Cancer-related fatigue and functional impairment – towards an understanding of cognitive and behavioural factors

Abstract

Background: Fatigue is a highly prevalent and debilitating problem in women with breast cancer undergoing chemotherapy. This study investigated the cognitive, behavioural, interpersonal and affective responses associated with and predictive of cancer-related fatigue and related functional impairment. Method: 151 women diagnosed with breast cancer and undergoing or about to undergo a course of chemotherapy completed a range of measures. Correlational and multiple regression analyses were used to explore associations between fatigue severity, social adjustment and a range of psychological, behavioural, demographic and clinical variables. Fifty-two patients completed measures prior to chemotherapy and were followed up prospectively to examine the relationship between psychosocial variables and fatigue and functional impairment as measured after three cycles of chemotherapy. Findings: A range of cognitive, behavioural and affective variables were associated with increased fatigue severity and poorer social adjustment. Key cognitive and behavioural correlates included increased symptom focusing, all-or-nothing behaviour, avoidance behaviour and health anxiety. Furthermore, prospective analyses suggested that an increased presence of unhelpful behaviours and beliefs prior to chemotherapy predicted the presence of fatigue and functional impairment after three cycles of chemotherapy. Key prospective predictors included embarrassment about having cancer, avoidance behaviour and expectations of future fatigue. Discussion: Psychological and behavioural factors may make important contributions to cancer-related fatigue and associated impairments. Such factors are potentially amenable to change within the context of cognitive behavioural therapy.