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Persistent fatigue in disease-free breast cancer survivors: Evaluating long-term effects of pretreatment depression and cancer-specific avoidance coping

Lindgren, Monica Elissa

Abstract Details

2016, Doctor of Philosophy, Ohio State University, Psychology.
Breast cancer survivors with histories of depression experience heightened fatigue long after treatment. The mechanisms by which prior depression influences persistent post-treatment fatigue are not fully understood; however, psychological processes are hypothesized to influence this relationship. This study investigated how cancer-specific avoidance, a coping strategy whereby survivors intentionally deny and avoid negative thoughts and emotions about cancer, may explain this association. Further, the study tested if past depression’s indirect effects on fatigue (through avoidance coping) intensified when women also experienced more severe physical symptoms during treatment. Effects of pretreatment depression histories on survivors’ fatigue trajectories from diagnosis to 18-months after treatment were also examined. Women with newly-diagnosed breast cancer (N = 209) were followed across three time points, at diagnosis, then 6-months and 18-months post-treatment. At each assessment, women completed self-report questionnaires, including the Multidimensional Fatigue Symptom Inventory-Short Form to measure fatigue, the Impact of Events Scale to measure avoidance coping, and the Center for Epidemiological Depression Scale to measure concurrent depressive symptoms. Depression before treatment was assessed via a clinical interview. Severity of physical symptoms during treatment were collected from medical records and measured as: (1) number of acute treatment side-effects and toxicities, and (2) nurse-assessed, objective ratings of patients’ physical disability (performance status scores). Hierarchical linear growth modeling was used to examine the shape of survivors’ fatigue trajectories over time. Moderated mediation was used to examine whether greater post-treatment avoidance coping explained associations between pretreatment depression and post-treatment fatigue, conditioned upon severity of survivors’ physical symptoms during treatment. Analyses controlled for factors with previously-established relationships to persistent cancer-related fatigue. As expected, previously-depressed women’s fatigue did not decline as much as never-depressed women’s fatigue across assessments. However, there was no evidence that greater avoidance coping, even when following more severe physical symptoms during treatment, explained associations between pretreatment depression histories and post-treatment fatigue levels. Findings suggest early fatigue interventions for patients with pretreatment depression may prevent persistently elevated fatigue in the 18-months following treatment. Results also suggest cognitive-behavioral treatment models for cancer-related fatigue, which focus on correcting dysfunctional coping strategies like cancer-specific avoidance, may have limited therapeutic relevance for breast cancer survivors with pretreatment depression histories.
Janice Kiecolt-Glaser, Ph.D. (Advisor)
Julian Thayer, Ph.D. (Committee Co-Chair)
Amelia Aldao, Ph.D. (Committee Member)
153 p.

Recommended Citations

Citations

  • Lindgren, M. E. (2016). Persistent fatigue in disease-free breast cancer survivors: Evaluating long-term effects of pretreatment depression and cancer-specific avoidance coping [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1468288760

    APA Style (7th edition)

  • Lindgren, Monica. Persistent fatigue in disease-free breast cancer survivors: Evaluating long-term effects of pretreatment depression and cancer-specific avoidance coping . 2016. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1468288760.

    MLA Style (8th edition)

  • Lindgren, Monica. "Persistent fatigue in disease-free breast cancer survivors: Evaluating long-term effects of pretreatment depression and cancer-specific avoidance coping ." Doctoral dissertation, Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1468288760

    Chicago Manual of Style (17th edition)