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Lin C, Tian H, Chen L, Yang Q, Wu J, Ji Z, Zheng D, Li Z, Xie Y. The efficacy of cognitive behavioral therapy for cancer: A scientometric analysis. Front Psychiatry 2022; 13:1030630. [PMID: 36419971 PMCID: PMC9676684 DOI: 10.3389/fpsyt.2022.1030630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is one of the most recognized psychological interventions to improve the overall quality of life of cancer survivors. To analyze current research trends in the field of the link between CBT and cancer and to provide potential future research directions, we conducted the scientometric analysis. The study was conducted on all documents in this field from 2012 to 2022 retrieved from Web of Science. Then Biblioshiny, VOSviewer software, and CiteSpace software were used for getting the information of article postings and citations, countries, institutions, journals, authors, and keywords. The number of documents about the link between CBT and cancer from 2012 to 19 July 2022, was 619, with 476 of articles and 143 of reviews. The number of annual publications has been fluctuating, with the highest number of publications in 2020. The country with the maximum number of publications and citations was the US. The University of Houston was the organization with the highest quantity of publications and total link strength (TLS). Psycho-Oncology was the most active journal in the field and has the highest h-index. Zvolensky MJ was the author with the highest quantity of publications. The most cited keywords were "Quality-of-life," "Cognitive-behavioral therapy," "Depression," "Cognitive therapy" and "Breast-cancer." And as evidenced by the keyword citations, the focus of this research area has gradually shifted to the mental health of patients and the underlying pathogenesis. The impact of CBT in cancer treatment is now well established and has gradually evolved toward symptom-specific treatment. However, the relationship between CBT and cancer has not been further developed. Future research is needed to be further developed in the identification of a generic formula for CBT in cancer and the exploration of mechanisms of CBT and cancer.
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Affiliation(s)
- Chuanghao Lin
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Huiting Tian
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Lingzhi Chen
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Qiuping Yang
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Jinyao Wu
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zeqi Ji
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Daitian Zheng
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Zhiyang Li
- Department of General Surgery, The Second Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Yanna Xie
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
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Addison S, Shirima D, Aboagye-Mensah EB, Dunovan SG, Pascal EY, Lustberg MB, Arthur EK, Nolan TS. Effects of tandem cognitive behavioral therapy and healthy lifestyle interventions on health-related outcomes in cancer survivors: a systematic review. J Cancer Surviv 2021. [PMID: 34357555 DOI: 10.1007/s11764-021-01094-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022]
Abstract
Purpose Healthy lifestyle (HL) behaviors and cognitive behavioral therapy (CBT) have been individually shown to improve adverse effects of cancer treatment. Little is known about how such programs in tandem affect health-related outcomes. This review evaluates extant literature on tandem CBT/HL interventions on health-related outcomes in cancer survivors. Methods A comprehensive search of PubMed, PsychINFO, CINAHL, and Embase databases revealed numerous studies involving CBT and HL tandem interventions in cancer survivors in the last 20 years. Studies meeting the inclusion criteria were examined and assessed by the authors. Results The 36 studies included 5199 participants. Interventions involved the use of CBT in combination with a HL condition (stress reduction, increasing physical activity, etc.). These tandem conditions were compared against no intervention, usual care, and/or CBT alone or HL alone. Interventions were delivered by a variety of interventionists, and over different durations. The most common HL target outcomes were stress, and insomnia. Most studies (31 of 36) reported a reduction in adverse treatment and/or cancer-related effects. Conclusion Findings were biased with the overrepresentation of breast cancer survivors, and underrepresentation of minority groups, and those with advanced cancer. Thus, this review highlights the need for further research to test tandem interventions against CBT alone and HL alone, and toward identifying the most efficacious interventions for dissemination and implementation across diverse groups of cancer survivors. Implications for cancer survivors Tandem CBT/HL interventions can improve health-related outcomes for cancer survivors when compared to usual care, but there is a paucity of knowledge to suggest differential outcomes when compared to CBT or HL alone.
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Poort H, de Rooij BH, Uno H, Weng S, Ezendam NPM, van de Poll-Franse L, Wright AA. Patterns and predictors of cancer-related fatigue in ovarian and endometrial cancers: 1-year longitudinal study. Cancer 2020; 126:3526-3533. [PMID: 32436610 DOI: 10.1002/cncr.32927] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fatigue is a common and distressing symptom for patients with gynecologic cancers. Few studies have empirically examined whether it spontaneously resolves. This study was aimed at identifying longitudinal patterns of fatigue and predictors of clinically significant fatigue 1 year after treatment completion. METHODS This was a prospective cohort study of women with newly diagnosed ovarian (n = 81) or endometrial cancer (n = 181) that did not progress or recur within 1 year of treatment completion. Symptoms of fatigue, depression, and anxiety were assessed after surgery and 6 and 12 months after treatment completion with the Fatigue Assessment Scale and the Hospital Anxiety and Depression Scale. Patients' fatigue scores over time were classified (scores of 22-50, clinically significant; scores of 10-21, not clinically significant). Logistic regression models were fit to examine associations between fatigue and patient characteristics. RESULTS Among 262 participants, 48% reported clinically significant fatigue after surgery. One year later, 39% reported fatigue. There were 6 patterns over time: always low (37%), always high (25%), high then resolves (18%), new onset (10%), fluctuating (6%), and incidental (5%). Patients with fatigue after surgery were more likely to report fatigue at 12 months in comparison with others (odds ratio [OR], 6.08; 95% confidence interval [CI], 2.82-13.11; P < .001). Patients with depressive symptoms also had higher odds of fatigue (OR, 3.36; 95% CI, 1.08-10.65; P = .039), although only one-third of fatigued patients reported depressive symptoms. CONCLUSION Nearly half of women with gynecologic cancers had clinically significant fatigue after surgery, whereas 44% and 39% had fatigue 6 months and 1 year later; this suggests that spontaneous regression of symptoms is relatively rare. Women who reported fatigue, depressive symptoms, or 2 or more medical comorbidities had higher odds of reporting fatigue 1 year later. Future studies should test scalable interventions to improve fatigue in women with gynecologic cancers.
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Affiliation(s)
- Hanneke Poort
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Belle H de Rooij
- Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Hajime Uno
- Department of Medical Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Shicheng Weng
- Department of Medical Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nicole P M Ezendam
- Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
| | - Lonneke van de Poll-Franse
- Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.,Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.,Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Alexi A Wright
- Department of Medical Oncology, Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Nguyen S, Wong D, McKay A, Rajaratnam SMW, Spitz G, Williams G, Mansfield D, Ponsford JL. Cognitive behavioural therapy for post-stroke fatigue and sleep disturbance: a pilot randomised controlled trial with blind assessment. Neuropsychol Rehabil 2017; 29:723-738. [PMID: 28521579 DOI: 10.1080/09602011.2017.1326945] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The objective of this study was to evaluate the effectiveness of individual cognitive behavioural therapy (CBT) for post-stroke fatigue and sleep disturbance compared to treatment as usual (TAU). In a parallel two-group pilot randomised controlled trial of 15 participants, nine were allocated to eight weekly sessions of adapted CBT and six continued usual care rehabilitation. The primary outcome was the Fatigue Severity Scale (FSS-7) at two and four months from baseline. Secondary outcomes included measures of sleep, mood and quality of life. Outcomes were assessed by a rater who was blind to group membership. At the four-month endpoint, the CBT group demonstrated significantly reduced fatigue relative to TAU (FSS-7 mean difference: 1.92, 95% CI: 0.24 to 3.60). Significant group differences also emerged for sleep quality and depression, favouring the CBT group. Insomnia and physical quality of life improved immediately post-therapy but were no longer superior to TAU at follow-up. Overall, CBT is a promising treatment for improving post-stroke fatigue, sleep quality and depression. Gains were maintained for two months after therapy cessation and represented large treatment effects. These findings highlight the feasibility of the intervention and warrant extension to a phase III clinical trial.
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Affiliation(s)
- Sylvia Nguyen
- a aMonash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences , Monash University , Melbourne , Australia.,b Monash-Epworth Rehabilitation Research Centre , Melbourne , Australia
| | - Dana Wong
- a aMonash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences , Monash University , Melbourne , Australia.,b Monash-Epworth Rehabilitation Research Centre , Melbourne , Australia
| | - Adam McKay
- a aMonash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences , Monash University , Melbourne , Australia.,b Monash-Epworth Rehabilitation Research Centre , Melbourne , Australia
| | - Shantha M W Rajaratnam
- a aMonash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences , Monash University , Melbourne , Australia
| | - Gershon Spitz
- a aMonash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences , Monash University , Melbourne , Australia.,b Monash-Epworth Rehabilitation Research Centre , Melbourne , Australia
| | - Gavin Williams
- c Epworth Healthcare , Physiotherapy Rehabilitation, Melbourne , Australia
| | - Darren Mansfield
- a aMonash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences , Monash University , Melbourne , Australia
| | - Jennie L Ponsford
- a aMonash Institute of Cognitive & Clinical Neurosciences and School of Psychological Sciences , Monash University , Melbourne , Australia.,b Monash-Epworth Rehabilitation Research Centre , Melbourne , Australia
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Poort H, Verhagen CAHHVM, Peters MEWJ, Goedendorp MM, Donders ART, Hopman MTE, Nijhuis-van der Sanden MWG, Berends T, Bleijenberg G, Knoop H. Study protocol of the TIRED study: a randomised controlled trial comparing either graded exercise therapy for severe fatigue or cognitive behaviour therapy with usual care in patients with incurable cancer. BMC Cancer 2017; 17:81. [PMID: 28129746 PMCID: PMC5273841 DOI: 10.1186/s12885-017-3076-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/19/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Fatigue is a common and debilitating symptom for patients with incurable cancer receiving systemic treatment with palliative intent. There is evidence that non-pharmacological interventions such as graded exercise therapy (GET) or cognitive behaviour therapy (CBT) reduce cancer-related fatigue in disease-free cancer patients and in patients receiving treatment with curative intent. These interventions may also result in a reduction of fatigue in patients receiving treatment with palliative intent, by improving physical fitness (GET) or changing fatigue-related cognitions and behaviour (CBT). The primary aim of our study is to assess the efficacy of GET or CBT compared to usual care (UC) in reducing fatigue in patients with incurable cancer. METHODS The TIRED study is a multicentre three-armed randomised controlled trial (RCT) for incurable cancer patients receiving systemic treatment with palliative intent. Participants will be randomised to GET, CBT, or UC. In addition to UC, the GET group will participate in a 12-week supervised exercise programme. The CBT group will receive a 12-week CBT intervention in addition to UC. Primary and secondary outcome measures will be assessed at baseline, post-intervention (14 weeks), and at follow-up assessments (18 and 26 weeks post-randomisation). The primary outcome measure is fatigue severity (Checklist Individual Strength subscale fatigue severity). Secondary outcome measures are fatigue (EORTC-QLQ-C30 subscale fatigue), functional impairments (Sickness Impact Profile total score, EORTC-QLQ-C30 subscale emotional functioning, subscale physical functioning) and quality of life (EORTC-QLQ-C30 subscale QoL). Outcomes at 14 weeks (primary endpoint) of either treatment arm will be compared to those of UC participants. In addition, outcomes at 18 and 26 weeks (follow-up assessments) of either treatment arm will be compared to those of UC participants. DISCUSSION To our knowledge, the TIRED study is the first RCT investigating the efficacy of GET and CBT on reducing fatigue during treatment with palliative intent in incurable cancer patients. The results of this study will provide information about the possibility and efficacy of GET and CBT for severely fatigued incurable cancer patients. TRIAL REGISTRATION NTR3812 ; date of registration: 23/01/2013.
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Affiliation(s)
- Hanneke Poort
- Expert Center for Chronic Fatigue, Radboud university medical center, Nijmegen, The Netherlands.
| | | | - Marlies E W J Peters
- Department of Medical Oncology, Radboud university medical center, Nijmegen, The Netherlands
| | - Martine M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Rogier T Donders
- Department of Health Evidence, Radboud university medical center, Nijmegen, The Netherlands
| | - Maria T E Hopman
- Department of Physiology, Radboud university medical center, Nijmegen, The Netherlands
| | | | - Thea Berends
- Expert Center for Chronic Fatigue, Radboud university medical center, Nijmegen, The Netherlands
| | - Gijs Bleijenberg
- Expert Center for Chronic Fatigue, Radboud university medical center, Nijmegen, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam Public Health research institute, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands.,Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
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6
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Pearson EJM, Morris ME, di Stefano M, McKinstry CE. Interventions for cancer-related fatigue: a scoping review. Eur J Cancer Care (Engl) 2016; 27. [PMID: 27254272 DOI: 10.1111/ecc.12516] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 01/09/2023]
Abstract
Cancer-related fatigue (CRF) is common and can be distressing for some survivors. There is increasing interest in measuring levels of CRF, highlighting its impact on quality of life. This review describes the nature and scope of evidence relating to interventions for CRF. Scoping review methodology was used to identify studies, extract data, collate and summarise results. Data were collated according to cancer tumour streams, stage of illness and the types of trial interventions. A total of 447 trials and 37 systematic reviews met the inclusion criteria. Nine papers reported longitudinal results. Populations studied were predominantly of mixed cancer diagnoses and breast cancer. The most frequent interventions were exercise, pharmacological, psycho-education and mind-body interventions. Fatigue was identified as a primary outcome measure (OM) in 58% of studies, with 58 different fatigue measures reported. Emerging evidence exists for the effectiveness of fatigue interventions for some cancer types. More research on interventions with participants with the same cancer type and illness phase is needed. Measurement of severity and impact of CRF using fewer, robust OMs will permit comparisons across studies.
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Affiliation(s)
- E J M Pearson
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
| | - M E Morris
- La Trobe University Centre for Sport and Exercise Medicine Research, School Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Vic., Australia.,Healthscope Australia, Australia
| | - M di Stefano
- VicRoads, Melbourne, Vic., Australia.,La Trobe University, Bundoora, Vic., Australia
| | - C E McKinstry
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Vic., Australia
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Abrahams HJG, Gielissen MFM, Goedendorp MM, Berends T, Peters MEWJ, Poort H, Verhagen CAHHVM, Knoop H. A randomized controlled trial of web-based cognitive behavioral therapy for severely fatigued breast cancer survivors (CHANGE-study): study protocol. BMC Cancer 2015; 15:765. [PMID: 26500019 PMCID: PMC4619089 DOI: 10.1186/s12885-015-1787-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/13/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND About one third of breast cancer survivors suffer from persistent severe fatigue after completion of curative cancer treatment. Face-to-face cognitive behavioral therapy (F2F CBT), especially designed for fatigue in cancer survivors, was found effective in reducing fatigue. However, this intervention is intensive and treatment capacity is limited. To extend treatment options, a web-based version of CBT requiring less therapist time was developed. This intervention is aimed at changing fatigue-perpetuating cognitions and behaviors. The efficacy of web-based CBT will be examined in a multicenter randomized controlled trial. METHODS In total, 132 severely fatigued breast cancer survivors will be recruited and randomized to either an intervention condition or care as usual (ratio 1:1). Participants will be assessed at baseline and 6 months thereafter. The intervention group will receive web-based CBT, consisting of three F2F sessions and maximally eight web-based modules over a period of 6 months. The care as usual group will be on a waiting list for regular F2F CBT. The total duration of the waiting list is 6 months. The primary outcome of the study is fatigue severity. Secondary outcomes are functional impairments, psychological distress and quality of life. DISCUSSION If web-based CBT is effective, it will provide an additional treatment option for fatigue in breast cancer survivors. Web-based CBT is expected to be less time-consuming for therapists than regular F2F CBT, which would result in an increased treatment capacity. Moreover, the intervention would become more easily accessible for a larger number of patients, and patients can save travel time and costs. TRIAL REGISTRATION Dutch Trial Registry--NTR4309.
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Affiliation(s)
- H J G Abrahams
- Expert Center for Chronic Fatigue (ECCF), Radboud University Medical Center, PO Box 9101, 916, 6500 HB, Nijmegen, The Netherlands.
| | - M F M Gielissen
- Expert Center for Chronic Fatigue (ECCF), Radboud University Medical Center, PO Box 9101, 916, 6500 HB, Nijmegen, The Netherlands.
| | - M M Goedendorp
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - T Berends
- Expert Center for Chronic Fatigue (ECCF), Radboud University Medical Center, PO Box 9101, 916, 6500 HB, Nijmegen, The Netherlands.
| | - M E W J Peters
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - H Poort
- Expert Center for Chronic Fatigue (ECCF), Radboud University Medical Center, PO Box 9101, 916, 6500 HB, Nijmegen, The Netherlands.
| | - C A H H V M Verhagen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - H Knoop
- Expert Center for Chronic Fatigue (ECCF), Radboud University Medical Center, PO Box 9101, 916, 6500 HB, Nijmegen, The Netherlands.
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Willems RA, Bolman CAW, Mesters I, Kanera IM, Beaulen AAJM, Lechner L. The Kanker Nazorg Wijzer (Cancer Aftercare Guide) protocol: the systematic development of a web-based computer tailored intervention providing psychosocial and lifestyle support for cancer survivors. BMC Cancer 2015; 15:580. [PMID: 26260318 PMCID: PMC4532144 DOI: 10.1186/s12885-015-1588-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 07/30/2015] [Indexed: 12/14/2022] Open
Abstract
Background After primary treatment, many cancer survivors experience psychosocial, physical, and lifestyle problems. To address these issues, we developed a web-based computer tailored intervention, the Kanker Nazorg Wijzer (Cancer Aftercare Guide), aimed at providing psychosocial and lifestyle support for cancer survivors. The purpose of this article is to describe the systematic development and the study design for evaluation of this theory and empirical based intervention. Methods/design For the development of the intervention, the steps of the Intervention Mapping protocol were followed. A needs assessment was performed consisting of a literature study, focus group interviews, and a survey study to get more insight into cancer survivors’ health issues. This resulted in seven problem areas that were addressed in the intervention: cancer-related fatigue, return to work, anxiety and depression, social relationships and intimacy, physical activity, diet, and smoking. To address these problem areas, the principles of problem-solving therapy and cognitive behavioral therapy are used. At the start of the intervention, participants have to fill in a screening questionnaire. Based on their answers, participants receive tailored advice about which problem areas deserve their attention. Participants were recruited from November 2013 through June 2014 by hospital staff from 21 hospitals in the Netherlands. Patients were selected either during follow-up visits to the hospital or from reviews of the patients’ files. The effectiveness of the intervention is being tested in a randomized controlled trial consisting of an intervention group (n = 231) and waiting list control group (n = 231) with a baseline measurement and follow-up measurements at 3, 6, and 12 months. Discussion Using the Intervention Mapping protocol resulted in a theory and evidence-based intervention providing tailored advice to cancer survivors on how to cope with psychosocial and lifestyle issues after primary treatment. Trial registration Dutch Trial Register NTR3375
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Affiliation(s)
- Roy A Willems
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
| | - Catherine A W Bolman
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
| | - Ilse Mesters
- CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Iris M Kanera
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
| | - Audrey A J M Beaulen
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
| | - Lilian Lechner
- Faculty of Psychology and Educational Sciences, Open University of the Netherlands, P.O. Box 2960, 6401 DL, Heerlen, The Netherlands.
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Zalai D, Carney CE, Sherman M, Shapiro CM, McShane K. Fatigue in chronic hepatitis C infection: Understanding patients' experience from a cognitive-behavioural perspective. Br J Health Psychol 2015; 21:157-72. [PMID: 26250404 DOI: 10.1111/bjhp.12155] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 07/11/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Fatigue is a leading concern of patients with chronic hepatitis C virus (HCV) infection. Despite its clinical significance, fatigue in HCV is poorly understood and therefore invariably under-treated. A cognitive-behavioural approach offers a framework to understand and treat fatigue, but the characteristics of fatigue in chronic HCV infection have not been documented from a cognitive-behavioural perspective. This study captured the common and unique aspects of fatigue from a cognitive-behavioural perspective in individuals with HCV infection and clinically significant fatigue. DESIGN Cross-sectional, qualitative using a critical realism approach. METHODS Fourteen individuals (64% women; age >18 years) participated in semi-structured interviews. The interviews documented the features, course, and perceived antecedents of fatigue; fatigue-specific cognitions; fatigue management behaviours; and the functional impact of fatigue. RESULTS Participants' descriptions included the aspects of fatigue that have been targets of cognitive-behavioural therapy in other medical conditions, including attributing fatigue to the illness; expectation of chronicity; low control; and fatigue-driven coping. There were also components of fatigue experience that appear to be unique characteristics of fatigue related to HCV, including predominantly physical fatigue; high acceptance of fatigue; and liver-protective diet as a fatigue management behaviour. CONCLUSIONS This was the first study to document the experience of fatigue in chronic HCV infection in a cognitive-behavioural framework. The findings suggest that the cognitive-behavioural approach can be applied to fatigue in chronic HCV infection. This would open an avenue to alleviate fatigue and thus improve the primary patient-reported outcome of the disease. STATEMENT OF CONTRIBUTION What is already known on this subject? Fatigue is a key patient-reported outcome measure of chronic hepatitis C virus (HCV) infection. Fatigue management is not part of the standard care, because fatigue is poorly characterized in this population. What does this study add? A cognitive-behavioural approach can be applied to understand fatigue in HCV infection. Identified aspects of fatigue (antecedents, consequences, cognitions, behaviours) that can be treatment targets. Cognitive-behavioural therapy would open a new treatment avenue to alleviate fatigue in HCV infection.
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Affiliation(s)
- Dora Zalai
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Colleen E Carney
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Morris Sherman
- Department of Gastroenterology, University Health Network, University of Toronto, Canada
| | - Colin M Shapiro
- Department of Psychiatry, University Health Network, University of Toronto, Canada.,Department of Ophthalmology, University Health Network, University of Toronto, Canada
| | - Kelly McShane
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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10
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Zalai D, Sherman M, McShane K, Shapiro CM, Carney CE. The importance of fatigue cognitions in chronic hepatitis C infection. J Psychosom Res 2015; 78:193-8. [PMID: 25433976 DOI: 10.1016/j.jpsychores.2014.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 11/09/2014] [Accepted: 11/12/2014] [Indexed: 12/17/2022]
Abstract
UNLABELLED Chronic Hepatitis C virus (HCV) infection is a source of significant public health burden worldwide. Fatigue is a cardinal patient reported consequence of the disease. HCV infection associated fatigue leads to significant impairment in the quality of life and day-to-day functioning. Despite its clinical significance, the factors that contribute to adverse impact of fatigue in HCV infection are largely unknown. OBJECTIVES This study evaluated the contributions of insomnia, depression symptoms, and fatigue-specific cognitions to fatigue-related functional impairment. METHODS Fatigue, insomnia, depression symptoms, as well as fatigue cognitions were assessed in participants (36% females; age>18 years, N=115) with chronic HCV infection at a tertiary hepatitis clinic. RESULTS Sixty percent of participants reported clinically significant fatigue (Fatigue Severity Index FSS ≥ 4). Comorbidities and fatigue perceptions accounted for 61% of the variation of fatigue. Fatigue perceptions were the main predictors of adverse fatigue outcomes (B=.114, 95% CI=.054-.154). Patients with clinically significant fatigue were four-times more likely than less fatigued patients to believe that the main cause of their fatigue was the infection. CONCLUSION Patients' beliefs about their fatigue were the main predictors of adverse fatigue outcomes. These results suggest that fatigue associated with chronic hepatitis C infection can be conceptualized using a cognitive behavioral approach. This was the first study to evaluate the role of both comorbid mood/sleep and cognitive predictors of fatigue in a single model. Integrating the findings into existing treatment strategies could improve patient reported outcomes in chronic hepatitis C infection.
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Affiliation(s)
- Dora Zalai
- Dept. of Psychology, Ryerson University, Toronto, Canada.
| | - Morris Sherman
- Dept. of Gastroenterology, University Health Network, University of Toronto, Toronto, Canada
| | - Kelly McShane
- Dept. of Psychology, Ryerson University, Toronto, Canada
| | - Colin M Shapiro
- Dept. of Psychiatry, University Health Network, University of Toronto, Toronto, Canada; Dept. of Ophthalmology, University Health Network, University of Toronto, Toronto, Canada
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