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Cancer-related fatigue and depression in breast cancer patients postchemotherapy: Different associations with optimism and stress appraisals

Published online by Cambridge University Press:  09 September 2014

Inbar Levkovich ,
Miri Cohen ,
Shimon Pollack ,
Karen Drumea  and
Georgeta Fried
Inbar Levkovich*
Affiliation:
Department of Gerontology, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
Miri Cohen
Affiliation:
Department of Gerontology and School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
Shimon Pollack
Affiliation:
Institute of Clinical Immunology, Allergy and AIDS, Rambam Health Care Campus, Haifa, Israel
Karen Drumea
Affiliation:
Oncology Unit, Rambam Health Care Campus, Haifa, Israel
Georgeta Fried
Affiliation:
Oncology Unit, Rambam Health Care Campus, Haifa, Israel
*
Address correspondence and reprint requests to: Inbar Levkovich, Department of Gerontology, University of Haifa, Mount Carmel, Haifa 31905, Israel. E-mail: inbar.lev2@gmail.com
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Abstract

Objective:

Symptoms of depression and cancer-related fatigue (CRF) are common among breast cancer patients postchemotherapy and may seriously impair quality of life (QoL). This study aimed to assess the relationship between depression and CRF in breast cancer patients postchemotherapy and to examine their relationships to optimism and to threat and challenge appraisals.

Method:

Participants included 95 breast cancer patients (stages 1–3) 1 to 6 months after completion of chemotherapy. Patients submitted personal and medical details and completed the following: physical symptom questionnaires (EORTC QLQ–C30, and QLQ–BR23), a symptoms of depression questionnaire (CES–D), the Fatigue Symptom Inventory (FSI), the Life Orientation Test (LOT–R), and a stress appraisals questionnaire.

Results:

We found levels of depression, CRF, and appraisals of cancer as a threat to be moderate and levels of optimism and appraisals of cancer as a challenge to be high. Depression and CRF were positively associated. A multivariate regression analysis revealed that 51% of the CRF variance was explained and, together with physical symptoms and threat appraisal, were significantly associated with CRF. A total 67% of depression was explained and, and together with challenge and threat appraisals, were significantly associated with depression.

Significance of Results:

Although CRF and depression were often experienced simultaneously and both were found to be higher among individuals who gave higher appraisals of cancer as a threat, only depression was related to optimism and challenge appraisals, while CRF was related mainly to intensity of physical symptoms. The different pattern of associations between optimism and appraisals warrants further clinical attention as well as future study.

Keywords

Breast cancerFatigueDepressionOptimismStress appraisals
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 5 , October 2015 , pp. 1141 - 1151
Copyright
Copyright © Cambridge University Press 2014 

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References

REFERENCES

Aaronson, N.K., Ahmedzai, S., Bergman, B., et al. (1993). The European Organization for Research and Treatment of Cancer QLQ–C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85, 365–376.CrossRefGoogle ScholarPubMed
Alcalar, N., Ozkan, S., Kucucuk, S., et al. (2012). Association of coping style, cognitive errors and cancer-related variables with depression in women treated for breast cancer. Japanese Journal of Clinical Oncology, 42, 940–947.CrossRefGoogle ScholarPubMed
Allison, P.J., Guichard, C. & Gilain, L. (2000). A prospective investigation of dispositional optimism as a predictor of health-related quality of life in head and neck cancer patients. Quality of Life Research, 9, 951–960.Google Scholar
American Cancer Society (ACS) (2011). Breast cancer: Resource document. Available from http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-030975.pdf.Google Scholar
Amir, M., Lewin-Epstein, N., Becker, G., et al. (2002). Psychometric properties of the SF–12 (Hebrew version) in a primary care population in Israel. Medical Care, 40, 918–928.Google Scholar
Andresen, E.M., Malmgren, J.A., Carter, W.B., et al. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES–D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 77–84.CrossRefGoogle Scholar
Bardwell, W.A., Natarajan, L., Dimsdale, J.E., et al. (2006). Objective cancer-related variables are not associated with depressive symptoms in women treated for early-stage breast cancer. Journal of Clinical Oncology, 24, 2420–2427.CrossRefGoogle Scholar
Baron, R.M. & Kenny, D.A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51,1173–1182.CrossRefGoogle ScholarPubMed
Ben-Zur, H. (2009). Coping styles and affect. International Journal of Stress Management, 16, 81–99.Google Scholar
Ben-Zur, H., Yagil, D. & Oz, D. (2005). Coping strategies and leadership in the adaptation to social change: The Israeli kibbutz. Anxiety, Stress, & Coping, 18, 87–103.CrossRefGoogle Scholar
Bigatti, S.M., Steiner, J.L. & Miller, K.D. (2012). Cognitive appraisals, coping and depressive symptoms in breast cancer patients. Stress and Health, 28, 355–361.Google Scholar
Bjorck, J.P., Hopp, D.P. & Jones, L.W. (1999). Prostate cancer and emotional functioning: Effects of mental adjustment, optimism, and appraisal. Journal of Psychosocial Oncology, 17, 71–85.CrossRefGoogle Scholar
Bower, J.E., Ganz, P.A., Desmond, K.A., et al. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18, 743–753.CrossRefGoogle ScholarPubMed
Bower, J.E., Ganz, P.A., Desmond, K.A., et al. (2006). Fatigue in long-term breast carcinoma survivors. Cancer, 106, 751–758.Google Scholar
Bower, J.E., Ganz, P.A., Irwin, M.R., et al. (2011). Inflammation and behavioral symptoms after breast cancer treatment: Do fatigue, depression, and sleep disturbance share a common underlying mechanism? Journal of Clinical Oncology, 29, 3517–3522.Google Scholar
Brown, K.W., Levy, A.R., Rosberger, Z., et al. (2003). Psychological distress and cancer survival: A follow-up 10 years after diagnosis. Psychosomatic Medicine, 65, 636–646.CrossRefGoogle ScholarPubMed
Brown, L.F. & Kroenke, K. (2009). Cancer-related fatigue and its associations with depression and anxiety: A systematic review. Psychosomatics, 50, 440–447.Google Scholar
Büssing, A. & Fischer, J. (2009). Interpretation of illness in cancer survivors is associated with health-related variables and adaptive coping styles. BMC Women's Health, 9, 2.Google Scholar
Carver, C.S., Smith, R.G., Antoni, M.H., et al. (2005). Optimistic personality and psychosocial well-being during treatment predict psychosocial well-being among long-term survivors of breast cancer. Health Psychology, 24, 508–516.CrossRefGoogle ScholarPubMed
Carver, C.S., Scheier, M.F. & Segerstrom, S.C. (2010). Optimism. Clinical Psychology Review, 30, 879–889.CrossRefGoogle ScholarPubMed
Chambers, S.K., Meng, X., Youl, P., et al. (2012). A five-year prospective study of quality of life after colorectal cancer. Quality of Life Research, 21, 1551–1564.Google Scholar
Cohen, M. (2002). Coping and emotional distress in primary and recurrent breast cancer patients. Journal of Clinical Psychology in Medical Settings, 9, 245–251.Google Scholar
Cohen, M. & Fried, G. (2007). Comparing relaxation training and cognitive–behavioral group therapy for women with breast cancer. Research on Social Work Practice, 17, 313–323.CrossRefGoogle Scholar
Cohen, M., Katz, D. & Baruch, Y. (2007 a). Stress among the family caregivers of liver transplant recipients. Progress in Transplantation, 17, 48–53.Google Scholar
Cohen, M., Mansoor, D., Langut, H., et al. (2007 b). Quality of life, depressed mood, and self-esteem in adolescents with heart disease. Psychosomatic Medicine, 69, 313–318.CrossRefGoogle ScholarPubMed
Curtis, R., Groarke, A., McSharry, J., et al. (2013). Experience of breast cancer. Cancer Nursing, 37(3), E21–30.CrossRefGoogle Scholar
Cwikel, J. & Segal-Engelchin, D. (2005). Implications of ethnic group origin for Israeli women's mental health. Journal of Immigrant Health, 7, 133–143.Google Scholar
Degner, L.F., Hack, T., O'Neil, J., et al. (2003). A new approach to eliciting meaning in the context of breast cancer. Cancer Nursing, 26, 169–178.Google Scholar
Donovan, K.A. & Jacobsen, P.B. (2010). The fatigue symptom inventory: A systematic review of its psychometric properties. Supportive Care in Cancer, 19, 1–17.Google Scholar
Dunn, J., Ng, S.K., Breitbart, W., et al. (2013). Health-related quality of life and life satisfaction in colorectal cancer survivors: Trajectories of adjustment. Health and Quality of Life Outcomes, 11, 46, 1–8.Google Scholar
Epping-Jordan, J.A.E., Compas, B.E., Osowiecki, D.M., et al. (1999). Psychological adjustment in breast cancer: Processes of emotional distress. Health Psychology, 18, 315–326.CrossRefGoogle ScholarPubMed
Franks, H.M. & Roesch, S.C. (2006). Appraisals and coping in people living with cancer: A meta-analysis. Psycho-Oncology, 15, 1027–1037.CrossRefGoogle ScholarPubMed
Gilbar, O., Ben-Zur, H. & Lubin, G. (2010). Coping, mastery, stress appraisals, mental preparation, and unit cohesion predicting distress and performance: A longitudinal study of soldiers undertaking evacuation tasks. Anxiety, Stress, & Coping, 23, 547–562.CrossRefGoogle ScholarPubMed
Grassi, L., Caruso, R. & Nanni, M.G. (2013). Somatization and somatic symptom presentation in cancer: A neglected area. International Review of Psychiatry, 25, 41–51.Google Scholar
Hann, D., Jacobsen, P., Azzarello, L., et al. (1998). Measurement of fatigue in cancer patients: Development and validation of the fatigue symptom inventory. Quality of Life Research, 7, 301–310.Google Scholar
Härtl, K., Engel, J., Herschbach, P., et al. (2010). Personality traits and psychosocial stress: Quality of life over 2 years following breast cancer diagnosis and psychological impact factors. Psycho-Oncology, 19, 160–169.Google Scholar
Henselmans, I., Sanderman, R., Baas, P.C., et al. (2009). Personal control after a breast cancer diagnosis: Stability and adaptive value. Psycho-Oncology, 18, 104–108.Google Scholar
Ho, S., Rajandram, R.K., Chan, N., et al. (2011). The roles of hope and optimism on posttraumatic growth in oral cavity cancer patients. Oral Oncology, 47, 121–124.Google Scholar
Hofman, M., Ryan, J.L., Figueroa-Moseley, C.D., et al. (2007). Cancer-related fatigue: The scale of the problem. The Oncologist, 12, 4–10.CrossRefGoogle ScholarPubMed
Howard-Anderson, J., Ganz, P.A., Bower, J.E., et al. (2012). Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: A systematic review. Journal of the National Cancer Institute, 104, 386–405.Google Scholar
Jacobsen, P.B., Donovan, K.A. & Weitzner, M.A. (2003). Distinguishing fatigue and depression in patients with cancer. Seminars in Clinical Neuropsychiatry, 8, 229–240.Google Scholar
Jean-Pierre, P., Figueroa-Moseley, C.D., Kohli, S., et al. (2007). Assessment of cancer-related fatigue: Implications for clinical diagnosis and treatment. The Oncologist, 12, 11–21.Google Scholar
Jobin, J., Wrosch, C. & Scheier, M.F. (2013). Associations between dispositional optimism and diurnal cortisol in a community sample: When stress is perceived as higher than normal. Health Psychology, 33(4), 382–391.CrossRefGoogle Scholar
Iecovich, E. & Cwikel, J. (2010). The relationship between well-being and self-rated health among middle-aged and older women in Israel. Clinical Gerontologist, 33, 255–269.Google Scholar
Irwin, M., Artin, K.H. & Oxman, M.N. (1999). Screening for depression in the older adult: Criterion validity of the 10-item center for epidemiological studies depression scale (CES–D). Archives of Internal Medicine, 159, 1701–1704.Google Scholar
Karademas, E.C., Karvelis, S. & Argyropoulou, K. (2007). Stress-related predictors of optimism in breast cancer survivors. Stress and Health, 23, 161–168.Google Scholar
Karakoyun-Celik, O., Gorken, I., Sahin, S., et al. (2010). Depression and anxiety levels in woman under follow-up for breast cancer: Relationship to coping with cancer and quality of life. Medical Oncology, 27, 108–113.Google Scholar
Kennedy, P., Evans, M. & Sandhu, N. (2009). Psychological adjustment to spinal cord injury: The contribution of coping, hope and cognitive appraisals. PsychologyHealth and Medicine, 14, 17–33.Google ScholarPubMed
Kim, S.H., Son, B.H., Hwang, S.Y., et al. (2008). Fatigue and depression in disease-free breast cancer survivors: Prevalence, correlates, and association with quality of life. Journal of Pain and Symptom Management, 35, 644–655.Google Scholar
Kohout, F.J., Berkman, L.F., Evans, D.A., et al. (1993). Two shorter forms of the CES–D (Center for Epidemiological Studies–Depression) depression symptoms index. Journal of Aging and Health, 5, 179–193.Google Scholar
Koller, M., Aaronson, N.K., Blazeby, J., et al. (2007). Translation procedures for standardised quality of life questionnaires: The European Organisation for Research and Treatment of Cancer (EORTC) approach. European Journal of Cancer, 43, 1810–1820.Google Scholar
Kurtz, M.E., Kurtz, J.C., Given, C.W., et al. (2008). Patient optimism and mastery: Do they play a role in cancer patients' management of pain and fatigue? Journal of Pain and Symptom Management, 36, 1–10.Google Scholar
Lam, W.W.T., Bonanno, G.A., Mancini, A.D., et al. (2010). Trajectories of psychological distress among Chinese women diagnosed with breast cancer. Psycho-Oncology, 19, 1044–1051.Google Scholar
Lazarus, R.S. & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
Lee, M.K., Park, S., Lee, E.S., et al. (2011). Social support and depressive mood 1 year after diagnosis of breast cancer compared with the general female population: A prospective cohort study. Supportive Care in Cancer, 19, 1379–1392.Google Scholar
Littlewood, T.J., Kallich, J.D., San Miguel, J., et al. (2006). Efficacy of darbepoetin alfa in alleviating fatigue and the effect of fatigue on quality of life in anemic patients with lymphoproliferative malignancies. Journal of Pain and Symptom Management, 31, 317–325.Google Scholar
Liu, L., Fiorentino, L., Natarajan, L., et al. (2009). Pre-treatment symptom cluster in breast cancer patients is associated with worse sleep, fatigue and depression during chemotherapy. Psycho-Oncology, 18, 187–194.Google Scholar
Lukkahatai, N. & Saligan, L.N. (2012). Association of catastrophizing and fatigue: A systematic review. Journal of Psychosomatic Research, 74, 100–109.CrossRefGoogle ScholarPubMed
Matthews, E.E., Schmiege, S.J., Cook, P.F., et al. (2012). Breast cancer and symptom clusters during radiotherapy. Cancer Nursing, 35, E1–E11.Google Scholar
Mendoza, T.R., Laudico, A.V., Wang, X., et al. (2010). Assessment of fatigue in cancer patients and community dwellers: Validation study of the Filipino version of the brief fatigue inventory. Oncology, 79, 112–117.Google Scholar
Mitchell, A.J., Chan, M., Bhatti, H., et al. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative care settings: A meta-analysis of 94 interview-based studies. The Lancet Oncology, 12, 160–174.Google Scholar
Monga, U., Garber, S.L., Thornby, J., et al. (2007). Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy. Archives of Physical Medicine and Rehabilitation, 88, 1416–1422.CrossRefGoogle ScholarPubMed
Morrow, G.R., Andrews, P.L., Hickok, J.T., et al. (2002). Fatigue associated with cancer and its treatment. Supportive Care in Cancer, 10, 389–398.Google Scholar
Mui, A., Burnette, D. & Chen, L. (2002). Cross-cultural assessment of geriatric depression: A review of the CES–D and GDS. In Multicultural measurement in older populations. Skinner, J.H. et al. . (eds.), pp 147–177. New York: Springer.Google Scholar
Mustian, K.M., Morrow, G.R., Carroll, J.K., et al. (2007). Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. The Oncologist, 12, 52–76.Google Scholar
Naaman, S.C., Radwan, K., Fergusson, D., et al. (2009). Status of psychological trials in breast cancer patients: A report of three meta-analyses. Psychiatry, 72, 50–69.Google Scholar
Nail, L.M. (2002). Fatigue in patients with cancer. Oncology Nursing Forum, 29, 537–546.Google Scholar
Newton, A.T. & McIntosh, D.N. (2010). Specific religious beliefs in a cognitive appraisal model of stress and coping. International Journal for the Psychology of Religion, 20, 39–58.Google Scholar
Otte, J.L., Carpenter, J.S., Russell, K.M., et al. (2010). Prevalence, severity, and correlates of sleep–wake disturbances in long-term breast cancer survivors. Journal of Pain and Symptom Management, 39, 535–547.Google Scholar
Palesh, O.G., Roscoe, J.A., Mustian, K.M., et al. (2010). Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center, community clinical oncology program. Journal of Clinical Oncology, 28, 292–298.CrossRefGoogle ScholarPubMed
Paltiel, O., Avitzour, M., Peretz, T., et al. (2001). Determinants of the use of complementary therapies by patients with cancer. Journal of Clinical Oncology, 19, 2439–2448.CrossRefGoogle ScholarPubMed
Paschoin de Oliveira Campos, M., Hassan, B.J., Riechelmann, R., et al. (2011). Cancer-related fatigue: A review. Revista da Associação Médica Brasileira, 57, 206–214.Google Scholar
Peleg, G., Barak, O., Harel, Y., et al. (2009). Hope, dispositional optimism and severity of depression following traumatic brain injury. Brain Injury, 23, 800–808.Google Scholar
Petticrew, M., Bell, R. & Hunter, D. (2002). Influence of psychological coping on survival and recurrence in people with cancer: Systematic review. BMJ (Clinical Research ed.), 325, 1066.Google Scholar
Radloff, L.S. (1977). The CES–D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 358–401.Google Scholar
Raison, C. & Miller, A. (2013). Role of inflammation in depression: Implications for phenomenology, pathophysiology and treatment. In Inflammation in Psychiatry. Halaris, A. & Leonard, B.E. (eds.), pp. 33–48. Basel: Karger.CrossRefGoogle Scholar
Reichelt, J.G., Møller, P., Heimdal, K., et al. (2008). Psychological and cancer-specific distress at 18 months post-testing in women with demonstrated BRCA1 mutations for hereditary breast/ovarian cancer. Familial Cancer, 7, 245–254.Google Scholar
Reuter, K., Classen, C.C., Roscoe, J.A., et al. (2006). Association of coping style, pain, age and depression with fatigue in women with primary breast cancer. Psycho-Oncology, 15, 772–779.Google Scholar
Ryan, J.L., Carroll, J.K., Ryan, E.P., et al. (2007). Mechanisms of cancer-related fatigue. The Oncologist, 12, 22–34.Google Scholar
Scheier, M.F. & Carver, C.S. (1985). Optimism, coping, and health: Assessment and implications of generalized outcome expectancies. Health Psychology, 4, 219–247.Google Scholar
Scheier, M.F. & Carver, C.S. (1992). Effects of optimism on psychological and physical well-being: Theoretical overview and empirical update. Cognitive Therapy and Research, 16, 201–228.Google Scholar
Scheier, M.F., Carver, C.S. & Bridges, M.W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the life orientation test. Journal of Personality and Social Psychology, 67, 1063–1078.Google Scholar
Schmid-Büchi, S., Halfens, R.J.G., Dassen, T., et al. (2011). Psychosocial problems and needs of posttreatment patients with breast cancer and their relatives. European Journal of Oncology Nursing, 15, 260–266.Google Scholar
Schultz, S.L., Dalton, S.O., Christensen, J., et al. (2011). Factors correlated with fatigue in breast cancer survivors undergoing a rehabilitation course, Denmark, 2002–2005. Psycho-Oncology, 20, 352–360.Google Scholar
Schumacher, A., Wewers, D., Heinecke, A., et al. (2002). Fatigue as an important aspect of quality of life in patients with acute myeloid leukemia. Leukemia Research, 26, 355–362.Google Scholar
So, W.K., Marsh, G., Ling, W., et al. (2009). The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: A multicenter study. Oncology Nursing Forum, 36, E205–E214.Google Scholar
Sobel, M.E. (1982). Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology, 13, 290–312.Google Scholar
Sprangers, M., Groenvold, M., Arraras, J.I., et al. (1996). The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: First results from a three-country field study. Journal of Clinical Oncology, 14, 2756–2768.Google Scholar
Vahdaninia, M., Omidvari, S. & Montazeri, A. (2010). What do predict anxiety and depression in breast cancer patients? A follow-up study. Social Psychiatry and Psychiatric Epidemiology, 45, 355–361.Google Scholar
Zenger, M., Brix, C., Borowski, J., et al. (2010). The impact of optimism on anxiety, depression and quality of life in urogenital cancer patients. Psycho-Oncology, 19, 879–886.CrossRefGoogle ScholarPubMed