King's College London, Department of Psychological Medicine, Institute of Psychiatry, DeCrespigny Park, London SE5 8AF, UK.
St George's Hospital, Blackshaw Rd, London SW17 0QT, UK; King's College London, Institute of Psychiatry, Department of Psychology, Henry Wellcome Building, De Crespigny Park, London SE5 8AF, UK.
J Psychosom Res. 2020 Jul;134:110127. doi: 10.1016/j.jpsychores.2020.110127. Epub 2020 May 5.
Fatigue is a highly prevalent and debilitating problem in women with breast cancer. This study investigated the cognitive, behavioural, interpersonal and affective responses associated with fatigue and functional impairment for women with breast cancer undergoing chemotherapy. A nested prospective study examined factors predictive of cancer-related fatigue after three cycles of chemotherapy.
159 women with breast cancer who were about to begin or undergoing chemotherapy completed a range of measures. Correlational and multiple regression analyses explored associations between fatigue severity, functioning and a range of psychological, behavioural, demographic and clinical variables. Forty-two patients were followed-up prospectively to examine the relationship between psychosocial variables, fatigue and functioning after three cycles of chemotherapy.
A range of cognitive, behavioural and affective variables were associated with increased fatigue severity and poorer functioning. Key cognitive and behavioural correlates included, all-or-nothing behaviour, avoidance behaviour, cancer-related catastrophising and critical/punishing responses from others. For the women in the nested prospective study, fatigue significantly increased after three cycles of chemotherapy. Increased fatigue was predicted by increased anxiety before starting chemotherapy.
Behavioural factors and cancer-specific cognitions make important contributions to cancer-related fatigue and associated impairments. Such factors are potentially amenable to change within the context of cognitive behavioural therapy.
疲劳是乳腺癌女性中一种普遍且虚弱的问题。本研究调查了接受化疗的乳腺癌女性的疲劳和功能障碍相关的认知、行为、人际和情感反应。一项嵌套前瞻性研究检查了化疗三个周期后与癌症相关的疲劳相关的预测因素。
159 名即将开始或正在接受化疗的乳腺癌女性完成了一系列措施。相关性和多元回归分析探讨了疲劳严重程度、功能与一系列心理、行为、人口统计学和临床变量之间的关系。42 名患者进行了前瞻性随访，以检查化疗三个周期后心理社会变量、疲劳和功能之间的关系。
一系列认知、行为和情感变量与疲劳严重程度增加和功能下降有关。关键的认知和行为相关性包括全有或全无行为、回避行为、与癌症相关的灾难化和来自他人的批评/惩罚反应。对于嵌套前瞻性研究中的女性，化疗三个周期后疲劳明显增加。化疗前焦虑增加预测疲劳增加。
行为因素和癌症特定认知对癌症相关疲劳及其相关障碍有重要贡献。这些因素在认知行为治疗的背景下可能具有可改变性。
