Objective: Fatigue is investigated in 57 severely fatigued disease-free breast cancer patients and in 57 gender- and age-matched patients with chronic fatigue syndrome (CFS) using multidimensional and multimethod assessment. A comparison between these groups of patients is important to determine whether a cognitive behavioural intervention to reduce fatigue in CFS patients would be appropriate as well for severely fatigued disease-free breast cancer patients. Methods: Measurement included computerised questionnaires and a standardised neuropsychological test. Furthermore, patients filled out a daily Self-Observation List (SOL) and wore an actometer during a period of 12 days. Results: In comparison to severely fatigued disease-free breast cancer patients, CFS patients score more problematic with regard to the level of fatigue, functional impairment, physical activity, pain and self-efficacy. However, a subgroup of severely fatigued disease-free breast cancer patients reports the same amount of problems as CFS patients with regard to psychological well-being, sleep and concentration. Finally, CFS patients and severely fatigued breast cancer patients score equal on measures of social support. Conclusion: There seem to be some similarities but also many differences between severely fatigued breast cancer survivors and females with CFS. Therefore, cognitive behaviour therapy (CBT) to reduce fatigue after treatment for cancer should also differ in certain aspects from cognitive behaviour therapy as it has been developed for patients with CFS.
Fatigue is a complaint that is often reported by cancer patients while they are undergoing treatment for cancer [1]. In the last few years, several studies have demonstrated that many patients also experience fatigue (long) after curative treatment for cancer has been terminated [2], [3], [4], [5], [6], [7], [8], [9], [10] and [11]. At this moment, little is known about the factors that may cause or perpetuate fatigue. However, it seems that characteristics of the disease and treatment are not related to the severity of fatigue long after treatment has ended. A treatment for fatigue long after treatment for cancer is not available.
Another patient population with severe fatigue complaints, for which up until now no physical explanation has been found, are patients with chronic fatigue syndrome (CFS). CFS is characterised by persistent or recurrent fatigue that lasts for 6 or more consecutive months. Fatigue is not the result of constant exertion, does not improve by rest and has leaded to substantial decrease of former standards of professional, social and personal functioning [12]. There is increasing evidence that cognitive behaviour therapy (CBT) is effective for patients with CFS [13] and [14].
Our research group has developed a multidimensional assessment method to measure fatigue in patients with CFS [15]. Factor analyses has identified nine dimensions, namely fatigue severity, functional impairment, psychological well-being, sleep disturbances, neuropsychological impairment, physical activity, social support, causal attributions and self-efficacy. These dimensions appeared to be relatively independent, meaning that each dimension uniquely contributes to the description of a patient.
Using this assessment method, we are able to examine to what extent a patient who experiences severe fatigue after treatment for cancer resembles a patient with CFS. The purpose of this study is to compare, where possible, a group of severely fatigued disease-free cancer patients with a group of CFS patients on the above-described dimensions. We added the dimension “pain” in this study, because pain is a frequent complaint, besides fatigue, of CFS patients. A comparison between these groups of patients is important to determine whether a cognitive behavioural intervention to reduce fatigue in CFS patients would be appropriate as well for severely fatigued disease-free breast cancer patients.
The specific research questions we would like to answer are the following:
1. How many severely fatigued disease-free breast cancer patients fulfill the criteria (severity of fatigue and functional impairment) for CFS?
2. Do severely fatigued disease-free breast cancer patients (those who fulfill the criteria for CFS and those who do not fulfill these criteria) differ from CFS patients on the dimensions self-efficacy, psychological well-being, sleep, concentration, physical activity, social support and pain?
