Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Journal of Cancer Survivorship
Published in: Journal of Cancer Survivorship 2/2014

01-06-2014

Impact of autonomic and self-regulation on cancer-related fatigue and distress in breast cancer patients – a prospective observational study

Authors: M. Kröz, M. Reif, C. Bartsch, C. Heckmann, R. Zerm, F. Schad, M. Girke

Published in: Journal of Cancer Survivorship | Issue 2/2014

Login to get access

Abstract

Purpose

Cancer-related fatigue (CRF) has a major impact on the quality of life in breast cancer patients (BC). So far, only a few prospective studies have investigated the effect of adaptive salutogenic mechanisms on CRF. The aim of our study was to evaluate the possible prospective influence of autonomic Regulation (aR) and self-regulation (SR) on CRF and distress in long-term survivors.

Methods

95 BC and 80 healthy female controls (C) had been included in the observational study between 2000 and 2001 and completed the questionnaires on aR, SR and Hospital Anxiety and Depression Scale (HADS). Of these, 62 BC, and 58 C participated in the re-evaluation 6.6 years later: 16 participants were deceased (14 BC and 2 C). During follow-up, participants were requested to answer questions involving (Cancer Fatigue Scales) CFS-D, aR, SR and HADS. Multiple regression analysis was used to evaluate the influence of aR, SR, age, Charlson co-morbidity-index and diagnosis on CFS-D and HADS, and to select further potentially relevant factors.

Results

High aR values showed significant effects, namely inverse relationships with CFS-D, cognitive fatigue, anxiety and depression. SR showed a reduced influence on anxiety and depression (all p < 0.05).

Conclusions

Autonomic regulation might have an independent, reductive influence on global fatigue, cognitive fatigue and – together with self-regulation – it seems to have a protective influence on anxiety and depression. The connection between these parameters is still unclear and awaits further evaluation.

Implication for Cancer Survivors

AR seems to be a prognostic factor in breast cancer survivors, capable of reducing cancer-related fatigue and self-regulation distress as well. Further research is necessary in order to show how aR can be improved by therapeutic interventions.
Literature
1.
Greenberg D, Earle C, Fang CH, Eldar-Lissai A, Neumann PJ. When is cancer care cost-effective? A systematic overview of cost-utility analyses in oncology. J Natl Cancer Inst. 2010;102:82–8.PubMedCentralCrossRefPubMed
2.
Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med. 2002;346:235–42.CrossRefPubMed
3.
O'Brien SG, Guilhot F, Larson RA, Gathmann I, Baccarani M, Cervantes F, et al. Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia. N Engl J Med. 2003;348:994–1004.CrossRefPubMed
4.
Mauri D, Polyzos NP, Salanti G, Pavlidis N, Ioannidis JP. Multiple-treatments meta-analysis of chemotherapy and targeted therapies in advanced breast cancer. J Natl Cancer Inst. 2008;100:1780–91.CrossRefPubMed
5.
Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. N Engl J Med. 2004;350:2343–51.CrossRefPubMed
6.
Kindler HL, Niedzwiecki D, Hollis D, Sutherland S, Schrag D, Hurwitz H, et al. Gemcitabine plus bevacizumab compared with gemcitabine plus placebo in patients with advanced pancreatic cancer: phase III trial of the Cancer and Leukemia Group B (CALGB 80303). J Clin Oncol. 2010;28:3617–22.PubMedCentralCrossRefPubMed
7.
Osoba D, Aaronson N, Zee B, Sprangers M, te Velde A. Modification of the EORTC QLQ-C30 (version 2.0) based on content validity and reliability testing in large samples of patients with cancer. The Study Group on Quality of Life of the EORTC and the Symptom Control and Quality of Life Committees of the NCI of Canada Clinical Trials Group. Qual Life Res. 1997;6:103–8.CrossRefPubMed
8.
Kramer JA, Curran D, Piccart M, de Haes JC, Bruning P, Klijn J, et al. Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer. Eur J Cancer. 2000;36:1498–506.CrossRefPubMed
9.
Alexander S, Minton O, Andrews P, Stone P. A comparison of the characteristics of disease-free breast cancer survivors with or without cancer-related fatigue syndrome. Eur J Cancer. 2009;45:384–92.PubMedCentralCrossRefPubMed
10.
Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N. Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey, Cancer Fatigue Forum. Ann Oncol. 2000;11:971–5.CrossRefPubMed
11.
Roscoe JA, Kaufman ME, Matteson-Rusby SE, Palesh OG, Ryan JL, Kohli S, et al. Cancer-related fatigue and sleep disorders. Oncologist. 2007;12 Suppl 1:35–42.CrossRefPubMed
12.
Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H. Persistence of restrictions in quality of life from the first to the third year after diagnosis in women with breast cancer. J Clin Oncol. 2005;23:4945–53.CrossRefPubMed
13.
Berger AM, Gerber LH, Mayer DK. Cancer-related fatigue: Implications for breast cancer survivors. Cancer. 2012;118:2261–9.CrossRefPubMed
14.
Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, et al. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer. 2006;106:751–8.CrossRefPubMed
15.
Roscoe JA, Morrow GR, Hickok JT, Bushunow P, Matteson S, Rakita D, et al. Temporal interrelationships among fatigue, circadian rhythm and depression in breast cancer patients undergoing chemotherapy treatment. Support Care Cancer. 2002;10:329–36.CrossRefPubMed
16.
Kröz M, Feder G, von Laue H, Zerm R, Reif M, Girke M, et al. Validation of a questionnaire measuring the regulation of autonomic function. BMC Complement Alternat Med. 2008;8:26.CrossRef
17.
Kröz M, Zerm R, Reif M, von Laue HB, Schad F, Bussing A, et al. Validation of the German version of the Cancer Fatigue Scale (CFS-D). Eur J Cancer Care (Engl). 2008;17:33–41.
18.
Zerm R, Brauer D, Girke M. Kröz. Daily activity, quality of sleep, autonomic regulation and self-regulation in breast cancer and insomniac patients. Eur J Integr Med. 2010;2:219.CrossRef
19.
Steiner R. 5.Vortrag vom 25.3.1920. In: Geisteswissenschaft und Medizin. Bibl.Nr. 312. Dornach: Rudolf Steiner Verlag, 1990; 96–116.
20.
Antonovsky A. Unraveling the mystery of health. How people manage stress and stay well. ed. San Francisco, London: Jossey-Bass; 1987.
21.
Grossarth-Maticek R. Systemische Epidemiologie und präventive Verhaltensmedizin chronischer Erkrankungen. ed. Berlin, New York: Walter de Gruyter; 1999.CrossRef
22.
Wainwright NW, Surtees PG, Welch AA, Luben RN, Khaw KT, Bingham SA. Sense of coherence, lifestyle choices and mortality. J Epidemiol Community Health. 2008;62:829–31.CrossRefPubMed
23.
Ziegler R, Grossarth-Maticek R. Individual Patient Data Meta-analysis of Survival and Psychosomatic Self-regulation from Published Prospective Controlled Cohort Studies for Long-term Therapy of Breast Cancer Patients with a Mistletoe Preparation (Iscador). Evid Based Complement Alternat Med. 2008;11:11.
24.
25.
Büssing A, Girke M, Heckmann C, Schad F, Ostermann T, Kröz M. Validation of the self regulation questionnaire as a measure of health in quality of life research. Eur J Med Res. 2009;14:223–7.PubMedCentralCrossRefPubMed
26.
Grossarth-Maticek R, Kiene H, Baumgartner SM, Ziegler R. Use of Iscador, an extract of European mistletoe (Viscum album), in cancer treatment: prospective nonrandomized and randomized matched-pair studies nested within a cohort study. Altern Ther Health Med. 2001;7:57–66. 68–72, 74–56 passim.PubMed
27.
Grossarth-Maticek R, Eysenck HJ. Self-regulation and mortality from cancer, coronary heart disease, and other causes: a prospective study. Personal Individ Differ. 1995;19:781–95.CrossRef
28.
Brennan C, Worrall-Davies A, McMillan D, Gilbody S, House A. The Hospital Anxiety and Depression Scale: a diagnostic meta-analysis of case-finding ability. J Psychosom Res. 2010;69:371–8.CrossRefPubMed
29.
Herrmann C, Buss U. HADS-D, Hospital Anxiety and Depression Scale- Deutsche Version. Testdokumentation und Handanweisung. ed. Bern, Göttingen, Toronto, Seattle: Verlag Hans Huber; 1995.
30.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40:373–83.CrossRefPubMed
31.
Okuyama T, Akechi T, Kugaya A, Okamura H, Shima Y, Maruguchi M, et al. Development and validation of the cancer fatigue scale: a brief, three-dimensional, self-rating scale for assessment of fatigue in cancer patients. J Pain Symptom Manag. 2000;19:5–14.CrossRef
32.
33.
Reif M, Kröz M, Schad F, von Laue H, Feder G, Matthes H, Girke M. Classification procedure of the German Version of the Cancer Fatigue Scale (CFS-D) In: ASCO, vol. 27. Orlando, 2009; abstract e20608.
34.
Brunner E. U M. Nicht-parametrische Datenanalyse. ed. Berlin: Springer; 2002.CrossRef
35.
Kröz M, Reif M, Büssing A, Zerm R, von Laue H, Bockelbrink A, et al. Does Self Regulation and Autonomic Regulation have an influence on survival in breast and colon carcinoma patients? Results of a prospective outcome study. Health Qual Life Outcome. 2011;9:85.CrossRef
36.
Innominato PF, Focan C, Gorlia T, Moreau T, Garufi C, Waterhouse J, et al. Circadian rhythm in rest and activity: a biological correlate of quality of life and a predictor of survival in patients with metastatic colorectal cancer. Cancer Res. 2009;69:4700–7.PubMedCentralCrossRefPubMed
37.
Jansen CE, Cooper BA, Dodd MJ, Miaskowski CA. A prospective longitudinal study of chemotherapy-induced cognitive changes in breast cancer patients. Support Care Cancer. 2011;19:1647–56.CrossRefPubMed
38.
Reinertsen KV, Cvancarova M, Loge JH, Edvardsen H, Wist E, Fossa SD. Predictors and course of chronic fatigue in long-term breast cancer survivors. J Cancer Surviv. 2011;4:405–14.CrossRef
39.
Duijts SF, Faber MM, Oldenburg HS, van Beurden M, Aaronson NK. Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors-a meta-analysis. Psychooncology. 2011;20:115–26.CrossRefPubMed
40.
Dimeo F, Schwartz S, Wesel N, Voigt A, Thiel E. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Ann Oncol. 2008;19:1495–9.CrossRefPubMed
41.
Palesh O, Zeitzer JM, Conrad A, Giese-Davis J, Mustian KM, Popek V, et al. Vagal regulation, cortisol, and sleep disruption in women with metastatic breast cancer. J Clin Sleep Med. 2008;4:441–9.PubMedCentralPubMed
42.
Sephton SE, Sapolsky RM, Kraemer HC, Spiegel D. Diurnal cortisol rhythm as a predictor of breast cancer survival. J Natl Cancer Inst. 2000;92:994–1000.CrossRefPubMed
43.
Bower JE, Ganz PA, Dickerson SS, Petersen L, Aziz N, Fahey JL. Diurnal cortisol rhythm and fatigue in breast cancer survivors. Psychoneuroendocrinology. 2005;30:92–100.CrossRefPubMed
44.
Filipski E, Li XM, Levi F. Disruption of circadian coordination and malignant growth. Cancer Causes Control. 2006;17:509–14.CrossRefPubMed
45.
Schernhammer ES, Kroenke CH, Laden F, Hankinson SE. Night work and risk of breast cancer. Epidemiology. 2006;17:108–11.CrossRefPubMed
46.
Bartsch C, Bartsch H. The anti-tumor activity of pineal melatonin and cancer enhancing kife styles in industrialized societies. Cancer Causes Control. 2006;17:559–71.CrossRefPubMed
47.
Groenvold M, Petersen MA, Idler E, Bjorner JB, Fayers PM, Mouridsen HT. Psychological distress and fatigue predicted recurrence and survival in primary breast cancer patients. Breast Cancer Res Treat. 2007;105:209–19.CrossRefPubMed
48.
Berger AM, Kuhn BR, Farr LA, Von Essen SG, Chamberlain J, Lynch JC, et al. One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. J Clin Oncol. 2009;27:6033–40.PubMedCentralCrossRefPubMed
49.
Grossarth-Maticek R, Eysenck HJ, Boyle GJ, Heep J, Costa SD, Diel IJ. Interaction of psychosocial and physical risk factors in the causation of mammary cancer, and its prevention through psychological methods of treatment. J Clin Psychol. 2000;56:33–50.CrossRefPubMed
50.
Eysenck HJ, Grossarth-Maticek R. Creative novation behaviour therapy as a prophylactic treatment for cancer and coronary heart disease: Part II–Effects of treatment. Behav Res Ther. 1991;29:17–31.CrossRefPubMed
51.
Kröz M, Zerm R, Fink M, Reif M, Grobecker S, Winter K, Storch Th, Brauer D, Candir F, Quetz M, Zastruzki S, Houben H, Gelin-Kröz B, Naghavi M, Klug P, von Laue HB, Frühwirth M, Brinkhaus B, Girke M, Gutenbrunner C. Predictors of therapy responsiveness for a multimodal therapy concept and aerobic training in breast cancer patients with chronic Cancer-Related-Fatigue. In: European Congress of Integrative Medicine, vol. oral presentations oncology 1 OP-018. Berlin, 7.10.2011, 2011.
Metadata
Title
Impact of autonomic and self-regulation on cancer-related fatigue and distress in breast cancer patients – a prospective observational study
Authors
M. Kröz
M. Reif
C. Bartsch
C. Heckmann
R. Zerm
F. Schad
M. Girke
Publication date
01-06-2014
Publisher
Springer US
Published in
Journal of Cancer Survivorship / Issue 2/2014
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI
https://doi.org/10.1007/s11764-013-0314-6

Other articles of this Issue 2/2014

Journal of Cancer Survivorship 2/2014 Go to the issue

OriginalPaper

The integration of cancer survivorship training in the curriculum of hematology/oncology fellows and radiation oncology residents

OriginalPaper

Function and friction at work: a multidimensional analysis of work outcomes in cancer survivors

OriginalPaper

Emotional distress among adult survivors of childhood cancer

OriginalPaper

Measurement of physical activity in cancer survivors: a validity study

OriginalPaper

Unintended consequences: the social context of cancer survivors and work

OriginalPaper

A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits