- Volume 16 Issue 3
DOI QR Code
Cognitive Behavioral Therapy in Breast Cancer Patients - a Feasibility Study of an 8 Week Intervention for Tumor Associated Fatigue Treatment
- Eichler, Christian (Department of Gynecology and Obstetrics, Holweide Hospital) ;
- Pia, Multhaupt (Brustzentrum, Krankenhaus Holweide, Department of Gynecology and Obstetrics) ;
- Sibylle, Multhaupt (Brustzentrum, Krankenhaus Holweide, Department of Gynecology and Obstetrics) ;
- Sauerwald, Axel (Hospital Duren GmbH) ;
- Friedrich, Wolff (Department of Gynecology and Obstetrics, Holweide Hospital) ;
- Warm, Mathias (Brustzentrum, Krankenhaus Holweide, Department of Gynecology and Obstetrics)
- Published : 2015.03.04
Background: Tumor associated fatigue (TAF) or cancer related fatigue (CRF) is not a new concept. Nonetheless, no real headway has been made in the quantitative analysis of its successful treatment via cognitive behavioral therapy. Since 20 to 30% of all breast cancer patients suffer from anxiety and/or depression within the first year of their diagnosis, this issue needs to be addressed and a standard treatment protocol has to be developed. This study focused on developing a simple, reproducible and short (8 weeks) protocol for the cognitive behavioral therapy support of tumor associated fatigue patients. Materials and Methods: Between the year 2011 and 2012, 23 breast cancer patients fulfilled the diagnosis TAF requirements and were introduced into this study. Our method focused on a psycho-oncological support group using a predetermined, highly structured and reproducible, cognitive behavioral therapy treatment manual. Eight weekly, 90 minute sessions were conducted and patients were evaluated before and after this eight session block. Tumor fatigue specific questionnaires such as the multidimensional fatigue inventory (MFI) as well as the hospital anxiety and depression scale (HADS) were used in order to quantitatively evaluate patient TAF. Results: Of the 23 patients enrolled in the study, only 7 patients fulfilled the TAF diagnostic criteria after the psycho-oncological group treatment. This represents a 70% reduction in diagnosable tumor associated fatigue. The HADS analysis showed a 33% reduction in patient anxiety as well as a 57% reduction in patient depression levels. The MFI scores showed a significant reduction in 4 of the 5 evaluate categories. With the exception of the "mental fatigue" MFI category all results were statistically significant. Conclusions: This study showed that a highly structured, cognitive behavioral therapy group intervention will produce significant improvements in breast cancer patient tumor associated fatigue levels after only 8 weeks.
Breast cancer;cognitive behavioral therapy;tumor associated fatigue;cancer related fatigue
- Campos MP, Hassan BJ, Riechelmann R, et al (2011). Cancerrelated fatigue: a review. Rev Assoc Med Bras, 57, 211-9. https://doi.org/10.1590/S0104-42302011000200021
- Cella D, Davis K, Breitbart W, et al (2001). Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol, 19, 3385-91.
- Abu-Helalah M, Al-Hanaqta M, Alshraideh H, et al (2014). Quality of life and psychological well-being of breast cancer survivors in Jordan. Asian Pac J Cancer Prev, 15, 5927-36. https://doi.org/10.7314/APJCP.2014.15.14.5927
- Bjorneklett HG, Lindemalm C, Rosenblad A, et al (2012). A randomised controlled trial of support group intervention after breast cancer treatment: results on anxiety and depression. Acta Oncol, 51, 198-207. https://doi.org/10.3109/0284186X.2011.610352
- Chan R (2011). Cochrane review summary for cancer nursing: drug therapy for the management of cancer-related fatigue. Cancer Nurs, 34, 250-1. https://doi.org/10.1097/NCC.0b013e31820aeb72
- Cosco TD, Doyle F, Ward M, et al (2012). Latent structure of the Hospital Anxiety And Depression Scale: a 10-year systematic review. J Psychosom Res, 72, 180-4. https://doi.org/10.1016/j.jpsychores.2011.06.008
- Curt GA, Breitbart W, Cella D, et al (2000). Impact of cancerrelated fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist, 5, 353-60. https://doi.org/10.1634/theoncologist.5-5-353
- Duijts SF, Faber MM, Oldenburg HS, et al (2011). Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors--a meta-analysis. Psychooncology, 20, 115-26. https://doi.org/10.1002/pon.1728
- Fafouti M, Paparrigopoulos T, Zervas Y, et al (2010). Depression, anxiety and general psychopathology in breast cancer patients: a cross-sectional control study. In Vivo, 24, 803-10.
- Finnegan-John J, Molassiotis A, Richardson A, et al (2013). A systematic review of complementary and alternative medicine interventions for the management of cancer-related fatigue. Integr Cancer Ther, 12, 276-90. https://doi.org/10.1177/1534735413485816
- Fitch MI (2012). Systematic review and meta-analysis of the correlates of cancer-related fatigue. Evid Based Nurs, 15, 108-9. https://doi.org/10.1136/ebnurs-2012-100688
- Irwin ML CB, Gross C, Ercolano E, et al (2013). Randomized trial of exercise vs. usual care on aromatase inhibitorassociated arthralgias in women with breast cancer: The hormones and physical exercise (HOPE) study San Antonio Breast Cancer Symposium 2013.
- Kangas M, Bovbjerg DH, Montgomery GH (2008). Cancerrelated fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull, 134, 700-41. https://doi.org/10.1037/a0012825
- Kovacs Z, Szabo C, Fulop E (2013). The therapy helps - psychosocial support of patients diagnosed with breastcancer; reducing anxiety and depression.. Psychiatr Hung, 28, 454-63 (in Hungarian).
- Larkey LK, Roe DJ, Weihs KL, et al (2014). Randomized controlled trial of qigong/tai chi easy on cancer-related fatigue in breast cancer survivors. Ann Behav Med (Epub ahead of print).
- Li SX, Liu BB, Lu JH (2014). Longitudinal study of cancerrelated fatigue in patients with colorectal cancer. Asian Pac J Cancer Prev, 15, 3029-33. https://doi.org/10.7314/APJCP.2014.15.7.3029
- Minton O, Richardson A, Sharpe M, et al (2008). A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. J Natl Cancer Inst, 100, 1155-66. https://doi.org/10.1093/jnci/djn250
- Mitchell SA (2010). Cancer-related fatigue: state of the science. PMR, 2, 364-83.
- Montazeri A, Jarvandi S, Haghighat S, et al (2001). Anxiety and depression in breast cancer patients before and after participation in a cancer support group. Patient Educ Couns, 45, 195-8. https://doi.org/10.1016/S0738-3991(01)00121-5
- Roth AJ, Nelson C, Rosenfeld B, et al (2010). Methylphenidate for fatigue in ambulatory men with prostate cancer. Cancer, 116, 5102-10. https://doi.org/10.1002/cncr.25424
- Schleife H, Sachtleben C, Finck Barboza C, et al (2012). Anxiety, depression, and quality of life in German ambulatory breast cancer patients. Breast Cancer, 21, 208-13.
- Schmidt ME, Chang-Claude J, Seibold P, et al (2014). Determinants of long-term fatigue in breast cancer survivors: results of a prospective patient cohort study. Psychooncology.
- Smets EM, Garssen B, Bonke B, et al (1995). The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res, 39, 315-25. https://doi.org/10.1016/0022-3999(94)00125-O
- Vodermaier A, Millman RD (2011). Accuracy of the hospital anxiety and depression scale as a screening tool in cancer patients: a systematic review and meta-analysis. Support Care Cancer, 19, 1899-908. https://doi.org/10.1007/s00520-011-1251-4
- Zigmond AS, Snaith RP (1983). The hospital anxiety and depression scale. Acta Psychiatr Scand, 67, 361-70 https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
- The relationship between patient activation, confidence to self-manage side effects, and adherence to oral oncolytics: a pilot study with Michigan oncology practices vol.25, pp.6, 2017, https://doi.org/10.1007/s00520-017-3584-0
- Fatigue among patients with brain tumors vol.5, pp.2, 2016, https://doi.org/10.2217/cns-2015-0008