Abbie O. Beacham

Use of a Case Definition Approach to Identify Cancer-Related Fatigue in Women Undergoing Adjuvant Therapy for Breast Cancer

PURPOSE Use a proposed case-definition approach to identify the prevalence of cancer-related fatigue (CRF), demographic, clinical and psychosocial predictors of subsequent CRF, and psychosocial factors associated with concurrent CRF. PATIENTS AND METHODS Women (n = 288) undergoing adjuvant therapy for early-stage breast cancer were recruited from two outpatient clinics. Women completed a baseline assessment before adjuvant therapy and a post-treatment assessment at the conclusion of an initial course of adjuvant chemotherapy or radiotherapy. At both assessments, women completed a clinical interview and measures of fatigue, distress, coping, and quality of life (QOL). The clinical interview consisted of modules from the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) and a diagnostic interview to identify cases of CRF. RESULTS CRF prevalence at the baseline and post-treatment assessments was 10% and 26%, respectively. Multivariate analyses identified factors prospectively associated with greater risk for CRF at the post-treatment assessment, including receipt of adjuvant chemotherapy and a tendency to catastrophize in response to fatigue. Patients with and without CRF differed on a host of concurrent measures of fatigue, depression, functioning, and QOL with mean effect sizes in the range of 1.0 standard deviation. CONCLUSION CRF is a clinical syndrome experienced before and during adjuvant therapy for breast cancer. Results suggest CRF has a multifactorial etiology and support use of the proposed case definition approach to defining CRF. Future research is necessary to determine the scientific value of these criteria for understanding the etiology and management of fatigue in the oncology setting.

Ecological Momentary Assessment of fatigue following breast cancer treatment

Fatigue is a common and debilitating symptom often experienced during and following cancer treatment. An Ecological Momentary Assessment (EMA) approach was used to examine the diurnal pattern of off-treatment fatigue in breast cancer survivors. Twenty-five breast cancer (BC) survivors 6–26 months posttreatment and age-matched groups of healthy women (HC; n = 25) and women with benign breast problems (BBP; n = 24) completed four daily diary measures of fatigue, pain, and mood for 5 consecutive days. Type of activity engaged in at the time of the diary assessments, as well as daily pedometer activity level, and nightly sleep duration were also assessed. While BC survivors reported greater levels of fatigue relative to BBP and HC groups, no group differences in mood, activity type or level, sleep duration, or diurnal pattern of fatigue were evident. The results confirm that fatigue may continue to be experienced long after conclusion of cancer treatment while questioning its clinical significance, provide insight into potential etiological mechanisms underlying off-treatment fatigue in, and demonstrate the value of EMA approaches to the study of cancer-related fatigue.

Prospective, longitudinal study of leisure-time exercise in women with early-stage breast cancer.

Physical activity can have a beneficial effect on both physical and mental health in cancer survivors. However, evidence from cross-sectional and/or retrospective research suggests that cancer treatment can be associated with both short- and long-term reductions in physical activity. A prospective, longitudinal research design was used to examine the trajectory of leisure-time exercise in early-stage breast cancer patients from two treatment centers (n = 231). Participation in mild, moderate, and strenuous leisure-time exercise was assessed before, during, and following completion of adjuvant radiotherapy (n = 136) or chemotherapy + radiation (n = 95). Results indicated significant decreases, relative to pre-diagnosis baseline, in total estimated weekly metabolic equivalents and minutes of leisure-time exercise during adjuvant therapy for both the radiotherapy and chemotherapy + radiation groups. However, activity levels seemed to quickly recover and did not differ from pre-diagnosis baseline at assessments 2 and 6 months following completion of adjuvant radiotherapy or chemotherapy + radiation. Although suggesting little effect of breast cancer diagnosis and treatment on participation in leisure-time exercise at 6-month follow-up, these group analyses obscure the fact that a large number of individuals (35.5%) exhibited clinically significant change, both decreases or increases, in total weekly metabolic equivalents between pre-diagnosis baseline and 6-month follow-up. Fostering appropriate participation in physical activity in cancer patients and survivors is likely to be enhanced by better understanding of the beliefs and motivations that underlie spontaneous changes in participation in leisure-time exercise. (Cancer Epidemiol Biomarkers Prev 2007;16(3):430–8)

Feasibility of a pilot intervention targeting self-care behaviors in adults with diabetes mellitus

Diabetes has reached epidemic proportions and is widely encountered by clinicians in medical settings. National Standards for diabetes education recommend utilization of an interdisciplinary team, setting individual lifestyle goals and managing barriers. However, typical diabetes education programs lack integration of strategies for translating recommendations into behavioral actions. The present intervention was developed to assess the feasibility and efficacy of a short-term cognitive-behavioral intervention aimed at optimizing self-care behaviors in adults with diabetes in a “real world” medical setting. Participants were 20 adults who had completed medical model outpatient diabetes education. The intervention consisted of 6 weekly sessions that addressed the role of behavior in diabetes including self-care barriers, cognitions and self-regulation. Pre-post intervention data indicated greater specificity in goal-setting. Participants who kept activity records had the greatest lifestyle activity behavior change. Findings suggest that a brief intervention addressing realistic goal-setting is feasible and can promote meaningful health behavior changes. Clinical psychology can provide a bridge between current diabetes care recommendations and available medical resources by providing training in and delivery of empirically supported behavior change strategies and evaluation of diabetes care treatment approaches.

The Gap Between Clinical Trial and Application in Health Behavior Counseling: Can Behavioral Medicine Build a Bridge?

Patients desire to have information about health-related behaviors (e.g., exercise) provided to them by their health care provider. Outcomes of clinical trials in physical activity counseling are modest at best and therefore, the degree of effectiveness of physical activity counseling in the primary care setting remains unclear. We describe what may be considered a “real-world” example of behavior change counseling aimed at primary or secondary risk factor identification and modification for CHD in women. We examined rates of baseline and follow-up physical activity in our sample of midlife Caucasian and African American women (N = 227) participating in a hospital-based CHD-risk screening. Baseline physical activity levels and rates of return for follow-up appointments were quite low with only negligible achievement of behavior change recommendations. In light of these findings, the potential role of behavioral medicine in training and collaboration with health care providers in primary care behavior counseling is discussed.

New diabetes screening criteria for midlife women evaluated for coronary heart disease risk

The usefulness of new, lowered diabetes diagnostic criterion to identify undiagnosed diabetics in a high-risk sample of women was evaluated. Participants were 228 midlife women undergoing screening for heart attack risk. Fasting plasma glucose levels of participants who were not diagnosed with diabetes were examined to assess the number of women who would meet diagnostic criteria for diabetes using old (140 mg/dL) and new 126 mg/dL) American Diabetes Association criteria. The new criterion identified more women than did the old criterion, particularly African Americans. Use of the new criterion flagged nearly 50% as many women as originally diagnosed as diabetic at the time of screening. Early identification of diabetes may afford earlier, preventive interventions that may reduce morbidity and mortality. Thus, findings from this study suggest that use of the new, lowered diabetes diagnostic criterion may have significant public health benefits for midlife women.