Personalizing psychological care for chronic cancer-related fatigue: A case study on symptom dynamics.
Open accessAbstract
Approximately 25% of cancer patients suffer from chronic cancer-related fatigue (CCRF), which is a complex, multifactorial condition. While there are evidence-based interventions, it remains unclear what treatment works best for the individual patient. Psychological network models can offer a schematic representation of interrelations among fatigue and protective and perpetuating factors for the individual patient. We explored whether feedback based on these individual fatigue networks can help personalize psychological care for CCRF. A 34-year old woman with CCRF was referred to our mental healthcare institute for psycho-oncology. During the waitlist period, she filled out an experience sampling app for 101 days, including five daily assessments of fatigue, pain, mood, activity and fatigue coping. The interplay between items was visualized in network graphs at the moment-level and day-level, which were discussed with the patient. For example, acceptance of fatigue in the past three hours was associated with less hopelessness and less fatigue in the following moment. At the day-level, acceptance was also being associated with less fatigue, less hopelessness, a better mood, and more motivation to do things. The patient recognized these patterns and explained how unexpected waves of fatigue can make her feel hopeless. This started a dialogue on how cultivating acceptance could potentially help her handle the fatigue. The patient would discuss this with her therapist. Feedback based on individual fatigue networks can provide direct insight into how one copes with CCRF and subsequently offer directions for treatment. Further research is needed in order to implement this in clinical practice.
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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 [4]
The Results and Discussion report that, for one patient with chronic cancer-related fatigue, greater acceptance was associated with less fatigue at the next assessment and at the day level. The paper does not establish that this association holds across patients or that acceptance protects against fatigue persisting over time. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFeeling guilty is expected to perpetuate one's fatigue, as falling short of one's own and others' expectations can take up a lot of energy.
“Feeling guilty is another factor that is expected to perpetuate one's fatigue.The idea of falling short of one's own and others' expectations can take up a lot of energy.4,20”
From Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer-related fatigue (2023) · cites this paper as [4]
In Results (Moment-Level Temporal Network), Sylvia reports feeling guilty when fatigue or pain kept her from taking good care of herself; Results (Experiences with feedback) says that guilt became a treatment target. The paper does not say that guilt perpetuates fatigue or that falling short of her own and others’ expectations consumes energy. It reports no temporal connections between different symptoms. (LLM, conf=0.82)
Experimental — accuracy not yet measuredCRF is experienced as a dynamic and unpredictable condition, with patients reporting sudden drops in energy levels and gradual build-up of fatigue throughout the day.
“CRF is experienced as a dynamic and unpredictable condition, with patients reporting sudden drops in energy levels, as well as a gradual build-up of their fatigue throughout the day.4,5”
From Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer-related fatigue (2023) · cites this paper as [4]
The Introduction describes CCRF as unpredictable, with sudden drops in energy and episodes of exhaustion. Results > Course of Fatigue reports fatigue increasing through the day, but that observation comes from one patient, Sylvia; the paper does not establish a gradual daily build-up as a general pattern reported by patients. (LLM, conf=0.85)
Experimental — accuracy not yet measured
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- Authors
- Schellekens, M. P. J., Bootsma, T. I., Van Woezik, R. A. M., & Van der Lee, M. L.
- Affiliations
- Tilburg University (NL)
- Corresponding author
- Schellekens, Melanie P. J.
- Venue
- Journal for Person-Oriented Research
- Publisher
- Journal for Person-Oriented Research
- Published
- 2021-08-26
- Volume
- 7
- Issue
- 1
- Pages
- 1-13
- ISSN
- 2002-0244 (ISSN-L)
- 2003-0177
- PMC
- PMC8411882
- OpenAlex
- W3197935910
- Cited by
- 9
- References
- 34
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 2 · 2022: 2
- FWCI
- 0.55
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Journal for Person-Oriented Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- Research portal (Tilburg University) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- KWF Kankerbestrijding (10761)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- psycho-oncology, acceptance, hopelessness, symptom dynamics, ecological momentary assessment, cancer patients
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