dr sahil suleman guy s st thomas nhs foundation trust institute of psychiatry n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Dr Sahil Suleman Guy’s & St Thomas’ NHS Foundation Trust & Institute of Psychiatry PowerPoint Presentation
Download Presentation
Dr Sahil Suleman Guy’s & St Thomas’ NHS Foundation Trust & Institute of Psychiatry

Loading in 2 Seconds...

play fullscreen
1 / 25

Dr Sahil Suleman Guy’s & St Thomas’ NHS Foundation Trust & Institute of Psychiatry - PowerPoint PPT Presentation


  • 95 Views
  • Uploaded on

Dr Sahil Suleman Guy’s & St Thomas’ NHS Foundation Trust & Institute of Psychiatry. Cognitive and behavioural Factors associated with fatigue and disability in women with breast cancer. CANCER. Increasingly viewed as an LTC  Survivorship =  Symptoms & Side Effects from treatment Pain

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

Dr Sahil Suleman Guy’s & St Thomas’ NHS Foundation Trust & Institute of Psychiatry


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
dr sahil suleman guy s st thomas nhs foundation trust institute of psychiatry
Dr Sahil Suleman

Guy’s & St Thomas’ NHS Foundation Trust

& Institute of Psychiatry

Cognitive and behavioural Factors associated with fatigue and disability in women with breast cancer

cancer
CANCER
  • Increasingly viewed as an LTC
  • Survivorship = Symptoms & Side Effects from treatment
  • Pain
  • Swelling
  • Lymphoedema
  • Hair Loss
  • Dry mouth
  • Infection
  • Cognitive Impairment
  • Nausea
  • Hormonal Changes
  • FATIGUE
cancer related fatigue crf
“CANCER-RELATED FATIGUE” (CRF)
  • “a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness, or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning”

National Comprehensive Cancer Network (2011)

  • Lack of consensus over definition
  • ICD-10 Criteria for Cancer Related Fatigue Syndrome
why focus on cancer related fatigue
WHY FOCUS ON CANCER-RELATED FATIGUE?
  • 39% - 90+% of those in treatment

(Prue et al., 2006)

  • Significant impact on the ability to function and quality of life
  • Most important and distressing symptom

(Curt et al., 2000)

  • Curt (2000) - Prevented “normal life” (91%) and changed daily routine (88%)
  • Carers – for 65%, fatigue had resulted in partners having taken at least one day (and a mean of four and a half days) off work

(Curt, 2000)

uniqueness of cancer related fatigue experience vs fatigue
UNIQUENESS OF CANCER-RELATED FATIGUE EXPERIENCE VS. FATIGUE
  • More severe and distressing than fatigue

(Andrykowski et al., 2010; Jacobsen et al., 1999)

  • Less frequently relieved by adequate sleep or rest than fatigue

(Poulson, 2001; Stone et al., 1999)

factors associated with cancer related fatigue
FACTORS ASSOCIATED WITH CANCER-RELATED FATIGUE
  • Disease-related
  • Treatment-related
  • Other Physiological Markers
  • Demographic
  • Behavioural & Symptom
  • Psychological
    • Found to supersede physiological and demographic data in their ability to predict CRF

(Hwang et al., 2003)

psychological factors associated with cancer related fatigue
PSYCHOLOGICAL FACTORS ASSOCIATED WITH CANCER-RELATED FATIGUE
  • Depression & Anxiety
  • Personality Traits
    • Trait Anxiety
    • Neuroticism
    • Extraversion
  • Maladaptive Coping Styles
    • Higher order coping styles
    • Beliefs/Cognitions about experience and management of CRF
interventions targeting cancer related fatigue
INTERVENTIONS TARGETING CANCER-RELATED FATIGUE
  • Pharmacological
  • Exercise & Activity
  • Complementary & Lifestyle
  • Psychological
    • Wider Psychosocial Approaches
      • education, social support, relaxation, self-care
    • Cognitive Behavioural Approaches
so where does this leave us
SO WHERE DOES THIS LEAVE US…
  • Range of factors contributing to CRF
  • Psychological factors are important
  • Targeting psychological factors has been successful in reducing CRF
  • CBT works in CFS
  • CBT works for other physical health conditions and for specific symptoms
  • Limited evidence that CBT works in CRF…
  • But how/why does it work?
suleman s rimes k chalder t 2011
SULEMAN, S., RIMES, K. & CHALDER, T. (2011)
  • Cross-sectional investigation of the role of range of psychological variables in a sample of women undergoing chemotherapy for breast cancer
    • Relationship between these variables and Fatigue and Functional Impairment
    • Also considered demographic and clinical variables
  • Prospective exploratory investigation of the role of psychological (and other) variables identified at commencement of chemotherapy in predicting Fatigue and Functional Impairment after 3 cycles of chemotherapy
methodology
METHODOLOGY
  • Questionnaire Study
  • 100 Female Patients from Breast Care Clinic at King’s College Hospital, London
    • 3 groups - pre-chemotherapy, in chemotherapy or post-chemotherapy
  • 33 pre-chemotherapy participants followed up after 3 cycles of chemotherapy
  • FEC-T Chemotherapy Regimen
measures
MEASURES
  • Fatigue - Chalder Fatigue Questionnaire (Chalder et al., 1993) & Visual Analogue Scale – Fatigue (VAS-F)
  • Physical Functioning - European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, Version 3 (EORTC QLQ-C30; Aaronson et al., 1993)
  • Social Functioning - Work and Social Adjustment Scale (Marks, 1986)
  • Cognitive and Behavioural Responses to Symptoms Questionnaire (CBRSQ; Moss-Morris et al., in preparation)
  • Beliefs about Emotions Scale (BES; Rimes & Chalder, 2010)
  • West Haven-Yale Multidimensional Pain Inventory – Part II - Significant Other Response Scales (WHYMPI; Kerns et al., 1985)
  • Short Health Anxiety Inventory - Retrospective (SHAI-R; Salkovskis et al., 2002)
  • Very Short Health Anxiety Inventory (Salkovskis, correspondence)
  • Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983)
  • State Trait Anxiety Inventory – Trait (STAI-T; Spielberger et al., 1970)
  • Jenkins Sleep Scale (Jenkins et al., 1988)
  • Visual Analogue Scale – Expected Fatigue (VAS-E)
  • Cancer-specific Cognitions (exploratory)
  • Use of Coping Strategies (exploratory)
  • Demographic & Clinical Information
measures continued
MEASURES (CONTINUED)
  • Cognitive and Behavioural Responses to Symptoms Questionnaire
    • 6 subscales
      • catastrophising, symptom-focusing, fear avoidance, embarrassment avoidance, avoidance behaviour, all-or-nothing behaviour
    • 1 new scale – ‘embarrassment avoidance (cancer-related)’
  • Beliefs about Emotions Scale
  • West Haven-Yale Multidimensional Pain Inventory – Part II - Significant Other Response Scales
    • Perceived punishing, distracting and over-solicitous responses
preliminary results
PRELIMINARY RESULTS
  • Comparison between sample and population norms

(Fayers et al., 2001; Loge et al., 1998)

  • Comparison of 3 groups – One way ANOVA
    • No difference between pre-chemotherapy, in chemotherapy and post-chemotherapy groups on fatigue, social adjustment or physical functioning scores
    • Treated as 1 group for subsequent analyses
cross sectional correlations
CROSS-SECTIONAL CORRELATIONS

Significance

* = .05 level

** = .01 level

*** = .001 level

cross sectional correlations cont d
CROSS-SECTIONAL CORRELATIONS (CONT’D)

Significance

* = .05 level

** = .01 level

*** = .001 level

slide17

CROSS-SECTIONAL CORRELATIONS (CONT’D)

  • Point bi-serial correlations of dichotomised demographic and clinical variables OR Spearman’s rank correlation coefficients
  • No significant correlations found for age, having sought help for other psychiatric problems, 5 comorbidity variables and 6 medication variables

Significance

* = .05 level

** = .01 level

*** = .001 level

cross sectional predictors multiple regression
CROSS-SECTIONAL PREDICTORS – MULTIPLE REGRESSION
  • Psychological Predictors

- Hierarchical stepwise multiple regression

    • Step 1 – cognitive behavioural variables
    • Step 2 – wider psychological and behavioural variables
  • Psychological & Demographic/Clinical Predictors

- Hierarchical forced entry multiple regression

    • Step 1 – demographic/clinical variables
    • Step 2 – psychological predictors from previous model
cross sectional predictors of fatigue
CROSS-SECTIONAL PREDICTORS OF FATIGUE
  • Demographic / Clinical predictors in final model
    • Further education vs. no further education
    • Help sought for fatigue previously
  • Exploratory predictors
    • Expectation of future fatigue
cross sectional predictors of social adjustment
CROSS-SECTIONAL PREDICTORS OF SOCIAL ADJUSTMENT
  • Demographic / Clinical predictors in final model
    • White vs. non-white
    • Help sought for fatigue previously
  • Exploratory predictors
    • Expectation of future fatigue (minimally significant)
cross sectional predictors of physical functioning
CROSS-SECTIONAL PREDICTORS OF PHYSICAL FUNCTIONING
  • Demographic / Clinical predictors in final model
    • Further education vs. no further education
    • White vs. non-white
    • Working vs. not working
    • Help sought for fatigue previously
  • Exploratory predictors
    • Expectation of future fatigue
key findings
KEY FINDINGS
  • More detailed picture of cognitions, behaviours and other psychological factors playing a part in CRF
    • Beyond umbrella terms e.g. ‘depression’
    • Preliminary evidence of presence of maladaptive cognitions and behaviours prior to chemotherapy impacting on CRF over course of chemotherapy i.e. predictive role
  • Corroborates evidence from chronic fatigue syndrome and comparable health conditions
    • Wide range of patterns of cognition and behaviour
    • Unique aspects of CRF e.g. embarrassment avoidance (cancer-related), perceived punishing responses of significant others
  • Preliminary evidence for psychometric properties of new ‘embarrassment avoidance (cancer-related)’ scale
clinical implications
CLINICAL IMPLICATIONS
  • Development of targeted CBT interventions for CRF
    • Particular prominence to cognitive and behavioural aspects of avoidance behaviour and embarrassment avoidance in cancer
  • Screening and early intervention
    • Informing staff and validating patients
    • Carers
  • Staff training
    • Stepped care approach
  • Limitations
  • Future Research