Cognitive Behavioral Aspects of Cancer-Related Fatigue

It is eBdmatcdthat 118.700Amerk;anwoqn wm be diagnosed with breast canca in 1998. A Jarl8 proponion of these women-iU be troattd with adjuvantchemotherapy based on evidence wbich sl1l1cSf8 .that such treatment extend. disease-tree survival u wen as overan survival. AJ more WODIOUreceive adjuvant chemotherapy, there is a growing recognition of the potential fot' lana.term side effects. AIoD& these Jines, it bat _n shown that 8dminJstration of adjuV8fttchemotherapymay result in secondary leukemia, cardiotoxicit)', BDdovarian failure. CIioWaIobservations and a lDni1ednumber of ~seud1 ropons sQIICIt that many WOlDlnmay also exporleace pmisteftt fatisue as I IODl-term side L':ffcctof adjuvant chemotherapy treatment. Althouah fatigue bas been id~tifted u otte of the molt frequent and distressittg symptoms atfecting breast cancer patients previously treated with adjuvant chemotherapy, zeJatively HttJeis knowa a~t its characmistfcs, etiology. or treatmem. The proposed study will address these mwes by conducting the fl1'Stcontrolled, longitudinal study of fatigue In breast cancer patients befo~, du.rlng,aDdaf\e:r84juvant cbemotbetapy treatment. ~Im 1: 10 determine tbe le'Yerit1, dtronJdty, and COW'Ieof fatigue U80dattd wftJI acljU't'1IDt trutm.ent of breast aneer. Bued onpriorresearch.we hypothes!ze that fatigu~ wm worsen in breast cancer patients upon the :initiationof adjuvant b'eatnl8nt. Levell of fatiauc are expected to ~UmJn above pretreaumut Jevell durin. the six-JnQnthperiod IoDowinl completion of atijuvant trcttUJDdt8Dd to be areater than levels of fatiguesreported by an ale-matched comparison group of women with no hfstmy of oancer. Abn Z: To ehancterlze tbe coptU'fe, aft'edlft; 88IdbeIIavloni mulfestadObl of f8tipe tItM PtI'IiIt8 tbllowiag adjuvant treatDaent of bl'l8lt C!8QCIt,Consistent with a mulddbnensio.w. colmepmaUzarion, we hypothesize that worse fatigue among bloat cancer patients following comp1etionof ~uvant treatment will be ISlOClated with greater copitive probJcms (copitive col'q)Iaint& and copDtive d)'sfunctton), affective prob1ema (a.iJcctive disturbance aud a1fective disorder), and bcha\'ioral problems (physical, social, aid tOle disability). This hypothesis will be evaluated by testina for cx~d re1at1ons between indices of fatigue and indices of cognitive, aftective~ ad be~vior.l1imctioninl among breast cancer patients and by determinina whether differences In cognkive, affective, and behavioral functioning between 1nut cancer patients I11d~omparl8on subjects are mediated by fatigue. Aim 3: To teIt the utiDt, 01 . wpitiTe~beb.vioral model d.peel to gpIadn tile perpetaatioII of fadpe tolknrinl BCUtmnttr8tment of breast cancer. Based on cognitive~behavioral models of the de~lQPmcnt of chronic pain and chromefatigue, ~ hypothcllze that patients' copiDgresponscsduring adjuvant treatment wi11explain the perpetuation of fatigue foUowinl treatment completioft. S~citlcal1y, we hJPotbeiizc that patieftu who arc mote reliant on certain maladaptive coping strateS.. (cat8SttOphiztng, b:uaiDg on symptoms, aecomrnodatina to Illness. and fallinS to maintain activity) durin8 adjuvant ttelltD11t wi11experience worse foDomg tl'eattn8ntcompletion. Validation of this model is exp~i1 to lead to the adaptation and pilot testin&of Bcogniti\'e-bebavioral intervention developed for chronic fatigue for UIR!! with CUQtf patients experlcnch\, fatipe related to chemotherapy and radiotherapy.