Trajectories of fatigue in cancer patients during psychological care.

OBJECTIVE: Psycho-oncological institutions offer specialized care for cancer patients. Little is known how this care might impact fatigue. This study aimed to identify fatigue trajectories during psychological care, examined factors distinguishing these trajectories and predicted fatigue severity after nine months of psychological care. DESIGN: Naturalistic, longitudinal study of 238 cancer patients receiving psycho-oncological care in the Netherlands. Data were collected before initiation of psychological care (T1) and three (T2) and nine months (T3) afterwards. Latent class growth analysis, repeated measure analyses (RMA) and linear regression analysis were performed. MAIN OUTCOME MEASURES: Fatigue severity: Checklist Individual Strength. RESULTS: Three fatigue trajectories were identified: high- (30%), moderate- (62%) and low-level fatigue (8%). While statistically significant decreases in fatigue were found, this decrease was not clinically relevant. RMA showed main effects for time for fatigue trajectories on depression, anxiety, personal control and illness cognitions. Fatigue severity and physical symptoms at T1, but not demographic or clinical factors, were predictive of fatigue severity at T3. CONCLUSIONS: Fatigue is very common during psycho-oncological care, and notably not clinically improving. As symptoms of fatigue, depression, anxiety and physical symptoms often cluster, supplementary fatigue treatment should be considered when it is decided to treat other symptoms first.

Associations between self-efficacy, distress and anxiety in cancer patient-relative dyads visiting psychosocial cancer support services: Using actor-partner interdependence modelling.

BACKGROUND: Patients with cancer and their relatives often suffer from psychosocial burdens following a cancer diagnosis. Psychosocial cancer support services offer support for cancer patients and their relatives. Only a few studies have focused on associations of psychological factors within patient-relative dyads. This study aims to assess associations between the patients' or relatives' self-efficacy and their levels of distress and anxiety who seek help together at psychosocial cancer support centres. METHODS: Participants were recruited at two psychosocial cancer support centres in a major city in Germany. Patients with cancer and their relatives seeking support together received the questionnaire before their first support session. Self-efficacy was assessed with the Pearlin sense of mastery scale, distress with the distress thermometer and anxiety with the General Anxiety Disorder questionnaire (GAD-7). For the analysis, the actor-partner interdependence model was applied. RESULTS: The data analysis was based on 41 patient-relative dyads (patients: 39% women, mean age 53.5; relatives: 66% women, mean age 52.16). A significant actor effect from self-efficacy to distress was found for patients (r = -0.47) but not for relatives (r = -0.15). Partner effects from self-efficacy to distress were not significant (r = -0.03, r = -0.001). The actor effect from self-efficacy to anxiety for patients (r = -0.61) as well as relatives was significant (r = -0.62), whereas the partner effect was significant for patients (r = 0.16) but not for relatives (r = -0.46). CONCLUSION: The results suggest that patients' and relatives' self-efficacy is associated with their distress and anxiety. Partner effects were visible for patients' self-efficacy and relatives' anxiety. These findings suggest that self-efficacy is an important factor for the psychological well-being of patients and relatives and that it may additionally be associated with the partners' well-being. Longitudinal research with larger samples is needed to support the findings.

Evaluations of psychosocial cancer support services: A scoping review.

BACKGROUND: A diagnosis of cancer leaves most patients with cancer and their relatives with an increased psychological burden. Throughout the course of the illness, social, occupational or legal changes may lead to psychological distress. Psychosocial cancer support services offer psychological, social and legal support. However, little is known about the effectiveness of psychosocial support services implemented in health care. Therefore, this scoping review aims to provide an overview of current literature evaluating out-patient psychosocial support services. METHODS: Databases searched were PubMed, PsycINFO, PSYNDEX, PsycArticle, Medline, Web of Science, Google Scholar, Cochrane, and Embase. Two independent researchers conducted the systematic search. We included studies that were published in English and assessed at least one patient reported outcome measure. Studies that assessed psychotherapy, online support or telephone counselling were excluded. The review was reported according to PRISMA-ScR guidelines. A search of the databases identified 2104 articles. After excluding duplicates, screening titles, abstracts and full-texts, 12 studies matching the criteria were identified. RESULTS: One study was an RCT, six were prospective with no control group and five studies were cross-sectional with one measurement point. The most common outcome measures across studies were well-being, concerns and satisfaction with the support services. CONCLUSION: While the included studies indicate some improvements to well-being for patients with cancer, the low number and lack of high quality of studies indicate these findings should be interpreted with caution. However, high-quality research on the effectiveness of psychosocial support services is needed to determine that the interventions are effective.