Advertisement

Journal of Cancer Research and Clinical Oncology

, Volume 133, Issue 8, pp 511–518 | Cite as

The influence of resilience on fatigue in cancer patients undergoing radiation therapy (RT)

  • Bernhard StraussEmail author
  • Christina Brix
  • Sebastian Fischer
  • Karena Leppert
  • Jürgen Füller
  • Bernd Roehrig
  • Christine Schleussner
  • Thomas G. Wendt
Original Paper

Abstract

Purpose

The primary goal of the study was to determine if resilience influences fatigue in a consecutive sample of cancer patients treated with radiotherapy (RT) at the beginning and at the end of the treatment.

Methods

Out of an initial sample of 250 patients, 239 could be assessed at the beginning of their RT. Two hundred and eight patients were reassessed at the end of RT 4–8 weeks later. Measures comprised the Resilience Scale (RS), the Multidimensional Fatigue Inventory (MFI), and the SF-12 as a measure of health related Quality of Life (QoL). Medical data were continuously registered.

Results

As hypothesized, the sample revealed higher scores in the MFI and lower scores in the SF-12 than normative samples. Resilience scores were higher than in the norm population. Fatigue increased during RT. Using multiple regression analyses, fatigue scores at the beginning of treatment were shown to be higher in inpatients and patients undergoing palliative treatment. Initial fatigue was best predicted by the patients’ initial resilience scores. Changes of fatigue scores during RT depended on initial scores, decrease in Hb and the patients’ experience with RT. Resilience could not be determined as a predictor of changes in fatigue during RT.

Conclusions

The study confirmed that fatigue is an important problem among RT patients. Resilience turned out to powerfully predict the patients’ fatigue at least early in RT. This result is in line with other studies, showing resilience to be an important psychological predictor of QoL and coping in cancer patients. On the other hand, resilience seems to have little influence on treatment related fatigue during RT.

Keywords

Fatigue Resilience Radiation therapy Quality of life 

References

  1. AHRQ (Agency for Healthcare Research and Quality) (2002) Management of cancer symptoms: pain, depression, and fatigue. Evidence Report Number 61, US Department of Health and Human Services, WashingtonGoogle Scholar
  2. Antoni MH, Goodkin K (1988) Host moderator variables in the promotion of cervical neoplasia—personality facets. J Psychosom Res 32:327–338PubMedCrossRefGoogle Scholar
  3. Bender D, Lösel F (1997) Risiko- und Schutzfaktoren in der Genese und der Bewältigung von Misshandlung und Vernachlässigung. In: Egle U, Hoffmann SO, Joraschky P (eds) Sexueller Missbrauch, Misshandlung, Vernachlässigung. Erkennung und Behandlung psychischer und Psychosomatischer Folgen früher Traumatisierungen, Schattauer, Stuttgart, pp 35–53Google Scholar
  4. Bowen DJ, Morasca AA, Meischke H, et al (2003) Measures and correlates of resilience. Women Health 38:65–76PubMedCrossRefGoogle Scholar
  5. Bull AA, Meyerowitz BE, Hart S, et al (1999) Quality of life in women with recurrent breast cancer. Breast Cancer Res Treat 54:47–57PubMedCrossRefGoogle Scholar
  6. Bullinger M, Kirchberger I (1998) SF-36 Fragebogen zum Gesundheitszustand. Handanweisung, Hogrefe, GöttingenGoogle Scholar
  7. Farber E, Schwartz A, Schaper P, et al (2000) Resilience factors associated with adaptation to HIV disease. Psychosomatics 41(2):140–146PubMedCrossRefGoogle Scholar
  8. Glaus A, Crow A, Hammond S (1996) A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals. Support Care Cancer 4(2):82–96PubMedCrossRefGoogle Scholar
  9. Glaus A, Müller S (2000) Hämoglobin und Müdigkeit bei Tumorpatienten: Untrennbare Zwillinge? Schweiz Med Wochenschr 130:471–477PubMedGoogle Scholar
  10. Gotay CC, Isaacs P, Pagano I (2003) Quality of life in patients who survive a dire prognosis compared to control cancer survivors. Psychooncology 13:882–892Google Scholar
  11. Haase JE, Heiney SP, Ruccione KS, et al (1999) Research triangulation to derive meaning-based quality of life theory: adolescent resilience model and instrument development. Int J Cancer 12(S):125–131CrossRefGoogle Scholar
  12. Hickok JT, Morrow GR, Mc Donald S, et al (1996) Frequency and correlates of fatigue in lung cancer patients receiving radiation therapy: implications for management. J Pain Symptom Manage 11(6):370–377PubMedCrossRefGoogle Scholar
  13. Jereczek-Fossa BA, Marsiglia HR, Orecchia R (2002) Radiotherapy related fatigue. Crit Rev Oncol Hematol 41:317–325PubMedGoogle Scholar
  14. Leppert K, Strauss B (2002) Resilienzskala. In: Brähler E, Schumacher J, Strauss B (eds) Psychodiagnostische Verfahren in der Psychotherapie. Hogrefe, GöttingenGoogle Scholar
  15. National Institute of Health State of the Science Panel (2003) Symptom management in cancer: pain, depression, and fatigue. J Natl Cancer Inst 95(15):1110–1117CrossRefGoogle Scholar
  16. Nelson AE, Haase J, Kupst MJ, et al (2004) Consensus statements: interventions to enhance resilience and quality of life in adolescents with cancer. J Pediatr Oncol Nurs 21:305–307PubMedCrossRefGoogle Scholar
  17. Newell S, Sanson-Fisher RW, Savolainen NJ (2002) Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst 94:558–584PubMedGoogle Scholar
  18. Parry C (2003) Embracing uncertainty: an exploration of the experiences of childhood cancer survivors. Qual Health Res 13:227–246PubMedCrossRefGoogle Scholar
  19. Ream E, Richardson A (1997) Fatigue in patients with cancer and chronic obstructive airways disease: a phenomenological enquiry. Int J Nurs Stud 34(1):44–53PubMedCrossRefGoogle Scholar
  20. Rutter M (1987) Psychosocial resilience and protective mechanisms. Am J Orthopsychiatry 57(3):316–331PubMedCrossRefGoogle Scholar
  21. SAS Institute I (2001) SAS/STAT User’s Guide. Version 8.2. SAS Institute, Cary, NCGoogle Scholar
  22. Schumacher J, Leppert K, Gunzelmann T, et al (2005) Die Resilienzskala—Ein Fragebogen zur Erfassung der psychischen Widerstandsfähigkeit als Personmerkmal. Z Klin Psychol Psychiatr Psychother 53:16–39Google Scholar
  23. Schwarz R, Krauss O, Hinz A (2003) Fatigue in the general population. Onkologie 26:140–144PubMedCrossRefGoogle Scholar
  24. Seegenschmidt MH, Haase W, Schnabel K, et al (1996) Leitlinien zur Dokumentation von Nebenwirkungen in der Radioonkologie. Strahlenther Onkol 172S:9–12Google Scholar
  25. Smets E, Garssen B, Bonke B, et al (1995) The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39(3):315–325PubMedCrossRefGoogle Scholar
  26. Smets E, Garssen B, Cull A, et al (1996) Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. Br J Cancer 73:241–245PubMedGoogle Scholar
  27. Smets E, Visser M, Willems-Groot A, et al (1998a) Fatigue and radiotherapy: (A) experience in patients undergoing treatment. Br J Cancer 78(7):899–906Google Scholar
  28. Smets E, Visser M, Willems-Groot A, et al (1998b) Fatigue and radiotherapy: (B) experience in patients 9 months following treatment. Br J Cancer 78(7):907–912Google Scholar
  29. SPSS Inc. (2004) SPSS Base 12.0 User’s Guide. SPSS, ChicagoGoogle Scholar
  30. Stasi R, Abriani L, Beccaglia P, et al (2003) Cancer-related fatigue: evolving concepts in evaluation and treatment. Cancer 98(9):1786–1801PubMedCrossRefGoogle Scholar
  31. Staudinger M, Marsiske M, Baltes P (1996b) Resilience and levels of reserve capacity in later adulthood: perspectives from life-span-theory. Dev Psychopathol 5:541–566CrossRefGoogle Scholar
  32. Staudinger U, Freund A (1998) Krank und “arm” im hohen Alter und trotzdem guten Mutes? Z Klin Psychol 27(2):78–85Google Scholar
  33. Staudinger U, Freund A, Linden M, et al (1996a) Selbst, Persönlichkeit und Lebensgestaltung im Alter: Psychologische Widerstandsfähigkeit und Vulnerabilität. In: Mayer KU, Baltes PB (eds) Die berliner altersstudie. Akademie-Verlag, Berlin, pp 321–350Google Scholar
  34. Stewart DE, Wong F, Duff S, et al (2001) “What doesn’t kill you makes you stronger”: an ovarian cancer study. Gynecol Oncol 83:537–543PubMedCrossRefGoogle Scholar
  35. Stone P, Richards M, Hardy J (1998) Review: fatigue in patients with cancer. Eur J Cancer 34(11):1670–1676PubMedCrossRefGoogle Scholar
  36. Surtess P, Wainwright N, Luben R, et al (2004) Sense of coherence and mortality in men and women in the EPIC-Norfol UK prospective cohort study. Am J Epidemiol 159:1202–1203CrossRefGoogle Scholar
  37. Visser M, Smets E (1998) Fatigue, depression and quality of life in cancer patients: how are they related? Support Care Cancer 6:101–108PubMedCrossRefGoogle Scholar
  38. Wagnild GM, Young HM (1993) Development and psychometric evaluation of the resilience scale. J Nurs Meas 1:165–178PubMedGoogle Scholar
  39. Ware JE Jr (1993) SF-36 health survey: manual and interpretation guide. The Health Institute, New England Medical Center, Boston, MAGoogle Scholar
  40. Weis J, Bartsch HH (2000) Fatigue nach Krebs: eine neue Herausforderung für Therapie und Rehabilitation. Karger, BaselGoogle Scholar
  41. Wenzel LB, Donnelly JP, Fowler JM, et al (2002) Resilience, reflection, and residual stress in ovarian cancer survivorship. Psychooncology 11:142–153PubMedCrossRefGoogle Scholar
  42. Woodgate RL (1999a) Conceptual understanding of resilience in the adolescent with cancer Part I. J Pediatr Oncol Nurs 16:35–43CrossRefGoogle Scholar
  43. Woodgate RL (1999b) Conceptual understanding of resilience in the adolescent with cancer Part II. J Pediatr Oncol Nurs 16:78–89CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Bernhard Strauss
    • 1
    Email author
  • Christina Brix
    • 1
  • Sebastian Fischer
    • 1
  • Karena Leppert
    • 1
  • Jürgen Füller
    • 2
  • Bernd Roehrig
    • 1
  • Christine Schleussner
    • 1
  • Thomas G. Wendt
    • 2
  1. 1.Institute of Psychosocial Medicine and Psychotherapy, University HospitalFriedrich-Schiller University JenaJenaGermany
  2. 2.Department of Radiation Oncology, University HospitalFriedrich Schiller UniversityJenaGermany

Personalised recommendations