Women’s Experiences of Managing Fatigue During Breast Cancer Treatment: Strategies from Patients in a Low-Resource Setting

Authors

DOI:

https://doi.org/10.25159/2957-3645/11102

Keywords:

breast cancer, fatigue, low-resource setting, coping, experience

Abstract

Cancer-related fatigue can lead to a reduced health-related quality of life among patients with cancer. We explored the experiences of fatigue among women undergoing breast cancer treatment at a public hospital in South Africa. We recruited 12 participants using purposive sampling. In-depth, semi-structured interviews were conducted by registered clinical psychologists. The interviews were audio recorded and transcribed. A thematic analysis of the data produced three themes, namely, fatigue is tiredness, the pervasive impact of fatigue and fatigue management strategies. These strategies included rest, pacing, physical activity, energy drinks, instrumental support and cognitive strategies such as distraction and self-talk. Our recommendation is that healthcare providers need to prioritise communication about fatigue and provide appropriate management strategies.

References

Appling, S. E., Scarvalone, S., MacDonald, R., McBeth, M., & Helzlsouer, K. J. (2012). Fatigue in breast cancer survivors: The impact of a mind-body medicine intervention. Oncology Nursing Forum, 39(3), 278–286. https://doi.org/10.1188/12.ONF.278-286 DOI: https://doi.org/10.1188/12.ONF.278-286

Barsevick, A. M., Newhall, T., & Brown, S. (2008). Management of cancer-related fatigue. Clinical Journal of Oncology Nursing, 12(5 Suppl.), 21–25. https://doi.org/10.1188/08.CJON.S2.21-25 DOI: https://doi.org/10.1188/08.CJON.S2.21-25

Bower, J. E. (2014). Cancer-related fatigue—Mechanisms, risk factors and treatments. Nature Reviews Clinical Oncology, 11(10), 597–609. https://doi.org/10.1038/nrclinonc.2014.127 DOI: https://doi.org/10.1038/nrclinonc.2014.127

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa DOI: https://doi.org/10.1191/1478088706qp063oa

Bullinger, M. (1991). Quality of life—Definition, conceptualization and implications—A methodologists view. Theoretic Surgery, 6(3), 138–142. https://eurekamag.com/research/033/050/033050321.php

Burotto, M., Wilkerson, J., Stein, W. D., Bates, S. E., & Fojo, T. (2019). Adjuvant and neoadjuvant cancer therapies: A historical review and a rational approach to understand outcomes. Seminars in Oncology, 46(1), 83–99. https://doi.org/10.1053/j.seminoncol.2019.01.002 DOI: https://doi.org/10.1053/j.seminoncol.2019.01.002

Campos, M. P. O., Hassan, B. J., Riechelmann, R., & Del Giglio, A. (2011). Cancer-related fatigue: A practical review. Annals of Oncology, 22(6), 1273–1279. https://doi.org/10.1093/ANNONC/MDQ458 DOI: https://doi.org/10.1093/annonc/mdq458

Cantarero-Villanueva, I., Fernández-Lao, C., Díaz-Rodriguez, L., Fernández-de-las-Peñas, C., Del Moral-Avila, R., & Arroyo-Morales, M. (2011). A multimodal exercise program and multimedia support reduce cancer-related fatigue in breast cancer survivors: A randomised controlled clinical trial. European Journal of Integrative Medicine, 3(3), e189–e200. https://doi.org/10.1016/J.EUJIM.2011.08.001 DOI: https://doi.org/10.1016/j.eujim.2011.08.001

Carayol, M., Ninot, G., Senesse, P., Bleuse, J. P., Gourgou, S., Sancho-Garnier, H., Sari, C., Romieu, I., Romieu, G., & Jacot, W. (2019). Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: The ‘APAD1’ randomized controlled trial. BMC Cancer, 19(1). https://doi.org/10.1186/S12885-019-5896-6 DOI: https://doi.org/10.1186/s12885-019-5896-6

Cruz, F. M., Munhoz, B. A., Alves, B. C., Gehrke, F. S., Fonseca, F. L. A., Kuniyoshi, R. K., . . . Del Giglio, A. (2015). Biomarkers of fatigue related to adjuvant chemotherapy for breast cancer: evaluation of plasma and lymphocyte expression. Clinical and Translational Medicine, 4(1), 4. http://doi.org/10.1186/s40169-015-0051-8 DOI: https://doi.org/10.1186/s40169-015-0051-8

Curt, G. A., Breitbart, W., Cella, D., Groopman, J. E., Horning, S. J., Itri, L. M., Johnson, D. H., Miaskowski, C., Scherr, S. L., Portenoy, R. K., & Vogelzang, N. J. (2000). Impact of cancer-related fatigue on the lives of patients: New findings from the Fatigue Coalition. Oncologist, 5(5), 353–360. https://doi.org/10.1634/theoncologist.5-5-353 DOI: https://doi.org/10.1634/theoncologist.5-5-353

De Villiers, K. (2021). Bridging the health inequality gap: An examination of South Africa’s social innovation in health landscape. Infectious Diseases of Poverty, 10(1), 1–7. https://doi.org/10.1186/s40249-021-00804-9 DOI: https://doi.org/10.1186/s40249-021-00804-9

Du, S., Hu, L., Dong, J., Xu, G., Jin, S., Zhang, H., & Yin, H. (2015). Patient education programs for cancer-related fatigue: A systematic review. Patient Education and Counseling, 98(11), 1308–1319. https://doi.org/10.1016/j.pec.2015.05.003 DOI: https://doi.org/10.1016/j.pec.2015.05.003

Fabi, A., Falcicchio, C., Giannarelli, D., Maggi, G., Cognetti, F., & Pugliese, P. (2017). The course of cancer related fatigue up to ten years in early breast cancer patients: What impact in clinical practice? Breast, 34, 44–52. https://doi.org/10.1016/j.breast.2017.04.012 DOI: https://doi.org/10.1016/j.breast.2017.04.012

Gielissen, M. F. M., Verhagen, C. A. H. H. V. M., & Bleijenberg, G. (2007). Cognitive behaviour therapy for fatigued cancer survivors: Long-term follow-up. British Journal of Cancer, 97(5), 612–618. https://doi.org/10.1038/sj.bjc.6603899 DOI: https://doi.org/10.1038/sj.bjc.6603899

Glaus, A., Crow, R., & Hammond, S. (1996). A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals. Supportive Care in Cancer, 4(2), 82–96. https://doi.org/10.1007/BF01845757 DOI: https://doi.org/10.1007/BF01845757

Hajj, A., Chamoun, R., Salameh, P., Khoury, R., Hachem, R., Sacre, H., Chahine, G., Kattan, J., & Rabbaa Khabbaz, L. (2022). Fatigue in breast cancer patients on chemotherapy: A cross-sectional study exploring clinical, biological, and genetic factors. BMC Cancer, 22(1), 1–11. https://doi.org/10.1186/S12885-021-09072-0/TABLES/6 DOI: https://doi.org/10.1186/s12885-021-09072-0

Heim, M. E., Elsner v. d. Malsburg, M.-L., & Niklas, A. (2007). Randomized controlled trial of a structured training program in breast cancer patients with tumor-related chronic fatigue. Oncology Research and Treatment, 30(8–9), 429–434. https://doi.org/10.1159/000104097 DOI: https://doi.org/10.1159/000104097

Hilfiker, R., Meichtry, A., Eicher, M., Nilsson Balfe, L., Knols, R. H., Verra, M. L., & Taeymans, J. (2018). Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: A systematic review incorporating an indirect-comparisons meta-analysis. British Journal of Sports Medicine, 52(10), 651–658. https://doi.org/10.1136/bjsports-2016-096422 DOI: https://doi.org/10.1136/bjsports-2016-096422

Horneber, M., Fischer, I., Dimeo, F., Rüffer, J. U., & Weis, J. (2012). Cancer-related fatigue: Epidemiology, pathogenesis, diagnosis, and treatment. Deutsches Ärzteblatt International, 109(9), 161. https://doi.org/10.3238/ARZTEBL.2012.0161 DOI: https://doi.org/10.3238/arztebl.2012.0161

Leventhal, H., Phillips, L. A., & Burns, E. (2016). The common-sense model of self-regulation (CSM): A dynamic framework for understanding illness self-management. Journal of Behavioral Medicine, 39(6), 935–946. https://doi.org/10.1007/s10865-016-9782-2 DOI: https://doi.org/10.1007/s10865-016-9782-2

Luthy, C., Cedraschi, C., Pugliesi, A., Di Silvestro, K., Mugnier-Konrad, B., Rapiti, E., & Allaz, A.-F. (2011). Patients’ views about causes and preferences for the management of cancer-related fatigue—A case for non-congruence with the physicians? Supportive Care in Cancer, 19(3), 363–370. https://doi.org/10.1007/s00520-010-0826-9 DOI: https://doi.org/10.1007/s00520-010-0826-9

Maass, S. W. M. C., Brandenbarg, D., Boerman, L. M., Verhaak, P. F. M., De Bock, G. H., & Berendsen, A. J. (2021). Fatigue among long-term breast cancer survivors: A controlled cross-sectional study. Cancers, 13(6), 1–11. https://doi.org/10.3390/CANCERS13061301 DOI: https://doi.org/10.3390/cancers13061301

Mayor, S. (2017). Exercise and psychological interventions reduce cancer related fatigue, review finds. BMJ, 356, j1127. https://doi.org/10.1136/BMJ.J1127 DOI: https://doi.org/10.1136/bmj.j1127

Minton, O., Berger, A., Barsevick, A., Cramp, F., Goedendorp, M., Mitchell, S. A., & Stone, P. C. (2013). Cancer-related fatigue and its impact on functioning. Cancer, 119(S11), 2124–2130. https://doi.org/10.1002/cncr.28058 DOI: https://doi.org/10.1002/cncr.28058

Mock, V., Frangakis, C., Davidson, N. E., Ropka, M. E., Pickett, M., Poniatowski, B., Stewart, K. J., Cameron, L., Zawacki, K., Podewils, L. J., Cohen, G., & McCorkle, R. (2005). Exercise manages fatigue during breast cancer treatment: A randomized controlled trial. Psycho-Oncology, 14(6), 464–477. https://doi.org/10.1002/pon.863 DOI: https://doi.org/10.1002/pon.863

Montgomery, G. H., Kangas, M., David, D., Hallquist, M. N., Green, S., Bovbjerg, D. H., & Schnur, J. B. (2009). Fatigue during breast cancer radiotherapy: An initial randomized study of cognitive-behavioral therapy plus hypnosis. Health Psychology, 28(3), 317–322. https://doi.org/10.1037/A0013582 DOI: https://doi.org/10.1037/a0013582

Park, H., & Kim, K. (2020). Impact of psycho-social factors on fatigue among breast cancer patients who are currently undergoing radiotherapy. International Journal of Environmental Research and Public Health, 17(17), 1–13. https://doi.org/10.3390/IJERPH17176092 DOI: https://doi.org/10.3390/ijerph17176092

Purcell, A., Fleming, J., Burmeister, B., Bennett, S., & Haines, T. (2011). Is education an effective management strategy for reducing cancer-related fatigue? Supportive Care in Cancer, 19(9), 1429–1439. https://doi.org/10.1007/s00520-010-0970-2 DOI: https://doi.org/10.1007/s00520-010-0970-2

Quesnel, C., Savard, J., Simard, S., Ivers, H., & Morin, C. M. (2003). Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer. Journal of Consulting and Clinical Psychology, 71(1), 189–200. https://doi.org/10.1037/0022-006X.71.1.189 DOI: https://doi.org/10.1037/0022-006X.71.1.189

Ramasubbu, S. K., Pasricha, R. K., Nath, U. K., Rawat, V. S., & Das, B. (2021). Quality of life and factors affecting it in adult cancer patients undergoing cancer chemotherapy in a tertiary care hospital. Cancer Reports, 4(2), e1312. https://doi.org/10.1002/CNR2.1312 DOI: https://doi.org/10.1002/cnr2.1312

Rock, C. L., Doyle, C., Demark-Wahnefried, W., Meyerhardt, J., Courneya, K. S., Schwartz, A. L., Bandera, E. V., Hamilton, K. K., Grant, B., McCullough, M., Byers, T., & Gansler, T. (2012). Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians, 62(4), 242–274. https://doi.org/10.3322/caac.21142 DOI: https://doi.org/10.3322/caac.21142

Sandler, C. X., Goldstein, D., Horsfield, S., Bennett, B. K., Friedlander, M., Bastick, P. A., Lewis, C. R., Segelov, E., Boyle, F. M., Chin, M. T., Webber, K., Barry, B. K., & Lloyd, A. R. (2017). Randomized evaluation of cognitive-behavioral therapy and graded exercise therapy for post-cancer fatigue. Journal of Pain and Symptom Management, 54(1), 74–84. https://doi.org/10.1016/j.jpainsymman.2017.03.015 DOI: https://doi.org/10.1016/j.jpainsymman.2017.03.015

Schmidt, H. S., Arndt, V., & Steindorf, K. (2020). Prevalence and severity of long‐term physical, emotional, and cognitive fatigue across 15 different cancer entities. Cancer Medicine, 9(21), 8053–8061. https://doi.org/10.1002/cam4.3413 DOI: https://doi.org/10.1002/cam4.3413

Schwartz, A. L., Mori, M., Gao, R., Nail, L. M., & King, M. E. (2001). Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Medicine and Science in Sports and Exercise, 33(5), 718–723. https://doi.org/10.1097/00005768-200105000-00006 DOI: https://doi.org/10.1097/00005768-200105000-00006

Scott, J. A., Lasch, K. E., Barsevick, A. M., & Piault-Louis, E. (2011). Patients’ experiences with cancer-related fatigue: A review and synthesis of qualitative research. Oncology Nursing Forum, 38(3), E191–E203. https://doi.org/10.1188/11.ONF.E191-E203 DOI: https://doi.org/10.1188/11.ONF.E191-E203

Stone, P., Richardson, A., Ream, E., Smith, A. G., Kerr, D. J., & Kearney, N. (2000). Cancer-related fatigue: Inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer Fatigue Forum. Annals of Oncology, 11(8), 971–975. https://doi.org/10.1023/A:1008318932641 DOI: https://doi.org/10.1023/A:1008318932641

Wang, S.-H., He, G.-P., Jiang, P.-L., Tang, L.-L., Feng, X.-M., Zeng, C., & Wang, G.-F. (2013). Relationship between cancer-related fatigue and personality in patients with breast cancer after chemotherapy. Psycho-Oncology, 22(10), 2386–2390. https://doi.org/10.1002/pon.3303 DOI: https://doi.org/10.1002/pon.3303

Wang, X. S., & Woodruff, J. F. (2015). Cancer-related and treatment-related fatigue. Gynecologic Oncology, 136(3), 446–452. https://doi.org/10.1016/j.ygyno.2014.10.013 DOI: https://doi.org/10.1016/j.ygyno.2014.10.013

Weis, J. (2011). Cancer-related fatigue: Prevalence, assessment and treatment strategies. Expert Review of Pharmacoeconomics & Outcomes Research, 11(4), 441–446. https://doi.org/10.1586/erp.11.44 DOI: https://doi.org/10.1586/erp.11.44

Zick, S. M., Colacino, J., Cornellier, M., Khabir, T., Surnow, K., & Djuric, Z. (2017). Fatigue reduction diet in breast cancer survivors: A pilot randomized clinical trial. Breast Cancer Research and Treatment, 161(2), 299. https://doi.org/10.1007/S10549-016-4070-Y DOI: https://doi.org/10.1007/s10549-016-4070-y

Published

2023-10-04

How to Cite

Roomaney, R., Coetzee, B., Smith, P., & Daniels, J. (2023). Women’s Experiences of Managing Fatigue During Breast Cancer Treatment: Strategies from Patients in a Low-Resource Setting. Social and Health Sciences, 21(1 and 2), 18 pages . https://doi.org/10.25159/2957-3645/11102

Issue

Section

Articles