Fatigue Perpetuating Factors As Mediators of Change in a Cognitive Behavioral Intervention for Targeted Therapy-Related Fatigue in Chronic Myeloid Leukemia: A Pilot Study

Overview

Journal Ann Behav Med

Publisher Oxford University Press

Specialty Social Sciences

Date 2021 May 15

PMID 33991085

Citations 6

Authors

Kelly A Hyland

Ashley M Nelson

Sarah L Eisel

Aasha I Hoogland

Javier Ibarz-Pinilla

Kendra Sweet

Paul B Jacobsen

Hans Knoop

Heather S L Jim

Affiliations

Soon will be listed here.

Abstract

Background: Cognitive behavioral therapy for targeted-therapy related fatigue (CBT-TTF) has demonstrated preliminary efficacy in reducing fatigue in patients treated with tyrosine kinase inhibitors (TKIs) for chronic myeloid leukemia (CML).

Purpose: The aim of the current analyses was to explore whether fatigue perpetuating factors (disturbed sleep/wake cycle, dysregulated activity patterns, maladaptive cognitions about fatigue and cancer, insufficient processing of cancer and treatment, inadequate social support and interactions, heightened fear of cancer progression) changed over time in patients receiving CBT-TTF, and whether the effect of CBT-TTF on fatigue was mediated by these factors.

Methods: Secondary data analyses were conducted from a pilot randomized controlled trial. Patients with CML treated with a TKI who reported moderate to severe fatigue were randomized 2:1 to CBT-TTF delivered via FaceTime for iPad or a waitlist control condition (WLC). Self-report measures of fatigue and fatigue perpetuating factors were obtained before randomization and post-intervention (i.e., approximately 18 weeks later). Mixed model and mediation analyses using bootstrap methods were used.

Results: A total of 36 participants (CBT-TTF n = 22, WLC n = 14) who had baseline and 18-week follow-up data and attended >5 sessions for CBT-TTF were included. Participants randomized to CBT-TTF reported improvements in activity (mental, physical, social, p's ≤ .023) and cognitions (helplessness, catastrophizing, focusing on symptoms, self-efficacy, p's ≤ .003) compared to WLC. Mental activity, social activity, self-efficacy, helplessness, and focusing on symptoms, as well as sleep and insufficient processing (avoidance) mediated the relationship between treatment group and fatigue.

Conclusions: CBT-TTF appears to improve TKI-related fatigue in CML patients through changes in behavior (sleep, activity patterns) and cognitions about fatigue and cancer. A larger randomized controlled trial is warranted to confirm these findings.

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References

Yellen S, Cella D, Webster K, Blendowski C, Kaplan E . Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage. 1997; 13(2):63-74. DOI: 10.1016/s0885-3924(96)00274-6. View

Bridges K, Sanderman R, van Sonderen E . An English language version of the social support list: preliminary reliability. Psychol Rep. 2002; 90(3 Pt 1):1055-8. DOI: 10.2466/pr0.2002.90.3.1055. View

Knoop H, Prins J, Moss-Morris R, Bleijenberg G . The central role of cognitive processes in the perpetuation of chronic fatigue syndrome. J Psychosom Res. 2010; 68(5):489-94. DOI: 10.1016/j.jpsychores.2010.01.022. View

Jacobsen P, Andrykowski M, Thors C . Relationship of catastrophizing to fatigue among women receiving treatment for breast cancer. J Consult Clin Psychol. 2004; 72(2):355-61. PMC: 2562276. DOI: 10.1037/0022-006X.72.2.355. View

Ray C, Weir W, Stewart D, Miller P, Hyde G . Ways of coping with chronic fatigue syndrome: development of an illness management questionnaire. Soc Sci Med. 1993; 37(3):385-91. DOI: 10.1016/0277-9536(93)90268-9. View

Poort H, Peters M, van der Graaf W, Nieuwkerk P, van de Wouw A, Nijhuis-van der Sanden M . Cognitive behavioral therapy or graded exercise therapy compared with usual care for severe fatigue in patients with advanced cancer during treatment: a randomized controlled trial. Ann Oncol. 2020; 31(1):115-122. DOI: 10.1016/j.annonc.2019.09.002. View

Abrahams H, Gielissen M, Donders R, Goedendorp M, van der Wouw A, Verhagen C . The efficacy of Internet-based cognitive behavioral therapy for severely fatigued survivors of breast cancer compared with care as usual: A randomized controlled trial. Cancer. 2017; 123(19):3825-3834. DOI: 10.1002/cncr.30815. View

Bergner M, Bobbitt R, Pollard W, Martin D, Gilson B . The sickness impact profile: validation of a health status measure. Med Care. 1976; 14(1):57-67. DOI: 10.1097/00005650-197601000-00006. View

Donovan K, Small B, Andrykowski M, Munster P, Jacobsen P . Utility of a cognitive-behavioral model to predict fatigue following breast cancer treatment. Health Psychol. 2007; 26(4):464-72. PMC: 2383279. DOI: 10.1037/0278-6133.26.4.464. View

10.

Menting J, Tack C, Donders R, Knoop H . Potential mechanisms involved in the effect of cognitive behavioral therapy on fatigue severity in Type 1 diabetes. J Consult Clin Psychol. 2018; 86(4):330-340. DOI: 10.1037/ccp0000290. View

11.

Booth M . Assessment of physical activity: an international perspective. Res Q Exerc Sport. 2015; 71 Suppl 2:114-20. DOI: 10.1080/02701367.2000.11082794. View

12.

Stanton A, Luecken L, MacKinnon D, Thompson E . Mechanisms in psychosocial interventions for adults living with cancer: opportunity for integration of theory, research, and practice. J Consult Clin Psychol. 2012; 81(2):318-35. DOI: 10.1037/a0028833. View

13.

Custers J, van den Berg S, van Laarhoven H, Bleiker E, Gielissen M, Prins J . The Cancer Worry Scale: detecting fear of recurrence in breast cancer survivors. Cancer Nurs. 2013; 37(1):E44-50. DOI: 10.1097/NCC.0b013e3182813a17. View

14.

Wiborg J, Knoop H, Stulemeijer M, Prins J, Bleijenberg G . How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol Med. 2010; 40(8):1281-7. DOI: 10.1017/S0033291709992212. View

15.

Evers A, Kraaimaat F, van Lankveld W, Jongen P, Jacobs J, Bijlsma J . Beyond unfavorable thinking: the illness cognition questionnaire for chronic diseases. J Consult Clin Psychol. 2002; 69(6):1026-36. View

16.

Gielissen M, Verhagen S, Witjes F, Bleijenberg G . Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. J Clin Oncol. 2006; 24(30):4882-7. DOI: 10.1200/JCO.2006.06.8270. View

17.

Gielissen M, Wiborg J, Verhagen C, Knoop H, Bleijenberg G . Examining the role of physical activity in reducing postcancer fatigue. Support Care Cancer. 2011; 20(7):1441-7. PMC: 3360858. DOI: 10.1007/s00520-011-1227-4. View

18.

Efficace F, Baccarani M, Breccia M, Cottone F, Alimena G, Deliliers G . Chronic fatigue is the most important factor limiting health-related quality of life of chronic myeloid leukemia patients treated with imatinib. Leukemia. 2013; 27(7):1511-9. DOI: 10.1038/leu.2013.51. View

19.

Horowitz M, WILNER N, Alvarez W . Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979; 41(3):209-18. DOI: 10.1097/00006842-197905000-00004. View

20.

Poort H, Meade C, Knoop H, Gielissen M, Pinilla-Ibarz J, Jacobsen P . Adapting an Evidence-Based Intervention to Address Targeted Therapy-Related Fatigue in Chronic Myeloid Leukemia Patients. Cancer Nurs. 2016; 41(1):E28-E37. PMC: 5422141. DOI: 10.1097/NCC.0000000000000446. View