.

    Lazarus, R.S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.

    Lemyre, L. (1986). Stress et appréhension cognitive [Stress and cognitive appraisal]. Unpublished doctoral dissertation, Université Laval, Québec, Canada.

    Longman, A.J., Braden, C.J., & Mishel, M.H. (1996). Side effects burden in women with breast cancer. Cancer Practice, 4, 274-280.

    Longman, A.J., Braden, C.J., & Mishel, M.H. (1999). Side-effects burden, psychological adjustment, and life quality in women with breast cancer: Pattern of association over time. Oncology Nursing Forum, 26, 909-915.

    Love, R.R., Cameron, L., Connell, B.L., & Leventhal, H. (1991). Symptoms associated with tamoxifen treatment in postmenopausal women. Archives of International Medicine, 151, 1842-1847.

    Mast, M.E. (1998). Correlates of fatigue in survivors of breast cancer. Cancer Nursing, 21, 136-142.

    National Cancer Institute of Canada. (2003). Canadian cancer statistics, 2003. Toronto, Canada: Author.

    Nunnally, J.C., & Bernstein, I.H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill.

    Okuyama, T., Akechi, T., Kugaya, A., Okamura, H., Imoto, S., Nakano, T., et al. (2000). Factors correlated with fatigue in disease-free cancer patients: Application of the Cancer Fatigue Scale. Supportive Care in Cancer, 8, 215-222.

    Pearce, S., & Richardson, A. (1996). Fatigue in cancer: A phenomenological perspective. European Journal of Cancer, 5, 111-115.

    Portenoy, R.K., & Itri, L.M. (1999). Cancer-related fatigue: Guidelines for evaluation and management. Oncologist, 4(1), 1-10.

    Richardson, A., & Ream, E.K. (1997). Self-care behaviours initiated by chemotherapy patients in response to fatigue. International Journal of Nursing Studies, 34, 35-43.

    Savard, J., Laberge, B., Gauthier, J.G., & Bergeron, M.G. (1999). Screening clinical depression in HIV-seropositive patients using the hospital anxiety and depression scale. AIDS and Behavior, 3, 167-175.

    Servaes, P., Verhagen, S., & Bleijenberg, G. (2002). Determinants of chronic fatigue in disease-free breast cancer patients: A cross-sectional study. Annals of Oncology, 13, 589-598.

    Shacham, S. (1983). A shortened version of the Profile of Mood States. Journal of Personality Assessment, 47, 305-306.

    Shimozuma, K., Ganz, P. A., Petersen, L., & Hirji, K. (1999). Quality of life in the first year after breast cancer surgery: Rehabilitation needs and patterns of recovery. Breast Cancer Research and Treatment, 56, 45-57.

    Smets, E.M., Garssen, B., Bonke, B., & de Haes, J.C. (1995). The Multidimensional Fatigue Inventory (MFI): Psychometric qualities of an instrument to assess fatigue. Journal of Psychosomatic Research, 39, 315-325.

    Smets, E.M., Visser, M.R., Garssen, B., Frijda, N.H., Oosterveld, P., & de Haes, J.C. (1998). Understanding the level of fatigue in cancer patients undergoing radiotherapy. Journal of Psychosomatic Research, 45, 277-293.

    Smets, E.M., Visser, M.R., Willems-Groot, A.F., Garssen, B., Oldenburger, F., Tienhoven, G.V., et al. (1998). Fatigue and radiotherapy: (A) Experience in patients undergoing treatment. British Journal of Cancer, 78, 899-906.

    Smets, E.M., Visser, M.R., Willems-Groot, A.F., Garssen, B., Schuster-Uitterhoeve, A.L., & de Haes, J.C. (1998). Fatigue and radiotherapy: (B) Experience in patients 9 months following treatment. British Journal of Cancer, 78, 907-912.

    Stein, K.D., Jacobsen, P.B., Hann, D.M., Greenberg, H., & Lyman, G. (2000). Impact of hot flashes on quality of life among postmenopausal women being treated for breast cancer. Journal of Pain and Symptom Management, 19, 436-445.

    Stone, P., Richards, M., A'Hern, R., & Hardy, J. (2000). A study to investigate the prevalence, severity and correlates of fatigue among patients with cancer in comparison with a control group of volunteers without cancer. Annals of Oncology, 11, 561-567.

    Stone, P., Richards, M., & Hardy, J. (1998). Fatigue in patients with cancer. European Journal of Cancer, 34, 1670-1676.

    Tabachnick, E.G., & Fidell, L.S. (2001). Using multivariate statistics (4th ed.). Needham Heights, ME: Allyn and Bacon.

    Tasmuth, T., Von Smitten, K., & Kalso, E. (1996). Pain and other symptoms during the first year after radical and conservative surgery for breast cancer. British Journal of Cancer, 74, 2024-2031.

    Vogelzang, N.J., Breitbart, W., Cella, D., Curt, G.A., Groopman, J.E., Horning, S.J., et al. (1997). Patient, caregiver, and oncologist perceptions of cancer-related fatigue: Results of a tripart assessment survey. Seminars in Hematology, 34(Suppl. 2), 4-12.

    Wessely, S.C. (1996). Cognitive-behavioral therapy for patients with chronic fatigue syndrome: Why? In M.A. Demitrack & S.E. Abbey (Eds.), Chronic fatigue syndrome: An integrative approach to evaluation and treatment (pp. 212-239). New York: Guilford Press.

    Woo, B., Dibble, S.L., Piper, B.F., Keating, S.B., & Weiss, M.C. (1998). Differences in fatigue by treatment methods in women with breast cancer. Oncology Nursing Forum, 25, 915-920.

    Zigmond, A.S., & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatric Scandinavian, 67, 361-370.