Advertisement

Fatigue and psychological distress – exploring the relationship in women treated for breast cancer

      Abstract

      Disabling fatigue and psychological symptoms of depression or anxiety are commonly reported by women with treated breast cancer. However, most instruments designed to assess fatigue do not assess concurrent psychological symptoms. This study compared the characteristics of two conceptually different, self-report instruments assessing fatigue to determine the extent to which common psychological symptoms co-exist with the symptom of fatigue in women treated for breast cancer. Women attending an oncology day-care facility for adjuvant treatment of breast cancer or ongoing surveillance post-treatment, completed two self-report questionnaires. The Somatic and Psychological Health REport-34 items (SPHERE) and the Functional Assessment of Cancer Therapy-Fatigue (FACT-F subscale-13 items).One hundred and nine women (mean age 52.8 years) completed both questionnaires and total scores on both fatigue assessment scales, FACT-F and SOMA-6, were highly correlated (r=0.72, P<0.001). Using the SPHERE case criteria, prolonged fatigue (37% [40/109]) and psychological distress 31% (34/109) were common in women treated for breast cancer. However, those who reported fatigue were much more likely to also report psychological symptoms (22/40 vs. 12/69, χ2=16.7: degrees of freedom (df)=1; P<0.001) and the levels of fatigue on the FACT-F were not significantly different between those who reported `fatigue only' and those who reported `psychological distress only' (18.8 vs. 17.8, P=0.79).Thus the recent emphasis on recording fatigue during and following treatments for cancer needs to be accompanied by concurrent measurement of psychological symptoms.

      Abbreviations:

      SPHERE=Somatic and Psychological Health REport (), FACT-F=Functional Assessment of Cancer Therapy-Fatigue (), DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ()

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Alexander F.E
        • Anderson T.J
        • Brown H.K
        • Forrest A.P.M
        • Hepburn W
        • Kirkpatrick A.E
        • et al.
        14 years of follow-up from the Edinburgh randomised trial of breast-cancer screening.
        Lancet. 1999; 353: 1903-1908
      1. UK Trial of Early Detection of Breast Cancer Group. 16-year mortality from breast cancer in the UK Trial of Early Detection of Breast Cancer. Lancet 1999, 353, 1909–1914

        • Curt G.A
        • Breitbart W
        • Cella D
        • Groopman J.E
        • Horning S.J
        • Itri L.M
        • et al.
        Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition.
        The Oncologist. 2000; 5: 353-360
        • Portenoy R.K
        Cancer-related fatigue: an immense problem.
        The Oncologist. 2000; 5: 350-352
        • Vogelzang N.J
        • Breibart W
        • Cella D
        • Curt G.A
        • Groopman J.E
        • Horning S.J
        • et al.
        Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey.
        Semin. Hematol. 1997; 34: 4-12
        • Servaes P
        • Verhagen S
        • Bleijenberg G
        Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study.
        Ann. Oncol. 2002; 13: 589-598
      2. Ahlberg K, Ekman T, Gaston-Johansson F, Mock V. Assessment and management of cancer-related fatigue in adults. The Lancet; 2003

        • Portenoy R.K
        • Itri L.M
        Cancer-related fatigue: guidelines for evaluation and management.
        The Oncologist. 1999; 4: 1-10
      3. Piper BF. Evidence-based fatigue guidelines two years later: How have they worked? In: Cancer-related fatigue: 2002 June 22–23. MD Anderson Cancer Center, Houston Texas: The University of Texas, MD, Anderson Cancer Center; 2002

        • Stone P
        • Richards M
        • Hardy J
        Fatigue in patients with cancer.
        Eur. J. Cancer. 1998; 34: 1670-1676
      4. de Jong N, Courtens AM, Abu-Saad HH. Fatigue in patients with breast cancer receiving adjuvant therapy: a review of the literature. Cancer Nurs 2002, 25(4), 283–297

        • Sadler I.J
        • Jacobsen P.B
        • Booth-Jones M
        • Belanger H
        • Weitzner M.A
        • Fields K.K
        Preliminary evaluation of a clinical syndrome approach to assessing cancer-related fatigue.
        J. Pain Symptom Manag. 2002; 23: 406-416
      5. NIH. NIH State of the Science Conference on Symptom Management in Cancer: Pain, Depression and Fatigue; 2002

        • Hayes J.R
        Depression and chronic fatigue in cancer patients.
        Prim. Care. 1991; 18: 327-339
        • Hickie I
        • Lloyd A.R
        • Wakefield D
        Chronic fatigue syndrome: current perspectives on evaluation and management.
        Med. J. Aust. 1995; 163: 314-318
        • Fuhrer R
        • Wessely S
        The epidemiology of fatigue and depression: a French primary-care study.
        Psychol. Med. 1995; 25: 895-905
        • Ibbotson T
        • Maguire P
        • Selby P
        • Priestman T
        • Wallace L
        Screening for anxiety and depression in cancer patients: the effects of disease and treatment.
        Eur. J. Cancer. 1994; 30A: 37-40
        • Kissane D.W
        • Clarke D.M
        • Ikin J
        • Bloch S
        • Smith G.C
        • Vitetta L
        • et al.
        Psychological morbidity and quality of life in Australian women with early-stage breast cancer: a cross-sectional survey.
        Med. J. Aust. 1998; 169: 192-196
        • Hall A
        • A'Hearn R
        • Fallowfield L
        Are we using appropriate self-report questionnaires for detecting anxiety and depression in women with early breast cancer?.
        Eur. J. Cancer. 1999; 35: 79-85
        • Aapro M
        • Cull A
        Depression in breast cancer patients: the need for treatment.
        Ann. Oncol. 1999; 10: 627-636
        • Wilkinson M.J.B
        • Barczak P
        Psychiatric screening in general practice: comparison of the General Health Questionnaire and the Hospital Anxiety Depression scale.
        J. R. Coll. Gen. Pract. 1988; 38: 311-313
        • Aaronson N.K
        • Ahmedzai S
        • Bergman B
        • Bullinger M
        • Cull A
        • Duez N.J
        • et al.
        The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.
        J. Natl. Cancer Inst. 1993; 85: 365-376
        • Demetri G.D
        • Kris M
        • Wade J
        • Degos L
        • Cella D
        Quality-of-life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response of tumor type: results from a prospective community oncology study.
        J. Clin. Oncol. 1998; 16: 3412-3425
        • Glaspy J
        • Bukowski R
        • Steinberg D
        • Taylor C
        • Tchekmedyian S
        • Vadhan-Raj S
        • et al.
        Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice.
        J. Clin. Oncol. 1997; 15: 1218-1234
      6. Greene F Page D.L Fleming I.D Fritz A.G Balch C.M Haller D.G AJCC cancer staging handbook. sixth ed. Springer, New York2002
        • Yellen S.B
        • Cella D.F
        • Webster K
        • Blendowski C
        • Kaplan E
        Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system.
        J. Pain Symptom Manage. 1997; 13: 63-74
        • Cella D
        The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue.
        Semin. Hematol. 1997; 34: 13-19
      7. Hadzi-Pavlovic D, Hickie I, Ricci C. Somatic and Psychological Health Report. Development and initial evaluation. Technical Report. Report. Sydney: School of Psychiatry, UNSW; and Academic Department of Psychiatry, The St. George Hospital and Community Health Service.; 1997. Report No.: TR-97-002

        • Hickie I.B
        • Davenport T.A
        • Hadzi-Pavlovic D
        • Koschera A
        • Naismith S.L
        • Scott E.M
        • et al.
        Development of a simple screening tool for common mental disorders in general practice.
        Med. J. Aust. 2001; 175: s10-s17
        • Hadzi-Pavlovic D
        • Hickie I.B
        • Wilson A.J
        • Davenport T.A
        • Lloyd A.R
        • Wakefield D
        Screening for prolonged fatigue syndromes: validation of the SOFA scale.
        Soc. Psychiatry Psychiatr. Epidemiol. 2000; 35: 471-479
        • Koschera A
        • Hickie I
        • Hadzi-Pavlovic D
        • Wilson A
        • Lloyd A
        Prolonged fatigue, anxiety and depression: exploring relationships in a primary care sample.
        Aust. NZ J. Psychiatry. 1999; 33: 545-552
        • Hickie I
        • Koschera A
        • Hadzi-Pavlovic D
        • Bennett B
        • Lloyd A
        The temporal stability and co-morbidity of prolonged fatigue: a longitudinal study in primary care.
        Psychol. Med. 1999; 29: 855-861
        • Hickie I
        • Kirk K
        • Martin M
        Unique genetic and environmental determinants of prolonged fatigue: a twin study.
        Psychol. Med. 1999; 29
        • Hickie I
        • Bennett B
        • Lloyd A
        • Heath A
        • Martin N
        Complex genetic and environmental relationships between psychological distress, fatigue and immune functioning: a twin study.
        Psychol. Med. 1999; 29: 269-277
        • Goldberg D
        • Williams P
        A users guide to the General Health Questionnaire.
        NFER-NELSON Publishing Company Ltd, Windsor1988
      8. SPSS Inc. SPSS for Windows. In: 9.0 ed. Chicago, IL, USA; 1999

        • Hjerl K
        • Andersen E.W
        • Keiding N
        • Mortensen P.B
        • Jorgensen T
        Increased incidence of affective disorders, anxiety disorders, and non-natural mortality in women after breast cancer diagnosis: a nation-wide cohort study in Denmark.
        Acta. Psychiatrica Scandinavica. 2002; 105: 258-264
        • Hjerl K
        • Andersen E.W
        • Keiding N
        • Mouridsen H.T
        • Mortensen P.B
        • Jorgensen T
        Depression as a prognostic factor for breast cancer mortality.
        Psychosomatics. 2003; 44: 24-30
        • Bennett B.K
        • Hickie I.B
        • Vollmer-Conna U.S
        • Quigley B
        • Brennan C.M
        • Wakefield D
        • et al.
        The relationship between fatigue, psychological and immunological variables in acute infectious illness.
        Aust. NZ J. Psychiatry. 1998; 32: 180-186