Petra Servaes

Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions

Research on the relationship between cancer and fatigue has increased considerably in recent years. In this review, we focus on fatigue observed in patients during and after treatment for cancer, using data from empirical studies. The results from these studies indicate that fatigue is mostly studied during active treatment for cancer, and is an important problem during this period. Studies that focused on fatigue in disease-free cancer patients, although less prominent, also indicate fatigue is an important complaint in this time period. It is hard to draw conclusions with regard to the relationships between fatigue and disease- and treatment-related characteristics, because these relationships are seldom properly investigated. Relationships between fatigue and psychological, social, behavioural and physical factors have been established in several studies. However, most studies focused on the depression-fatigue association. Finally, most intervention studies to reduce fatigue appear to be successful, but the follow-up analyses are lacking.

Fatigue in disease-free cancer patients compared with fatigue in patients with Chronic Fatigue Syndrome

Abstract The goal of our work was to assess fatigue in disease-free cancer patients with help of a validated fatigue questionnaire. Furthermore, we wished to analyse the relationship between severe fatigue and former treatment modalities, problems of concentration and motivation, physical activity, functional impairment, depression and anxiety and finally, to compare severely fatigued disease-free cancer patients and patients with Chronic Fatigue Syndrome (CFS). The participants were 85 adult cancer patients and 16 patients with CFS. The cancer patients were all disease-free and had been off treatment for a minimum of 6 months. They were asked to participate in this study by their physician when they came to the hospital for control visits. Patients who were willing to participate completed four questionnaires. The Checklist Individual Strength was used to measure fatigue. In addition, the Beck Depression Inventory, the Spielberger Trait Anxiety Inventory and the Nottingham Health Profile were used. Results indicate that 19% of the disease-free cancer patients were severely fatigued. Their fatigue experience is comparable to that of patients with CFS. Severe fatigue is associated with problems of concentration and motivation, reduced physical activity, emotional health problems and pain. Furthermore, a relation was found between fatigue and depression and anxiety. No relation was found between fatigue and type of cancer, former treatment modalities, duration of treatment and time since treatment ended. In conclusion, for one fifth of a group of disease-free cancer patients fatigue is a severe problem long after treatment. In addition to fatigue, these patients experience several psychological and physical problems.

Fatigue after breast cancer and in chronic fatigue syndrome: similarities and differences.

OBJECTIVE Fatigue is investigated in 57 severely fatigued disease-free breast cancer patients and in 57 gender- and age-matched patients with chronic fatigue syndrome (CFS) using multidimensional and multimethod assessment. A comparison between these groups of patients is important to determine whether a cognitive behavioural intervention to reduce fatigue in CFS patients would be appropriate as well for severely fatigued disease-free breast cancer patients. METHODS Measurement included computerised questionnaires and a standardised neuropsychological test. Furthermore, patients filled out a daily Self-Observation List (SOL) and wore an actometer during a period of 12 days. RESULTS In comparison to severely fatigued disease-free breast cancer patients, CFS patients score more problematic with regard to the level of fatigue, functional impairment, physical activity, pain and self-efficacy. However, a subgroup of severely fatigued disease-free breast cancer patients reports the same amount of problems as CFS patients with regard to psychological well-being, sleep and concentration. Finally, CFS patients and severely fatigued breast cancer patients score equal on measures of social support. CONCLUSION There seem to be some similarities but also many differences between severely fatigued breast cancer survivors and females with CFS. Therefore, cognitive behaviour therapy (CBT) to reduce fatigue after treatment for cancer should also differ in certain aspects from cognitive behaviour therapy as it has been developed for patients with CFS.

Empowerment in adolescents and young adults with cancer: Relationship with health‐related quality of life

The difficulties adolescents and young adults (AYAs) encounter during a cancer experience may result in a reduction in or absence of empowerment. The aims of the current study were to assess levels of empowerment and associated (demographic, clinical, or psychological) factors and examine the association between empowerment and health‐related quality of life (HRQOL) among AYA patients with cancer.

Cognitive Behavior Therapy for Fear of Cancer Recurrence: A Case Study

This case study describes the course and content of cognitive behavior therapy (CBT) for clinical fear of cancer recurrence (FCR) in a breast cancer survivor. The CBT for clinical FCR consisted of seven face-to-face therapy sessions and one telephone session. The primary treatment goal was to reduce FCR severity by modifying cognitive processes and dysfunctional behavior. Assessments of FCR and quality of life were completed by the breast cancer survivor pre-therapy, post-therapy, and at 6 and 12 months of post-therapy. In each treatment session, perceived control over FCR was assessed. A clinical nurse specialist participated in evaluation interviews. The patient’s perceived control over FCR increased during the therapy, and FCR severity declined to a non-clinical level. This improvement was still evident at the 6- and 12-month follow-up assessments and was supported by results for secondary and exploratory outcomes measures. FCR offers a great challenge for health care professionals due to the lack of effective treatment options. This case study shows how clinical FCR can be addressed with CBT and can contribute to the improvement of care for cancer survivors.

Experiences of Parents and General Practitioners with End-of-Life Care in Adolescents and Young Adults with Cancer

This study aims to analyze the experiences of Dutch bereaved parents and general practitioners (GPs) with palliative care of AYAs (18-35 years) in the terminal stage. Fifteen parents and nine GPs involved with nine deceased AYAs filled out questionnaires and were interviewed by telephone, respectively. In general, the parents were satisfied with the emotional care they themselves received and the medical care that their child received. The GPs were very satisfied with the cooperation with the palliative team. Gaps are present in the areas of symptom control, communication between hospital professionals and parents, aftercare, and transition between hospital and GP.

1410PADOLESCENT AND YOUNG ADULT CANCER PATIENT (AYAS) PARTICIPATION AS DRIVER OF A NEW “AYA PROOF” CANCER CARE CONCEPT

ABSTRACT Aim: Every year 2200 new patients are diagnosed with cancer at AYA age (18-35 years) in the Netherlands. Until 2008 no specific health care organization existed for AYAs in the Netherlands, whereas they expressed their wish to get more attention for their age-specific needs. This led to an initiative in the Radboud university medical center, called the AYA Expertise Platform in which complementary input and initiatives of both patients and caregivers is crucial. Methods: At start in 2008, we asked input from the Dutch Patient Foundation ‘Young and Cancer’, and later also from individual patients in building a digital AYA community in 2010. In 2012 a so-called AYA taskforce was installed in which AYAs and professional caregivers from adult medical disciplines meet each other 4 times a year and work in small dream teams toward solutions of topics which are prioritized by the patients. Results: Based on the first sessions we made a clinical hang-out spot for AYAs and appointed a specialized AYA nurse who started an outpatient clinic dedicated to age specific care. Patients visit this clinic with questions about education, work, coping with cancer, relations, fertility, financial issues etc. They are subsequently discussed within a multidisciplinary group consisting of this nurse, medical oncologist, social worker and psychologist. The tumor related follow-up is continued by their own oncologists. In 2010 an AYA driven digital community ‘AYA4’ was built in which patients are linked together in a protected way. AYAs express their feelings, help each other and organize activities where they can meet each other. Currently 105 AYAs are member of the community. Finally, the AYA taskforce generated a list of topics which were prioritized by the patients: food, fertility, spirituality and end of life issues. Conclusions: In our hospital AYAs, together with health care professionals, are gradually building their own AYA Expertise Platform to be used during and after treatment. Patients are in the lead in co-creating their own care together with their health care professionals of the hospital wide AYA team, which process is efficient and appealing to all. Currently, the concept is being extended to a national AYA platform. Disclosure: All authors have declared no conflicts of interest.