Psychosocial Support May Improve Cancer-Related Fatigue

Cognitive behavioral therapy help to improve the lives of patients experiencing cancer-related fatigue.

Fatigue is one of the most common symptoms reported by gynecologic cancer survivors, with about half (49%) of women presenting with clinically significant fatigue at diagnosis, and 42% experiencing persisting fatigue a year later.

When it comes to addressing cancer-related fatigue, oncology nurses might want to ask their patients about their social support system, as well as present the idea of cognitive behavioral therapy (CBT), which may be able to help, according to research conducted at the Dana-Farber Cancer Institute and the Netherlands Comprehensive Cancer Organisation.

“My experience in managing patients who experience cancer-related fatigue is that it’s often one of the most burdensome symptoms, and it impacts many aspects of their lives,” said Hanneke Poort, PhD, a psychologist and post-doctoral research fellow in the Department of Psychosocial Psychology and Palliative Care at the Dana-Farber Cancer Institute.

“Patients often don’t know that this is something that can be addressed, so they either do not report it to their doctors, or they feel that it is just something they have to live with. But fortunately, there are interventions that we can use to reduce [fatigue].”

While previous research has shown that exercise can benefit patients experiencing fatigue, Poort focused on CBT, which focuses on cancer-related factors — like fatigue – that persist over time.

Poort noted that patients with cancer can often catastrophize their fatigue and see it as an awful symptom that may never get better. Or, especially for those with advanced disease, individuals are burdened with a feeling of uncertainty about their illness and treatment. These two factors can exacerbate fatigue, but CBT may be able to help.

Additionally, social support systems may play a role in fatigue as well, Poort explained.

“Fatigue is a very invisible symptom, and it can be hard for patients — especially if they receive cancer treatments for a long time – to receive the support that they want,” Poort said. “We would talk to them about the potential discrepancy between the actual and perceived social support, and also teach them how they can communicate more assertively about the things that they might need in terms of support.”

Addressing the psychological side of fatigue is key in combatting the malady. In their study — which looked at 312 women with ovarian or endometrial cancer – the most important factor contributing to fatigue at baseline was depressive symptoms.

“Fortunately, there are interventions focusing on the psychological factors that have been shown to be helpful in reducing fatigue,” Poort said. “So, at Dana-Farber, we are currently adapting the CBT intervention that we previously tested in a larger sample of patients for women taking PARP inhibitors for advanced ovarian cancer. I think this is a really exciting study because it would be great if we can improve the quality of life for women taking these new, promising treatments.”

As new cancer treatments like PARP inhibitors continue to become available for women with gynecologic cancer, it is crucial to gain a better understanding of how patients tolerate the drugs, and any adverse events — like severe or chronic fatigue – that they might have.

These advancements, Poort said, may be laying the groundwork for future research.

“I also think that one of the new areas that would be really interesting for research is to look more into tolerance of uncertainty while being on these prolonged therapies,” she said. “There’s going to be many changes in the course of treatment where they might not respond to treatment anymore, and they might have to adjust. We don’t know a lot about how patients deal with these changes for a longer period of time.”