Abstract
Cancer-related fatigue (crf) is a highly prevalent and distressing side effect of treatment that can affect all aspects of quality of life. crf persists in the post-treatment survivorship period for some cancer patients, but this persistence is not fully explained by diagnosis or treatment variables. Qualitative data show that patients hold specific beliefs or attributions about fatigue that may influence central interpretation of this symptom and severity outcomes. Attributions or specific beliefs, thoughts, and emotions that patients’ hold about crf may play an important role in the etiology and persistence of fatigue, but that role has not been previously examined. OBJECTIVES: The specific research questions addressed were: What beliefs do cancer patients hold about crf? What is the independent contribution of beliefs/attributions on intensity of fatigue when other covariates are controlled? METHODS: Population cohorts of nonmetastatic breast, prostate, and colorectal cancer survivors (6–18 months; 2–3 years; and 5–6 years) posttreatment were identified through the Princess Margaret Hospital cancer registry and sent a questionnaire package that included the Fatigue Symptom Perception Questionnaire (fspq), ces-d short form, stai-s, msas-sf, Charlson comorbidity index, and who Disability Assessment Schedule. Demographic and clinical variables were abstracted from charts. We conducted a hierarchical regression multivariate analysis to examine the additional variance explained in fatigue severity when disease, treatment, and other symptom covariates are controlled. RESULTS: Overall, patients reported fatigue as cyclical, and they had low perceived consequences of fatigue and treatment control. Compared with prostate cancer survivors, breast cancer and colorectal patients reported higher emotional responses to fatigue. Fatigue attributions explained additional variance in fatigue severity when other variables were controlled in the analysis. CONCLUSIONS: The study results suggest that fatigue attributions like other symptoms that are interpreted as part of a central psychological-information processing system may play an important role in the central etiology of fatigue. This role should be examined in future research. Understanding patient perceptions of crf and the role of those perceptions in predicting intensity of crf in cancer survivors is critical to the design of clinical interventions.