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Self-regulatory Fatigue in Hematologic Malignancies: Impact on Quality of Life, Coping, and Adherence to Medical Recommendations

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Abstract

Background

Hematopoietic stem cell transplantation (HSCT) is an intensive cancer therapy entailing numerous physical, emotional, cognitive, and practical challenges. Patients’ ability to adjust and cope with such challenges may depend on their ability to exert control over cognitive, emotional, and behavioral processes, that is, ability to self-regulate. Self-regulatory capacity is a limited resource that can be depleted or fatigued (i.e., “self-regulatory fatigue”), particularly in the context of stressful life events such as cancer diagnosis and treatment.

Purpose

This is one of the first studies to examine self-regulatory fatigue in a cancer population. The current study aimed to (1) extract items for a specific scale of self-regulatory capacity and (2) examine the impact of such capacity on adaptation in patients with hematologic malignancies preparing for HSCT.

Methods

Factor analysis of four existing scales gauging psychological adjustment and well-being in 314 patients preparing for HSCT (63% male and 89% Caucasian) identified 23 items (α = 0.85) related to self-regulatory control or fatigue. This measure was then examined using existing clinical data obtained from 178 patients (57% male and 91% Caucasian) undergoing treatment for hematologic malignancies in relationship to quality of life, coping, and self-reported adherence to physicians’ recommendations.

Results

Controlling for pain severity, physical fatigue, and depression, self-regulatory fatigue scores were incrementally associated with decreased quality of life, use of avoidance coping strategies, and decreased adherence to physicians’ recommendations.

Conclusion

These results emphasize the potential role of self-regulatory capacity in coping with and adjusting to hematologic cancers and future research is warranted.

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References

  1. Cutler C, Antin JH. An overview of hematopoietic stem cell transplantation. Clin Chest Med. 2005;26:517–27.

    Article  PubMed  Google Scholar 

  2. McDiarmid S, Hutton B, Atkins H, Bence-Bruckler I, Bredeson C, Sabri E, et al. Perfoming allogeneic and autologous hematopoietic SCT in the outpatient setting: effects on infectious complication and early transplant outcomes. Bone Marrow Transplant. 2010;45(7):1220–6.

    Article  PubMed  CAS  Google Scholar 

  3. Baumeister RF, Bratslavsky E, Muraven M, Tice DM. Ego depletion: Is the active self a limited resource? J Pers Soc Psychol. 1998;74:1252–65.

    Article  PubMed  CAS  Google Scholar 

  4. Carver CS, Scheier MF. On the self-regulation of behavior. New York: Cambridge University Press; 1998.

    Book  Google Scholar 

  5. Baumeister RF. The self. In: Gilbert DT, Fiske ST, Lindzey G, editors. Handbook of social psychology. New York: McGraw-Hill; 1998.

    Google Scholar 

  6. Higgins ET. The “self-digest”: self-knowledge serving self-regulatory functions. J Pers Soc Psychol. 1996;71:1062–83.

    Article  PubMed  CAS  Google Scholar 

  7. Vohs KD, Baumeister RF. Understanding self-regulation. In: Baumeister RF, Vohs KD, editors. Handbook of self-regulation: research, theory, and applications. New York: Guilford Press; 2004.

    Google Scholar 

  8. Baumeister RF. Ego-depletion and self-control failure: an energy model of the self’s executive function. Self Ident. 2002;1:129–36.

    Article  Google Scholar 

  9. Muraven M, Baumeister RF. Self-regulation and depletion of limited resources: does self-control resemble a muscle? Psychol Bull. 2000;126:247–59.

    Article  PubMed  CAS  Google Scholar 

  10. Muraven M, Tice DM, Baumeister RF. Self-control as a limited resource: regulatory depletion patterns. J Pers Soc Psychol. 1998;74:774–89.

    Article  PubMed  CAS  Google Scholar 

  11. Segerstrom SC, Solberg Nes L. Heart rate variability indexes self-regulatory strength, exercise, and depletion. Psychol Sci. 2007;18:275–81.

    Article  PubMed  Google Scholar 

  12. Solberg Nes L, Roach AR, Segerstrom SC. Executive functions, self-regulation, and chronic pain: a review. Ann Behav Med. 2009;37:173–83.

    Article  PubMed  Google Scholar 

  13. Solberg Nes L, Carlson CR, Crofford LJ, de Leeuw R, Segerstrom SC. Self-regulatory deficits in fibromyalgia and temporomandibular disorders. Pain. 2010;151:37–44.

    Article  PubMed  Google Scholar 

  14. Andrykowski MA, Cordova MJ, Studts JL, Miller TW. Posttraumatic stress disorder after treatment for breast cancer: prevalence of diagnosis and use of the PTSD Checklist-Civilian Version (PCL-C) as a screening instrument. J Consult Clin Psychol. 1998;66:586–90.

    Article  PubMed  CAS  Google Scholar 

  15. Hann DM, Jacobsen P, Martin S, Azzarello L, Greenberg H. Fatigue and quality of life following radiotherapy for breast cancer: a comparative study. J Clin Psychol Med Set. 1998;5:19–33.

    Article  Google Scholar 

  16. Antman K. When are bone marrow transplants considered? Sci Am. 1996;275:124–5.

    Article  PubMed  CAS  Google Scholar 

  17. Andrykowski MA, Bishop MM, Hahn EA, Cella DF, Beaumont JL, Brady MJ, et al. Long-term health-related quality of life, growth, and spiritual well-being after hematopoietic stem-cell transplantation. J Clin Oncol. 2005;23:599–608.

    Article  PubMed  Google Scholar 

  18. Syrjala KL, Langer SL, Abrams JR, Storer B, Sanders JE, Flowers MED, et al. Recovery and long-term function after hematopoietic cell transplantation for leukemia or lymphoma. JAMA. 2004;291:2335–43.

    Article  PubMed  CAS  Google Scholar 

  19. Wingard JR, Majhail NS, Brazauskas R, Wang Z, Sobocinski KA, Jacobsohn D, et al. Long-term survival and late deaths after allogeneic hematopoietic cell transplantation. J Clin Oncol. 2011;29:1–11.

    Article  Google Scholar 

  20. Alter CL, Pelcovitz D, Axelrod A, Goldenberg B, Harris H, Meyers B, et al. Identification of PTSD in cancer survivors. Psychosom. 1996;37:137–43.

    Article  CAS  Google Scholar 

  21. Widows MR, Jacobsen PB, Fields KK. Relation of psychological vulnerability factors to posttraumatic stress disorder symptomatology in bone marrow transplant recipients. Psychosom Med. 2000;62:873–82.

    PubMed  CAS  Google Scholar 

  22. Schwartz LA, Drotar D. Health-related hindrance of personal goal pursuit and well-being of young adults with cystic fibrosis, pediatric cancer survivors, and peers without a history of chronic illness. J Ped Psychol. 2009;34(9):954–65.

    Article  Google Scholar 

  23. Street H. The psychosocial impact of cancer: exploring relationships between conditional goal setting and depression. Psycho-Oncol. 2003;12:580–9.

    Article  Google Scholar 

  24. Aaron LA, Burke MM, Buchwald D. Overlapping conditions among patients with chronic fatigues syndrome, fibromyalgia, and temporomandibular disorder. Arch Int Med. 2000;160:221–7.

    Article  CAS  Google Scholar 

  25. Mols F, Vingerhoets AJM, Coeberg JW, van de Poll-Franse LD. Quality of life among long-term breast cancer survivors: a systemic review. Euro J Cancer. 2005;41:2613–9.

    Article  Google Scholar 

  26. Perry SH, Kowalski TL, Chang CH. Quality of life assessment in women with breast cancer: benefits, acceptability and utilization. Health QoL Outcom. 2007;5:24–38.

    Article  Google Scholar 

  27. Carver CS, Scheier MF, Pozo C. Conceptualizing the process of coping with health problems. In: Friedman HS, editor. Hostility, coping & health. Washington, DC: American Psychological Association; 1992. p. 167–99.

    Chapter  Google Scholar 

  28. Culver JL, Arena PL, Antoni MA, Carver CS. Coping and distress among women under treatment for early stage breast cancer: comparing African Americans, Hispanics, and non-Hispanic Whites. Psycho-oncol. 2002;11:495–504.

    Article  Google Scholar 

  29. Epping-Jordan JE, Compas BE, Osowiecki DM, et al. Psychological adjustment in breast cancer: process of emotional distress. Health Psychol. 1999;18:315–26.

    Article  PubMed  CAS  Google Scholar 

  30. Brown JM, Miller WR, Lawendowski LA. The self-regulation questionnaire. In: VandeCreek L, Jackson TL, editors. Innovations in clinical practice: a sourcebook. Sarasota: Professional Resource Press; 1999. p. 281–9.

    Google Scholar 

  31. Ciarocco NJ, Twenge JM, Muraven M, Tice DM. Measuring state self-control: Reliability, validity, and correlations with physical and psychological stress. Monmouth, NJ: Monmouth University; (unpublished).

  32. John OP, Donahue EM, Kentle RL. The Big Five Inventory—versions 4a and 54. Berkeley, CA: University of California, Berkeley, Institute of Personality and Social Research; 1991.

  33. Costa Jr PT, McCrae RR. Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) manual. Odessa: Psychological Assessment Resources; 1992.

    Google Scholar 

  34. Benet-Martınez V, John OP. Los Cinco Grandes. Across cultures and ethnic groups: Multitrait-multimethod analyses of the Big Five in Spanish and English. J Pers Soc Psychol. 1998;75:729–50.

    Article  PubMed  Google Scholar 

  35. Horowitz MJ, Wilner NR, Alwarez W. Impact of events scale. A measure of subjective stress. Psychosom Med. 1979;41:209–18.

    PubMed  CAS  Google Scholar 

  36. Sack WH, Seeley JR, Him C, Clarke GN. Psychometric properties of the Impact of events Scale in traumatized Cambodian refugee youth. Pers Individ Diff. 1978;25:57–67.

    Article  Google Scholar 

  37. Spielberger CD. State-trait anger expression inventory: STAXI professional manual. Florida: Psychological Assessment Resources; 1991.

    Google Scholar 

  38. Spielberger CD. Manual for the state-trait anxiety inventory STAI (Form Y). Palo Alto: Mind Garden; 1983.

    Google Scholar 

  39. Gorsuch RL. Factor analysis. Hillsdale: Erlbaum; 1983.

    Google Scholar 

  40. Cella D, Tulsky D, Gray G, Sarafian B, Linn E, Bonomi A, et al. The Functional Assessment of Cancer Therapy Scale: development and validation of the general measure. J Clin Oncol. 1993;11:570–9.

    PubMed  CAS  Google Scholar 

  41. Carver CS. You want to measure coping but your protocol’s too long: consider the brief COPE. Int J Behav Med. 1997;4:92–100.

    Article  PubMed  CAS  Google Scholar 

  42. Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol. 1989;56:267–83.

    Article  PubMed  CAS  Google Scholar 

  43. Hays RD, Kravitz RL, Mazel RM, Sherbourne CD, DiMatteo MR, Rogers WH, et al. The impact of patient adherence on health outcomes for patients with chronic disease in the Medical Outcomes Study. J Behav Med. 1994;17:347–60.

    Article  PubMed  CAS  Google Scholar 

  44. Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, et al. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer. 1999;85:1186–96.

    Article  PubMed  CAS  Google Scholar 

  45. Mayo Clinic. Pain Assessment Scale, MC3100-03; 2002. http://mayoweb.mayo.edu/man-ipm/pa-painmgmt.html

  46. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory–II. San Antonio: Psychological Corporation; 1996.

    Google Scholar 

  47. Hall PA, Fong GT. Temporal self-regulation theory: a model for individual health behavior. Health Psychol Rev. 2007;1:6–52.

    Article  Google Scholar 

  48. Hall PA, Crossley M, D'Arcy C. Executive function and survival in the context of chronic illness. Ann Behav Med. 2010;39:119–27.

    Article  PubMed  Google Scholar 

  49. Hinkin CH et al. Medication adherence among HIV+ adults: effects of cognitive dysfunction and regimen complexity. Neurology. 2002;59:1944–50.

    Article  PubMed  CAS  Google Scholar 

  50. Muraven M, Baumeister RF, Tice DM. Longitudinal improvement of self-regulation through practice: Building self-control strength through repeated exercise. J Soc Psychol. 1999;139:446–57.

    Article  PubMed  CAS  Google Scholar 

  51. Solberg Nes L, Carlson CR, de Leeuw R, Schmidt JE, Segerstrom SC. Self-regulatory fatigue and chronic pain: From scale development to improving self-regulatory capacity; unpublished.

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Acknowledgments

This study was conducted using a database from a clinical practice intervention grant (CPI-10) from the Mayo Clinic. The authors would like to thank LeAnn Batterson for assistance with data collection and abstraction and would also like to thank the BMT practice group at the Mayo Clinic for all their support and assistance. Finally, we express gratitude to all the patients who volunteered use of their medical records to advance research.

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Authors and Affiliations

  1. Department of Psychiatry and Psychology, Mayo Clinic, Mayo West 11, 200 First Street SW, Rochester, MN, 55905, USA

    Lise Solberg Nes, Shawna L. Ehlers & Christi A. Patten

  2. College of Medicine, Mayo Clinic, Mayo West 11, 200 First Street SW, Rochester, MN, 55905, USA

    Dennis A. Gastineau

Authors
  1. Lise Solberg Nes
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  2. Shawna L. Ehlers
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  4. Dennis A. Gastineau
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Correspondence to Lise Solberg Nes.

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Solberg Nes, L., Ehlers, S.L., Patten, C.A. et al. Self-regulatory Fatigue in Hematologic Malignancies: Impact on Quality of Life, Coping, and Adherence to Medical Recommendations. Int.J. Behav. Med. 20, 13–21 (2013). https://doi.org/10.1007/s12529-011-9194-1

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