The reciprocal relationship between daily fatigue and catastrophizing following cancer treatment: Affect and physical activity as potential mediators.

OBJECTIVE: Fatigue is a distressing symptom many cancer patients experience even after completion of treatment. Although theory and empirical evidence indicate that negative cognitions perpetuate fatigue after completion of treatment, insight into how this process unfolds in daily life is limited. This study used an intensive longitudinal design to investigate the reciprocal relationship between catastrophizing and fatigue in daily life and whether affective and behavioral processes mediate these relationships. METHODS: Post-treatment colorectal cancer patients (n = 101) completed daily diaries (14 days, 3 times daily) regarding their fatigue, catastrophizing, positive and negative affect, and physical activity. Multilevel modeling was applied to investigate within-person associations within days. RESULTS: Analyses revealed a positive reciprocal relationship between fatigue and catastrophizing throughout the day. That is, high levels of catastrophizing were associated with increases in fatigue within patients. In turn, but to a lesser extent, high levels of fatigue predicted increases in catastrophizing at the next assessment. Low positive affect and high negative affect mediated the effect of catastrophizing on increases in fatigue. Only negative affect mediated the reverse relationship. Physical activity did not mediate either relationship. CONCLUSIONS: This study provides evidence for a mutually reinforcing relationship between catastrophizing and fatigue in daily life, which might explain the perpetuation of fatigue after completion of cancer treatment. Fatigue-specific cognitive behavior therapy could be improved by educating patients about this daily reciprocal relationship, train them to quickly replace catastrophizing thoughts in daily life, and help them to cope with affective changes induced by fatigue.

Which goal adjustment strategies do cancer patients use? A longitudinal study.

OBJECTIVE: A cancer diagnosis may lead to the need to adjust personal goals. This study longitudinally investigates patients' use of goal adjustment strategies with goal characteristics over time. Whether and which goal adjustment strategies are used after cancer diagnosis may depend on the period studied (treatment period or follow-up period) and illness variables such as illness severity. METHODS: Newly diagnosed colorectal cancer patients (n = 186) were asked about their personal goals during three assessments (within 1 month after diagnosis and 6 and 18 months after the first assessment). Eight goal adjustment strategies were assessed over the first 6 months (treatment period) and between 7 and 18 months (follow-up period) using goal characteristics. Illness variables were obtained from patients' medical records from the national cancer registry. RESULTS: Most patients used one strategy per period, and patients most often shifted their priorities across life domains. During the treatment period, more patients formed shorter-term goals than during the follow-up period, while during the follow-up period, more patients formed longer-term goals than during the treatment period. Illness variables were not related to the use of goal adjustment strategies. CONCLUSIONS: The findings show that cancer patients use different goal adjustment strategies and, interestingly, that the use of specific strategies depended on the period after diagnosis but not on illness variables.

Changes in cancer patients' personal goals in the first 6 months after diagnosis: the role of illness variables.

PURPOSE: Setting and pursuing personal goals is a vital aspect of our identity and purpose in life. Cancer can put pressure on these goals and may be a reason for people to adjust them. Therefore, this paper investigates (1) changes in cancer patients' goals over time and (2) the extent to which illness characteristics relate to goal changes. METHODS: At both assessment points (1 and 7 months post-diagnosis), colorectal cancer patients (n = 198) were asked to list their current goals and rate them on hindrance of illness, attainability, likelihood of success, temporal range and importance. All goals were coded by two independent raters on content (i.e. physical, psychological, social, achievement and leisure). Patients' medical data were obtained from the national cancer registry. RESULTS: Over time, patients reported a decrease in illness-related hindrance, higher attainability and likelihood of success, a decrease in total number of goals, goals with a shorter temporal range, and more physical and fewer social goals. At both assessments, patients with more advanced stages of cancer, rectal cancer, a stoma, and receiving additional chemotherapy and/or radiotherapy reported more illness-related hindrance in goal attainment, but only patients with a stoma additionally reported lower attainability, likelihood of success and more short-term goals. CONCLUSIONS: The results of this study support the assumption that cancer patients adjust their goals to changing circumstances and additionally show how patients adjust their goals to their illness. Moreover, we demonstrate that illness variables impact on goal change.

Is implementing screening for distress an efficient means to recruit patients to a psychological intervention trial?

OBJECTIVES: Psychological interventions show greater efficacy when evaluated with distressed patients. We report on the feasibility of implementing screening for recruiting distressed cancer patients to a randomized controlled trial of problem-solving therapy (PST), characteristics associated with enrolment, and time investment and challenges of implementing screening. METHODS: Three medical settings implemented screening of patients, directly after cancer treatment (T1) and 2 months later (T2), using Hopkins Symptom Checklist-25 and one question about need for services. Distressed patients indicating need for services were interviewed. Eligible patients were offered the possibility to participate in the trial. Consenting patients were randomized to PST or waitlist. RESULTS: At T1, 366 of 970 screened patients (37%) scored above the cutoff and at T2, 208 of 689 screened patients (30%). At either or both T1 and T2, 423 patients reported distress, of whom 215 indicated need for services. Only 36 (4% of 970) patients consented to trial participation. Twenty-seven patients needed to be screened to recruit a single patient, with 17 h required for each patient recruited. Barriers to screening were time constraints and negative attitudes of oncology staff towards screening. CONCLUSIONS: Implementing screening proved inefficient for recruiting distressed cancer patients post-treatment to a randomized controlled trial on PST, with need for services being much less than anticipated. Consecutively screening patients did not result in a sample representative of the larger pool of distressed patients, which may lower generalizability. An adequately powered intervention trial using screening requires a feasibility study establishing recruitment rates and dedicated, funded staff assistance.

Does screening for distress efficiently uncover meetable unmet needs in cancer patients?

OBJECTIVES: We evaluated screening for distress in terms of its ability to uncover unmet need for psychosocial services in cancer patients. Correlates of distress, need for services and met and unmet need for services were investigated. METHODS: Immediately after cancer treatment (T1) and 2 months later (T2), 302 patients completed the Hopkins Symptom Checklist-25 (HSCL-25) and a single question assessing the need for services. All distressed patients (HSCL-25≥39) and non-distressed patients endorsing a need for services were then called (n = 99) to assess their need. RESULTS: Thirty-seven percent (T1) and 31% (T2) of patients were distressed and 31% (T1) and 18% (T2) expressed the need for services. Both time points showed higher distress in younger patients and females and lower distress in prostate cancer and patients treated by radiotherapy only. Less need for services was found in prostate cancer (T1), greater need was related to being single (T1) and younger (T2). Distress and need for services were positively related (p<0.001). The HSCL-25 showed modest sensitivity (T1: 0.59, T2: 0.65) and specificity (T1: 0.75, T2: 0.78) as an indicator of need for services. Interviews at T2 revealed that 51% of distressed patients needed no psychosocial services and 25% were already receiving services. At T2, regardless of distress level, 10% of all screened patients reported an unmet need for psychosocial services. CONCLUSIONS: Depending on the clinical context, screening might be more efficient if it assessed the unmet need for services rather than distress. More attention should be concentrated on directing patients with meetable unmet needs to available services.

Personal control over the cure of breast cancer: adaptiveness, underlying beliefs and correlates.

OBJECTIVES: Although cognitive adaptation theory suggests that personal control acts as a stress buffer when facing adversity, maladaptive outcomes might occur when control is disconfirmed. The moderating effect of disappointing news on the adaptiveness of personal control over cure in women with breast cancer was examined and contrasted with the effect on the adaptiveness of general control over life. Additionally, the underlying beliefs and correlates of control over cure were explored. METHODS: Women with newly diagnosed breast cancer were assessed after surgery (n=228). For a sub-sample (n=133) data before surgery and after the end of treatment were available as well. Data were collected through questionnaires and face-to-face interviews. The prescription of chemotherapy after surgery was used as an indicator of disappointing news. RESULTS: A chemotherapy prescription neither enhances nor limits the adaptiveness of disease-specific or general control perceptions. Women reported that maintaining a positive attitude, accepting treatment and adopting a healthy life style gave them a sense of control over cure. Women with a strong sense of control over cure more often had invasive cancer, were younger and were best characterized by high optimism and strong sense of control over life. CONCLUSIONS: The findings add to our understanding of exaggerated control perceptions in cancer patients treated with curative intent and do not give reason to assume that such perceptions should be altered because of potentially maladaptive effects. On the contrary, a strong sense of control over the cure of breast cancer seems to reflect the capacity to adapt.

Personal control after a breast cancer diagnosis: stability and adaptive value.

OBJECTIVE: This longitudinal study aims to gain more insight in both the changes in personal control due to a breast cancer diagnosis, as well as in the stress-buffering effect of personal control. METHODS: Personal control and distress were assessed in breast cancer patients not treated with chemotherapy (n=47), breast cancer patients treated with chemotherapy (n=32) and in healthy women (n=58) at 3, 9 and 15 months after diagnosis. RESULTS: Results indicate that personal control was affected only in patients treated with chemotherapy, particularly right after the completion of treatment. Furthermore, the cross-sectional and longitudinal results provide modest support for the stress-buffering potential of control. CONCLUSIONS: The findings and future directions of research on the role of personal control in the adjustment to cancer will be discussed.

Couples' catastrophizing and co-rumination: Dyadic diary study of patient fatigue after cancer.

OBJECTIVE: Fatigue is a prevalent and long-lasting symptom among patients with cancer that is known to be worsened by patients' catastrophizing thoughts about their fatigue. Spouses are also burdened by patient fatigue, which may lead them to catastrophize as well. Based on the dyadic coping literature, this study hypothesized that patient and spouse catastrophizing translate into worse fatigue through co-rumination-couples' communications dwelling on the negative aspects of fatigue (H1). While maladaptive for fatigue, co-rumination also was expected to foster couple relationship satisfaction (H2). METHOD: Posttreatment patients with cancer and their spouses (n = 101 dyads) completed daily diaries for 14 days. Patients reported on their momentary fatigue severity. Both couple members reported on their catastrophizing about the patients' fatigue, co-rumination, and their momentary relationship satisfaction. Multilevel structural equation modeling was applied to test within-person actor- and partner-effects between catastrophizing, co-rumination, and changes in fatigue (H1) and between co-rumination and changes in relationship satisfaction (H2). RESULTS: Whereas patient catastrophizing was directly related to their fatigue (b = 0.52, 95% credibility interval [CI] [0.09, 0.95]), as hypothesized, the effect of spouse catastrophizing on patient fatigue was mediated through co-rumination (indirect effect = 0.32, 95% CI [0.07, 0.60]). Unexpectedly, patient- and spouse-reported co-rumination were unrelated to both couple members' relationship satisfaction. CONCLUSIONS: Spouse catastrophizing contributes to patient fatigue severity through couples' ruminative communications. Co-rumination was not related to relationship satisfaction. Reducing patient and spouse catastrophizing and fostering adaptive dyadic communication in daily life could be targets for future interventions aiming to relieve fatigue in patients after completion of cancer treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Associations of daily partner responses with fatigue interference and relationship satisfaction in colorectal cancer patients.

OBJECTIVE: This study investigates the associations of daily partner responses toward patient's fatigue and well behavior with patient's fatigue interference and relationship satisfaction. The moderating effect of fatigue severity was also examined. METHOD: In an intensive longitudinal design, patients treated for colorectal cancer and their partners (n = 101 dyads) completed diaries for 14 days. Patients and partners reported on partner responses toward patient's fatigue behavior (e.g., resting), partner responses toward patient's well behavior (e.g., being active), and fatigue severity. Patients also indicated their fatigue interference and relationship satisfaction. Multilevel modeling was applied to assess within-person main and interaction effects. RESULTS: Patient-reported solicitous responses toward fatigue behavior and negative responses toward well behavior were associated with increases in fatigue interference, while facilitative responses toward well behavior were associated with a decrease in fatigue interference. The latter two associations were intensified on days patients reported relatively high fatigue. Solicitous responses toward fatigue behavior and facilitative responses toward well behavior were also associated with increases in relationship satisfaction. Punishing responses toward fatigue behavior were associated with a decrease in relationship satisfaction, especially on days patients reported higher fatigue. Models using partner reports largely confirmed the main effects of partner responses on fatigue interference and relationship satisfaction but failed to reproduce the moderating effect of fatigue. CONCLUSIONS: Daily partner responses appear to impact patients' fatigue adjustment, especially on days patients experience high fatigue levels. Only facilitative responses toward well behavior seem to benefit both patients' fatigue interference and relationship satisfaction. Couple interventions should guide partners to encourage patients' well behavior and aid them to correctly estimate patients' current fatigue severity. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Clinically distinct trajectories of fatigue and their longitudinal relationship with the disturbance of personal goals following a cancer diagnosis.

OBJECTIVES: Most studies on fatigue in patients with cancer aggregate its prevalence and severity on a group level, ignoring the possibility that subgroups of patients may differ widely in their development of fatigue. This study aimed to identify subgroups of patients with clinically distinct trajectories of fatigue from diagnosis to 18 months post-diagnosis. As fatigue might trigger goal disturbance, the study also identified trajectories of concrete and abstract goal disturbance and longitudinally examined their co-occurrence with fatigue. DESIGN: Prospective design with quantitative and qualitative method of data collection. METHODS: Patients with colorectal cancer (n = 183) reported on their levels of fatigue and goal disturbance shortly after diagnosis (T1 ) and at 7 months (T2 ) and 18 months (T3 ) post-diagnosis. Growth mixture model analyses were performed to identify trajectories of fatigue and goal disturbance. Guidelines for the clinical relevance of fatigue were applied. RESULTS: Four clinically distinct trajectories of fatigue were identified as follows: (1) persistent severe fatigue (25.4%), (2) moderate fatigue (56.1%), (3) no fatigue (13.8%), and (4) rapidly improving fatigue (4.7%). The majority of patients with cancer reported high disturbance of their concrete goals, while high disturbance of abstract goals was less evident. Fatigue and concrete goal disturbance co-occurred longitudinally. CONCLUSIONS: The fatigue and goal disturbance experienced from diagnosis to 18 months post-diagnosis differ considerably for subgroups of patients with cancer. Fatigue and concrete goal disturbance are persistent burdens in the majority of patients. Investigating symptom burden beyond average trends can guide clinicians to identify patients most in need for treatment. Targeting goal disturbance might benefit the psychological well-being in patients suffering from persistent symptoms. Statement of contribution What is already known on this subject? Fatigue is a common and distressing symptom at all stages of the cancer experience. Earlier studies suggest that many patients recover from fatigue after treatment completion. Patients with cancer experience disturbance in their personal goals, which is related to poor psychological well-being. What does this study add? Developments of fatigue and goal disturbance differ between subgroups of patients with cancer but co-occur within these subgroups. About 30% of the patients experience severe fatigue after diagnosis, of which only few patients recover within 18 months post-diagnosis. Targeting goal disturbance might benefit patients with severe and ongoing symptoms.

People with cancer use goal adjustment strategies in the first 6 months after diagnosis and tell us how.

OBJECTIVES: Theory has offered suggestions on how people may adjust their personal goals after goal disturbance or altered life situations. However, the actual use of these goal adjustment strategies has rarely been studied. This study aimed to investigate whether the goal adjustment strategies identified in the literature are used in the first 6 months following a diagnosis of cancer and whether alternative strategies can be identified. DESIGN: Exploratory design with a qualitative method of data collection. METHODS: Patients were asked to list their current personal goals within a month after being diagnosed with colorectal cancer. Six months later, they were asked what had happened to each of these goals. For each goal, raters scored whether (1) it was achieved or being pursued as planned, (2) a known strategy was used, or (3) an alternative strategy was used. RESULTS: Patients with colorectal cancer (n = 130) reported that more than half of their goals had been achieved or were being pursued as planned. The remaining goals (n = 210) required goal adjustment strategies. Patients used five of six known strategies that involved mostly limited adjustment. Additionally, they used combinations of goal adjustment strategies, and two alternative strategies were identified. CONCLUSIONS: This study found that patients with cancer use goal adjustment strategies, and it provides illustrations on how these strategies are used, thus deepening and extending existing knowledge of and theory on goal adjustment. Future studies should take the newly identified strategies into account as well as the possible use of combinations of strategies. STATEMENT OF CONTRIBUTION: What is already known on this subject? The successful pursuit of personal goals is important for maintaining well-being. However, an unexpected and serious illness such as cancer can lead to the need to adjust goals, either because they have become difficult or impossible to attain due to physical hindrance of the illness and/or its treatment, or because other goals have become important due to the confrontation with the fragility of life. Theories have proposed options of how people may deal with their personal goals, but whether these so-called goal adjustment strategies are actually used by cancer patients, and whether there are alternative strategies we need to take into account, is still unclear. What does this study add? This study employs a qualitative method of data collection to study what actually happens to cancer patients' goals during the first 6 months after diagnosis. This study found that almost all goal adjustment strategies from theory are indeed used by cancer patients and that they mostly use strategies which involve only limited adjustment and a continued focus on the original goal. We found that patients with cancer use combinations of strategies and two alternative strategies, thereby complementing and expanding theories on goal adjustment.

A Reconsideration of the Self-Compassion Scale's Total Score: Self-Compassion versus Self-Criticism.

The Self-Compassion Scale (SCS) is currently the only self-report instrument to measure self-compassion. The SCS is widely used despite the limited evidence for the scale's psychometric properties, with validation studies commonly performed in college students. The current study examined the factor structure, reliability, and construct validity of the SCS in a large representative sample from the community. The study was conducted in 1,736 persons, of whom 1,643 were included in the analyses. Besides the SCS, data was collected on positive and negative indicators of psychological functioning, as well as on rumination and neuroticism. Analyses included confirmatory factor analyses (CFA), exploratory factor analyses (EFA), and correlations. CFA showed that the SCS's proposed six-factor structure could not be replicated. EFA suggested a two-factor solution, formed by the positively and negatively formulated items respectively. Internal consistency was good for the two identified factors. The negative factor (i.e., sum score of the negatively formulated items) correlated moderately to strongly to negative affect, depressive symptoms, perceived stress, as well as to rumination and neuroticism. Compared to this negative factor, the positive factor (i.e., sum score of the positively formulated items) correlated weaker to these indicators, and relatively more strongly to positive affect. Results from this study do not justify the common use of the SCS total score as an overall indicator of self-compassion, and provide support for the idea, as also assumed by others, that it is important to make a distinction between self-compassion and self-criticism.

The Impact of Goal Disturbance after Cancer on Cortisol Levels over Time and the Moderating Role of COMT.

Due to physical hindrance and time spent in hospital, a cancer diagnosis can lead to disturbance of personally important goals. Goal disturbance in cancer patients has been related to poorer psychological well-being. However, the relation with physiological measures is yet unknown. The purpose of the current study is to examine the impact of goal disturbance on cortisol as a measure of response to stress over time, and a possibly moderating role of a DNA genotype associated with HPA-axis functioning, Catechol-O-Methyl transferase (COMT). We examined the predictive value of goal disturbance on Cortisol Awakening Response (CAR) and Diurnal Cortisol Slope (DCS) over two periods: 1-7 and 7-18 months post-diagnosis, and the moderating role of COMT during these periods. Hierarchical regression analyses showed that goal disturbance 7 months post-diagnosis significantly predicted a steeper CAR a year later. During that period, the slow COMT variant moderated the relation, in that patients reporting high goal disturbance and had the Met/Met variant, had a more flattened CAR. No other significant effects were found. As steeper CARs have been related to adverse health outcomes, and COMT genotype may modify this risk, these results indicate that goal disturbance and genotype may be important factors to consider in maintaining better psychological and physical health in the already vulnerable population of cancer patients.

The tenacious goal pursuit and flexible goal adjustment scales: a validation study.

The flexible goal adjustment (FLEX) and tenacious goal pursuit (TEN) scales are used regularly in aging research. The current study examined their validity in a sample of 517 women (30-75 years) in multiple ways. Overall, the findings show that the scales do not clearly distinguish between FLEX and TEN. The direction in which the items were formulated was just as important as what was being measured. Moreover, face validity of the inversely phrased items in particular appeared to be weak. On the basis of these findings, the authors recommend a revision of the concept definitions as well as of the items.

[Waiting times in breast disease clinics and psychological well-being: speedy care is better care]. / Wachten in de mammazorg en emotioneel welbevinden: snellere zorg is betere zorg.

OBJECTIVE: To examine the effect of diagnostic speed and the waiting time before surgery on the psychological well-being of patients in breast disease clinics. DESIGN: Prospective cohort study METHOD: Women with suspected breast cancer completed questionnaires about their psychological well-being before the first outpatient clinic visit (time T1: with malignancy (n = 149); without malignancy (n = 515)), shortly after diagnosis (T2: n = 96 and n = 432, respectively) and 2-3 months later (T3: with malignancy (n = 139)). Two months after the end of treatment (T4: with malignancy (n = 202)), women with breast cancer indicated which period they considered most stressful in retrospect. Diagnostic speed and the waiting time before surgery were categorized and the relation with well-being was examined. Analyses were controlled for age and cancer stage. RESULTS: Although the period before diagnosis was experienced as stressful, diagnostic speed did not affect emotional well-being after a breast cancer diagnosis. However, a diagnosis that took a long time (> 2 weeks) did affect the emotional well-being of women who were not diagnosed with breast cancer. These women were worried and distressed for a longer period of time after diagnosis than women who received the favourable news sooner. The length of the waiting time before surgery did not affect the emotional well-being of patients thereafter: women who had surgery within two weeks were not worse or better off than women who had to wait longer. Yet, patients' emotional well-being did improve considerably after surgery, which indicates that short waiting times might shorten a period of psychological distress. CONCLUSION: The results support a speedy diagnosis and surgery. There was no support for short waiting times having a negative psychological effect.