Forming new habits in the face of chronic cancer-related fatigue: An interpretative phenomenological study
Open accessAbstract
Purpose: The growing group of patients who suffer from chronic cancer-related fatigue (CCRF) after cancer have helpful and less helpful ways of responding to this long-lasting and disruptive problem. This qualitative study aimed to gain insight in essential elements of how patients respond to CCRF, with a focus on helpful responses to facilitate adaptation. Methods: We conducted semi-structured interviews with a purposive sample of 25 participants who experienced severe CCRF for at least 3 months. Participants were recruited via media, patient associations, meetings, and health professionals until data saturation was attained. We used a topic guide with open-ended questions about lived experiences. Interpretative phenomenological analysis (IPA) was used for analysis of the transcripts. Results: We identified five interrelated themes of how patients respond to CCRF: (1) discovering physical and emotional boundaries; (2) communicating support needs; (3) reorganizing and planning activities and rest; (4) letting go of one’s habitual identity; and (5) recognizing and accepting CCRF. Conclusion: This study highlights the development of new habits and positive beliefs in the face of CCRF and the importance of (social) support in this process. This experiential knowledge on helpful responses can be used to inform patients and their significant others and improve self-efficacy. Health professionals could use these insights to improve recognition of CCRF and personalize treatment.
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Patients who are more accepting of their CRF show lower fatigue levels, suggesting acceptance may protect against fatigue persistence.
“Regarding protective factors, patients who are more accepting of their CRF show lower fatigue levels, suggesting that acceptance may protect patients from fatigue persistence.4,6,13”
From Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer-related fatigue (2023) · cites this paper as [6]
The Discussion (Clinical implications and future research; page unavailable) reports an association between acceptance of present-moment experiences and lower fatigue in hematological cancer patients. The Results (Responses to CCRF; page unavailable) discuss accepting chronic cancer-related fatigue, but this study does not show that patients who accept their fatigue have lower fatigue levels or that acceptance protects against its persistence. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe EMA protocol Energy InSight was developed based on quantitative and qualitative research findings, CRF literature, and clinical expertise.
“Based on our quantitative (i.e., cross-sectional group-level network analysis) and qualitative research findings (i.e., metaethnography), the CRF literature, and our clinical expertise, we developed the EMA protocol Energy InSight. 6,13,20”
From Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer-related fatigue (2023) · cites this paper as [6]
The Methods (Data-analysis; page unavailable) describe qualitative findings from interpretative phenomenological analysis, and the Discussion (Clinical implications and future research; page unavailable) suggests experience sampling as a future method. The paper does not report a metaethnography or say that its findings, CRF literature, and clinical expertise were used to develop the Energy InSight EMA protocol. (LLM, conf=0.78)
Experimental — accuracy not yet measuredAllowing oneself to rest may be a behavioral mechanism promoting adaptive functioning in the face of CRF, as patients often report coping by pacing and balancing activity and rest.
“Allowing oneself to rest may be another behavioral mechanism promoting adaptive functioning in the face of CRF, as patients often report that they cope with their fatigue by pacing themselves and by balancing activity and rest.6,11”
From Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer-related fatigue (2023) · cites this paper as [6]
Previous findings indicated that cancer patients take more time to rest when they feel more fatigued.
“Indeed, previous findings indicated that cancer patients take more time to rest when they feel more fatigued.6”
From Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer-related fatigue (2023) · cites this paper as [6]
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Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Depression and quality of life in older persons: A review
Sivertsen, H., Bjørkløf, G. H., Engedal, K., Selbæk, G., & Helvik, A.-S. (2015) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000437299 · Cited by 14,152 · see citing works
Interpretative Phenomenological Analysis: Theory, Method and Research
(2010) · QMiP Bulletin · doi:10.53841/bpsqmip.2010.1.10.44 · Cited by 8,189 · see citing works
(2008) · Medical Entomology and Zoology · Cited by 7,477 · see citing works
Mindfulness training as a clinical intervention: a conceptual and empirical review
Baer, R. A. (2003) · Clinical Psychology: Science and Practice · doi:10.1093/clipsy.bpg015 · Cited by 4,577 · see citing works
Mindfulness training as a clinical intervention: A conceptual and empirical review.
Baer, R. A. (2003) · Clinical Psychology: Science and Practice · doi:10.1093/clipsy/bpg015 · Cited by 4,576 · see citing works
Ouellette, J. A., & Wood, W. (1998) · Psychological Bulletin · doi:10.1037/0033-2909.124.1.54 · Cited by 3,480 · see citing works
Ideas Pertaining to a Pure Phenomenology and to a Phenomenological Philosophy
(1989) · Springer eBooks · doi:10.1007/978-94-009-2233-4 · Cited by 1,662 · see citing works
Dimensional assessment of chronic fatigue syndrome
Vercoulen, J. H. M. M., Swanink, C. M. A., Fennis, J. F. M., Galama, J. M. D., van der Meer, J. W. M., & Bleijenberg, G. (1994) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(94)90099-x · Cited by 1,306 · see citing works
Impact of Cancer-Related Fatigue on the Lives of Patients: New Findings From the Fatigue Coalition
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., et al. (2000) · The Oncologist · doi:10.1634/theoncologist.5-5-353 · Cited by 1,248 · see citing works
The Interpretative Phenomenological Analysis (IPA): A Guide to a Good Qualitative Research Approach
Alase, A. (2017) · International Journal of Education and Literacy Studies · doi:10.7575/aiac.ijels.v.5n.2p.9 · Cited by 1,088 · see citing works
Verplanken, B., & Aarts, H. (1999) · European Review of Social Psychology · doi:10.1080/14792779943000035 · Cited by 1,056 · see citing works
Mustian, K. M., Alfano, C. M., Heckler, C., Kleckner, A. S., Kleckner, I. R., Leach, C. R., Mohr, D., Palesh, O. G., Peppone, L. J., Piper, B. F., et al. (2017) · JAMA Oncology · doi:10.1001/jamaoncol.2016.6914 · Cited by 932 · see citing works
Lally, P., & Gardner, B. (2013) · Health Psychology Review · doi:10.1080/17437199.2011.603640 · Cited by 901 · see citing works
Psychological adjustment to chronic disease
de Ridder, D., Geenen, R., Kuijer, R., & van Middendorp, H. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61078-8 · Cited by 759 · see citing works
Stasi, R., Abriani, L., Beccaglia, P., Terzoli, E., & Amadori, S. (2003) · Cancer · doi:10.1002/cncr.11742 · Cited by 710 · see citing works
Hilfiker, R., Meichtry, A., Eicher, M., Nilsson Balfe, L., Knols, R. H., Verra, M. L., & Taeymans, J. (2018) · British Journal of Sports Medicine · doi:10.1136/bjsports-2016-096422 · Cited by 396 · see citing works
Mitchell, A. J., Meader, N., & Symonds, P. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.01.067 · Cited by 394 · see citing works
Cancer-related fatigue and associated disability in post-treatment cancer survivors
Jones, J. M., Olson, K. L., Catton, P. A., Catton, C., Fleshner, N. E., Krzyzanowska, M. K., McCready, D. R., Wong, R. K. S., Jiang, H., & Howell, D. (2015) · Journal of Cancer Survivorship · doi:10.1007/s11764-015-0450-2 · Cited by 339 · see citing works
Vodermaier, A., & Millman, R. D. (2011) · Supportive Care in Cancer · doi:10.1007/s00520-011-1251-4 · Cited by 332 · see citing works
Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study
Servaes, P., Verhagen, S. C. A. H. H. V. M., & Bleijenberg, G. (2002) · Annals of Oncology · doi:10.1093/annonc/mdf082 · Cited by 331 · see citing works
Positive affective processes underlie positive health behaviour change
Cappellen, P. V., Rice, E. L., Catalino, L. I., & Fredrickson, B. L. (2017) · Psychology and Health · doi:10.1080/08870446.2017.1320798 · Cited by 311 · see citing works
Phenomenology and its application in medicine
Carel, H. (2011) · Theoretical Medicine and Bioethics · doi:10.1007/s11017-010-9161-x · Cited by 252 · see citing works
Mindfulness‐based cognitive therapy reduces chronic cancer‐related fatigue: a treatment study
van der Lee, M. L., & Garssen, B. (2012) · Psycho-Oncology · doi:10.1002/pon.1890 · Cited by 178 · see citing works
Seiler, A., Klaas, V., Tröster, G., & Fagundes, C. P. (2017) · Psycho-Oncology · doi:10.1002/pon.4489 · Cited by 176 · see citing works
Cognitive behaviour therapy for fatigued cancer survivors: long-term follow-up
Gielissen, M. F. M., Verhagen, C. A. H. H. V. M., & Bleijenberg, G. (2007) · British Journal of Cancer · doi:10.1038/sj.bjc.6603899 · Cited by 166 · see citing works
Abrahams, H. J. G., Gielissen, M. F. M., Donders, R. R. T., Goedendorp, M. M., van der Wouw, A. J., Verhagen, C. A. H. H. V. M., & Knoop, H. (2017) · Cancer · doi:10.1002/cncr.30815 · Cited by 165 · see citing works
Goedendorp, M. M., Gielissen, M. F. M., Verhagen, C. A. H. H. V. M., & Bleijenberg, G. (2012) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2012.02.009 · Cited by 127 · see citing works
Bruggeman-Everts, F. Z., Wolvers, M. D. J., van de Schoot, R., Vollenbroek-Hutten, M. M. R., & van der Lee, M. L. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7180 · Cited by 104 · see citing works
The Impact of Chronic Diseases
Baanders, A. N., & Heijmans, M. (2007) · Family & Community Health · doi:10.1097/01.fch.0000290543.48576.cf · Cited by 99 · see citing works
Fatigue after treatment for malignant and benign bone and soft tissue tumors
Servaes, P., Verhagen, S. C. A. H. H. V. M., Schreuder, H. W. B., Veth, R. P. H., & Bleijenberg, G. (2003) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2003.03.001 · Cited by 97 · see citing works
Holley, S. (2000) · Cancer Practice · doi:10.1046/j.1523-5394.2000.82007.x · Cited by 96 · see citing works
Schellekens, M. P. J., Wolvers, M. D. J., Schroevers, M. J., Bootsma, T. I., Cramer, A. O. J., & van der Lee, M. L. (2020) · Journal of Behavioral Medicine · doi:10.1007/s10865-019-00084-7 · Cited by 93 · see citing works
Self-citationGoedendorp, M. M., Knoop, H., Gielissen, M. F. M., Verhagen, C. A. H. H. V. M., & Bleijenberg, G. (2013) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2013.02.014 · Cited by 67 · see citing works
Bootsma, T. I., Schellekens, M. P. J., van Woezik, R. A. M., van der Lee, M. L., & Slatman, J. (2020) · Psycho-Oncology · doi:10.1002/pon.5213 · Cited by 55 · see citing works
Self-citationSoares, A. R., Biasoli, I., Scheliga, A. A. D. S., Baptista, R. L. R., Brabo, E. P., Morais, J. C., Werneck, G. L., & Spector, N. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-013-1775-x · Cited by 46 · see citing works
Levkovich, I., Cohen, M., & Karkabi, K. (2019) · Behavioral Medicine · doi:10.1080/08964289.2017.1399100 · Cited by 43 · see citing works
‘Bodies (that) matter’: the role of habit formation for identity
Wehrle, M. (2020) · Phenomenology and the Cognitive Sciences · doi:10.1007/s11097-020-09703-0 · Cited by 42 · see citing works
White, K., Issac, M. S. M., Kamoun, C., Leygues, J., & Cohn, S. R. (2018) · Health Psychology Open · doi:10.1177/2055102918793552 · Cited by 40 · see citing works
Gledhill, J. (2005) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2004.11.002 · Cited by 33 · see citing works
Rosman, S. (2009) · European Journal of Cancer Care · doi:10.1111/j.1365-2354.2007.00863.x · Cited by 31 · see citing works
Predictors of fatigue and work ability in cancer survivors
van Muijen, P., Duijts, S. F. A., Bonefaas-Groenewoud, K., van der Beek, A. J., & Anema, J. R. (2017) · Occupational Medicine · doi:10.1093/occmed/kqx165 · Cited by 28 · see citing works
Kuba, K., Weißflog, G., Götze, H., García-Torres, F., Mehnert, A., & Esser, P. (2019) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2018.12.001 · Cited by 26 · cited 1× · see citing works
“5 years post diagnosis) and found that acceptance of one’s present moment experiences is associated with lower levels of fatigue and subjective cognitive impairment [39].”
BackgroundGarssen, B., Van der Lee, M., Van der Poll, A., Ranchor, A. V., Sanderman, R., & Schroevers, M. J. (2016) · Psychology & Health · doi:10.1080/08870446.2016.1204447 · Cited by 17 · see citing works
Müller, F., Stephenson, E., DeLongis, A., Smink, A., van Ginkel, R. J., Tuinman, M. A., & Hagedoorn, M. (2017) · Psycho-Oncology · doi:10.1002/pon.4574 · Cited by 15 · see citing works
Factors in Cancer-Related Fatigue Self-Management Behaviors of Outpatients Undergoing Chemotherapy
Chiba, I., Sasahara, T., & Mizuno, M. (2019) · Asia-Pacific Journal of Oncology Nursing · doi:10.4103/apjon.apjon_1_19 · Cited by 9 · see citing works
Feeling “Pooped” and “Run Down?”: Fatigue Experiences in Latino Cancer Patients
Cordero, E. D., Dimsdale, J. E., & Navarro, A. M. (2015) · Journal of Applied Biobehavioral Research · doi:10.1111/jabr.12030 · Cited by 6 · see citing works
de Ridder, D. T. D., Leseman, P. P. M., & de Rijk, A. E. (2004) · British Journal of Health Psychology · doi:10.1348/135910704322778731 · Cited by 6 · see citing works
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Sorted by citations
Schellekens, M. P. J., Zwanenburg, L. C., & van der Lee, M. L. (2024) · Current Oncology · doi:10.3390/curroncol31070297 · Cited by 29 · see citing works
Self-citationBootsma, T. I., Schellekens, M. P. J., van Woezik, R. A. M., Slatman, J., & van der Lee, M. L. (2022) · Internet Interventions · doi:10.1016/j.invent.2022.100568 · Cited by 16 · see citing works
Self-citationNavigating severe chronic cancer-related fatigue: an interpretative phenomenological analysis
Bootsma, T. I., Schellekens, M. P. J., van Woezik, R., van der Lee, M. L., & Slatman, J. (2021) · Psychology and Health · doi:10.1080/08870446.2021.1973468 · Cited by 15 · see citing works
Self-citationLi, H., Ng, M. S. N., Jin, X., & Wong, C. L. (2023) · Palliative Medicine · doi:10.1177/02692163231184926 · Cited by 13 · see citing works
van der Smissen, D., Lugtenberg, M., Enting, M., Beerepoot, L. V., Mols, F., Brouwers, E. P. M., Wasowicz, D. K., & Joosen, M. C. W. (2025) · PLoS ONE · doi:10.1371/journal.pone.0313984 · Cited by 10 · see citing works
van Roozendaal, A. S., Schellekens, M. P. J., van Woezik, R. A. M., & van der Lee, M. L. (2023) · Psycho-Oncology · doi:10.1002/pon.6235 · Cited by 6 · see citing works
“6,11 Self - efficacy, that is, one's confidence in their capability to influence one's fatigue, is also thought to promote adaptive health behaviors and mediate CRF severity.”
BackgroundInfluentialSelf-citationMoskalewicz, M., Kordel, P., Kokociński, M., Wiertlewska-Bielarz, J., & Makowski, P. T. (2023) · Scientific Reports · doi:10.1038/s41598-023-35856-4 · Cited by 6 · see citing works
Shu, J., Ren, W., Chen, S., Li, L., Zhu, H., & Jin, A. (2022) · American Journal of Clinical Oncology · doi:10.1097/coc.0000000000000922 · Cited by 5 · see citing works
Karakuş, Z. N., & Özer, Z. (2023) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2023.102483 · Cited by 4 · see citing works
Geerts, J. A., Siemerink, E., Sniehotta, F. F., Loman, L. J. M., Bode, C., & Pieterse, M. E. (2024) · Pilot and Feasibility Studies · doi:10.1186/s40814-024-01571-8 · Cited by 3 · see citing works
Profoundly Depleted: Qualitative Study of Persistent Fatigue Following Hematopoietic Cell Transplant
Nelson, A. M., Cronin, K. G., Wood, A. M., Traeger, L. N., Barata, A., Newcomb, R. A., Amonoo, H. L., Jim, H., Knoop, H., El-Jawahri, A. R., et al. (2025) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2025.06.009 · Cited by 1 · see citing works
Francken, K. F., Kooij, A., Zwahlen, D., Buffart, L. M., Dekker, J., van Laarhoven, H. W. M., Braamse, A. M. J., Müller, F., & Knoop, H. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09765-3 · Cited by 1 · see citing works
Geerts, J. A., Bode, C., Sniehotta, F. F., Siemerink, E., & Pieterse, M. E. (2025) · Journal of Psychosocial Oncology Research and Practice · doi:10.1097/or9.0000000000000181 · Cited by 1 · see citing works
Wehrle, M. (2022) · Philosophische Methoden · doi:10.1007/978-3-476-05778-5_3
Wehrle, M. (2025) · Springer eBooks · doi:10.1007/978-3-662-71777-6_3
Geerts, J. A., Pieterse, M. E., Siemerink, E., ten Klooster, P., Loman, L. J. M., Wensink, M., Sniehotta, F. F., & Bode, C. (2026) · Health Psychology Open · doi:10.1177/20551029261418060
Arumsari, A. D. (2025) · Sinergi International Journal of Psychology · doi:10.61194/psychology.v3i4.1129
- Authors
- Bootsma, T. I., Schellekens, M. P. J., van Woezik, R. A. M., Slatman, J., & van der Lee, M. L.
- Affiliations
- Tilburg University (NL)
- Corresponding author
- Bootsma, Tom I.
- ORCID
- Venue
- Supportive Care in Cancer
- Published
- 2021-05-06
- Volume
- 29
- Issue
- 11
- Pages
- 6651-6659
- ISSN
- 0941-4355 (ISSN-L)
- 1433-7339
- PMC
- PMC8464573
- OpenAlex
- W3157881121
- Cited by
- 17
- References
- 47
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 1
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Supportive Care in Cancer (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- Research portal (Tilburg University) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- KWF Kankerbestrijding (10761)
- Maarten van der Weijden Foundation (10761)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- coping strategies, habit formation, lived experience, social support, acceptance, self-efficacy, personal transformation, emotional boundaries
- MeSH terms
- Fatigue, Habits, Humans, Neoplasms, Social Support, Qualitative Research
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