Fatigue-Related Cognitive-Behavioral Factors in Survivors of Childhood Cancer, 2020, Knoop et al

[Andy]

Full title: Fatigue-Related Cognitive-Behavioral Factors in Survivors of Childhood Cancer: Comparison with Chronic Fatigue Syndrome and Survivors of Adult-Onset Cancer

Purpose: Cancer-related fatigue is a burdensome late effect of cancer treatment. A pilot study showed the effectiveness of cognitive-behavioral therapy (CBT) in fatigued survivors of childhood cancer (CCS). The aim of this study is to investigate whether the six cognitive-behavioral factors that are addressed during CBT differ in CCS compared with patients with chronic fatigue syndrome (CFS) and survivors of adult-onset cancer (ACS). Levels of self-esteem, optimism, and depressive symptoms, variables that are also related to fatigue, were also compared between groups.

Methods: Retrospective analyses were performed on 34 CCS (ages 11–42 years), 102 patients with CFS, and 95 ACS who were referred for evaluation of severe fatigue. Fatigue severity, possible cognitive-behavioral fatigue maintaining factors, depressive symptoms, self-esteem, and optimism were assessed using questionnaires and actigraphy.

Results: No significant differences were found in the factors coping with the experience of having had cancer, fear of cancer recurrence, physical activity, and in levels of self-esteem and optimism. CCS attributed their fatigue significantly more often to psychosocial causes and reported fewer problems in sleep/rest compared with patients with CFS. Compared with ACS, CCS reported significantly more social support, more problems in sleep/rest, and more depressive symptoms.

Conclusions: There is substantial overlap in cognitive-behavioral factors that can maintain fatigue between CCS and CFS patients or ACS. Also differences were found regarding attribution of fatigue, the sleep/rest pattern, social support, and depressive symptoms that might have clinical implications when CBT for fatigue is provided to CCS.

Paywall, https://www.liebertpub.com/doi/10.1089/jayao.2020.0094
Sci hub, https://sci-hub.tw/10.1089/jayao.2020.0094

 

[Arnie Pye]

From the Introduction (my emphasis) :

Cancer-related fatigue, defined as ‘‘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,’’ is a commonly described symptom in cancer survivors, and can have a negative impact on quality of life.2

I have recently wondered how often using the word "subjective" to describe anything in medicine is ever accurate.

If I break my leg and the injury shows up on x-ray then the pain I get from the injury would be considered by doctors to be "objective" and therefore "real".

If I had had cancer treatment - chemotherapy - then I have, in effect, been deliberately poisoned, just enough to (hopefully) kill cancer cells while people cross their fingers and hope the healthy cells I have stay alive. I think it might be common afterwards for testing not to show how well my body repairs or replaces those damaged, previously healthy cells - and if it (my body) does replace unhealthy cells they might not be the same as they would have been before chemo if the chemo had induced DNA damage. If enough healthy cells have been damaged and my body's repair systems can't actually repair them or replace them accurately then I might feel unwell for the rest of my life. But if those cells can't be found or tested for then doctors will tell me I'm absolutely fine and dandy and I'm well again and any feelings of being unwell are subjective.

I'm not dismissing the idea of something being subjective entirely. For example, someone with flu may shiver with cold when their body temperature is actually high with a fever. I would describe feeling cold in that situation as a subjective feeling (it's not "real"). But I do believe that the word "subjective" to describe anything in medicine is vastly over-used and it is often just a sleight of hand trick to hide what doctors don't actually understand or don't know.

 

[rvallee]

Levels of self-esteem, optimism, and depressive symptoms, variables that are also related to fatigue

Not a thing.

Clowns. These people are sewer-dwelling clowns.

 

[Mithriel]

In the 80s/90s there were a few children with ME after cancer treatments. Their mothers were at particular risk of being accused of munchhausen's by proxy as it was claimed they missed the attention they got as parents of sick children.