How Patients Experience and Give Meaning to Their Cancer-related Fatigue?

Abstract

Fatigue is a common experience occurring in 70% to 100% of advanced cancer patients with a great impact on quality of life and survival. Despite the complexity of this phenomenon, fatigue's psychosocial dimensions are still not well understood. The aim of this study was to deepen how Italian patients perceive and give meaning to their cancer-related fatigue through the analysis of their language. The study was designed using ethnoscience, an approach that allows to explore how meaning is conveyed through language. We interviewed 16 cancer patients with different level of fatigue (5 mild, 5 moderate, 6 severe). The data analysis showed that fatigue affected three experiential dimensions (mind, body and interpersonal relationships) which are characterized by different symptomatic manifestations depending on the level of fatigue. Patients' causal attributions also varied across levels of fatigue: patients with mild and moderate fatigue attributed their fatigue to psychological and contextual causes, whereas patients with severe fatigue attributed their fatigue to physical and medical causes. As fatigue affects multiple areas of patients' lives, this study suggests the importance of holistic treatments with a multidisciplinary approach able to support patient engagement and activation in their healthcare. This study also shows the importance of considering patients' causal attributions about fatigue, as these appeared to play a role in how patients managed fatigue. Finally, our data highlighted the importance of using a shared language when speaking with patients about fatigue as this may help patients to feel more understood and supported, thus also improving their quality of life and engagement in their care & cure process.

Engaging patients to recover life projectuality: an Italian cross-disease framework

“…Chronic disease is recognized as having a large impact on patient quality of life (QoL) [2][3][4][5][6], which can be defined as an individual's satisfaction or happiness with life in domains he or she considers important [7]. QoL affects the course of public health research as well as the agenda of healthcare policies [8].…”

Fatigue in children and adolescents with cancer from the perspective of health professionals

“…In addition, CRF patients mention a feeling that the health professionals do not recognize the tiredness 26 . Most physicians are unable to offer effective interventions to manage this symptom, due to the lack of information about fatigue and education for health professionals, patients and their families 27 - 28 .…”

“…Although fatigue is often mainly described as a physical symptom in the literature, promoting interventions that only consider this dimension and its biological manifestations, this symptom interferes in several areas of the patients' lives, affecting physical, cognitive, affective and behavioral domains and can be experienced at different levels, ranging from mild to severe 4 , 7 , 28 . The psychological and social support the patients require can vary depending on their fatigue level and interventions that strengthen the social support network, protecting them against the disease-related stress 27 - 28 . In addition, as part of a comprehensive assessment, it is important to closely listen to the patient's fatigue experience in order to provide information on the possible underlying cause 4 .…”

The Relationships Among Cancer-Related Fatigue Trajectories, Anxiety, and Health-Related Quality of Life in Ovarian Cancer Patients

“…Interestingly, this result is bolstered by prior qualitative research on the relationship of CRF with anxiety. Anxiety has been shown to be associated with sinister causal attributions of CRF (e.g., belief that CRF may be a sign of cancer recurrence or disease progression), difficulties with mental functioning (e.g., brain fog) and physical capabilities (e.g., need to nap or rest during the day, resulting in reduced productivity), as well as sleep disturbances (e.g., insomnia) commonly comorbid with CRF (Barello et al, 2013;Bennett et al, 2007). For example, Barello et al (2013) found that patients with mild CRF tended to minimize the dysfunctional nature of their fatigue and attribute it to treatment-related or contextual factors ("I feel weak because I've just done chemotherapy" or "I went out yesterday and this makes me tired").…”

“…Anxiety has been shown to be associated with sinister causal attributions of CRF (e.g., belief that CRF may be a sign of cancer recurrence or disease progression), difficulties with mental functioning (e.g., brain fog) and physical capabilities (e.g., need to nap or rest during the day, resulting in reduced productivity), as well as sleep disturbances (e.g., insomnia) commonly comorbid with CRF (Barello et al, 2013;Bennett et al, 2007). For example, Barello et al (2013) found that patients with mild CRF tended to minimize the dysfunctional nature of their fatigue and attribute it to treatment-related or contextual factors ("I feel weak because I've just done chemotherapy" or "I went out yesterday and this makes me tired"). In contrast, patients with more severe CRF tended to pay greater attention to their fatigue and attribute it to dysfunctional physical/medical origin, and often expressed feelings of helplessness ("I can't do anything, it is the cancer that makes me feel like this.…”