In view of the large body of research demonstrating that optimism has beneficial effects on people’s well-being and health, one may assume that it also protects against fatigue. However, few studies have investigated the association between optimism and cancer-related fatigue in cancer patients, and the results are inconsistent. Thus our aim was to investigate if optimism is associated with severe fatigue, when adjusting for known factors associated with fatigue such as age, emotional distress, pain, Body Mass Index (BMI), surgery type and adjuvant treatment. We conducted a nationwide survey of 832 Norwegian breast cancer survivors. The women completed the Fatigue Questionnaire, Brief Pain Inventory Questionnaire, the Hospital Anxiety and Depression Scale and the Life Orientation Test-Revised, two to six years after treatment. Results showed that 37% of the women reported severe fatigue. Women with severe fatigue scored lower on optimism than those without (15.5 vs 17.7, p < .0001). A logistic regression analysis with severe fatigue as the dependent variable showed that low level of optimism was significantly associated with severe fatigue, but the association was very low in comparison to emotional distress and chronic pain. The study’s findings may be useful in directing breast cancer centers’ effort to identify and provide comprehensive care for breast cancer survivors with severe fatigue.
KeywordsBreast Cancer SurvivorsEmotional DistressFatigueOptimismPain
Allison, P. J., Guichard, C., Fung, K., & Gilain, L. (2003). Dispositional Optimism Predicts Survival Status 1 Year after Diagnosis in Head and Neck Cancer Patients. Journal of Clinical Oncology, 21, 543-548. https://doi.org/10.1200/JCO.2003.10.092
Allison, P. J., Guichard, C., & Gilain, L. (2000). A Prospective Investigation of Dispositional Optimism as a Predictor of Health-Related Quality of Life in Head and Neck Cancer Patients. Quality of Life Research, 9, 951-960. https://doi.org/10.1023/A:1008931906253
Anthony, E. G., Kritz-Silverstein, D., & Barrett-Connor, E. (2016). Optimism and Mortality in Older Men and Women: The Rancho Bernardo Study. Journal of Aging Research, 2016, 5185104. https://doi.org/10.1155/2016/5185104
Bjelland, I., Dahl, A. A., Haug, T. T., & Neckelmann, D. (2002). The Validity of the Hospital Anxiety and Depression Scale. An Updated Literature Review. Journal of Psychosomatic Research, 52, 69-77. https://doi.org/10.1016/S0022-3999(01)00296-3
Bower, J. E. (2014). Cancer-Related Fatigue—Mechanisms, Risk Factors, and Treatments. Nature Reviews Clinical Oncology, 11, 597-609. https://doi.org/10.1038/nrclinonc.2014.127
Bower, J. E., Ganz, P. A., Desmond, K. A., Bernaards, C., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2006). Fatigue in Long-Term Breast Carcinoma Survivors: A Longitudinal Investigation. Cancer, 106, 751-758. https://doi.org/10.1002/cncr.21671
Breitbart, W., & Alici, Y. (2008). Pharmacologic Treatment Options for Cancer-Related Fatigue: Current State of Clinical Research. Clinical Journal of Oncology Nursing, 12, 27-36. https://doi.org/10.1188/08.CJON.S2.27-36
Cella, D., Davis, K., Breitbart, W., & Curt, G. (2001). Cancer-Related Fatigue: Prevalence of Proposed Diagnostic Criteria in a United States Sample of Cancer Survivors. Journal of Clinical Oncology, 19, 3385-3391. https://doi.org/10.1200/JCO.2001.19.14.3385
Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., & Wallace, E. P. (1993). Development of a Fatigue Scale. Journal of Psychosomatic Research, 37, 147-153. https://doi.org/10.1016/0022-3999(93)90081-P
Chambers, S. K., Meng, X., Youl, P., Aitken, J., Dunn, J., & Baade, P. (2012). A Five-Year Prospective Study of Quality of Life after Colorectal Cancer. Quality of Life Research, 21, 1551-1564. https://doi.org/10.1007/s11136-011-0067-5
Cleeland, C. S., & Ryan, K. M. (1994). Pain Assessment: Global Use of the Brief Pain Inventory. ANNALS Academy of Medicine Singapore, 23, 129-138.
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. New Jersey: Lawrence Erlbaum Associates.
de Ridder, D., Fournier, M., & Bensing, J. (2004). Does Optimism Affect Symptom Report in Chronic Disease? What Are Its Consequences for Self-Care Behaviour and Physical Functioning? Journal of Psychosomatic Research, 56, 341-350. https://doi.org/10.1016/S0022-3999(03)00034-5
Fishbain, D. A., Hall, J. A., Risser, R. C., & Gonzales, J. S. (2009). Does Pain Cause the Perception of Fatigue in Patients with Chronic Pain? Findings from Studies for Management of Diabetic Peripheral Neuropathic Pain with Duloxetine. Pain Practice, 9, 354-362. https://doi.org/10.1111/j.1533-2500.2009.00294.x
Goedendorp, M. M., Peters, M. E., Gielissen, M. F., Witjes, J. A., Leer, J. W., Verhagen, C. A., & Bleijenberg, G. (2010). Is Increasing Physical Activity Necessary to Diminish Fatigue During Cancer Treatment? Comparing Cognitive Behavior Therapy and a Brief Nursing Intervention with Usual Care in a Multicenter Randomized Controlled Trial. Oncologist, 15, 1122-1132. https://doi.org/10.1634/theoncologist.2010-0092
Hamid, P. N. (1990). Optimism and the Reporting of Flu Episodes. Social Behavior and Personality, 18, 225-234. https://doi.org/10.2224/sbp.1990.18.2.225
Hanssen, M. M., Peters, M. L., Vlaeyen, J. W., Meevissen, Y. M., & Vancleef, L. M. (2013). Optimism Lowers Pain: Evidence of the Causal Status and Underlying Mechanisms. Pain, 154, 53-58. https://doi.org/10.1016/j.pain.2012.08.006
Hanssen, M. M., Vancleef, L. M., Vlaeyen, J. W., & Peters, M. L. (2014). More Optimism, Less Pain! The Influence of Generalized and Pain-Specific Expectations on Experienced Cold-Pressor Pain. Journal of Behavioral Medicine, 37, 47-58. https://doi.org/10.1007/s10865-012-9463-8
Hosmer DW, l. S. (2012). Applied Logistic Regression (2nd ed.). New York: John Wiley.
Kangas, M., Bovbjerg, D. H., & Montgomery, G. H. (2008). Cancer-Related Fatigue: A Systematic and Meta-Analytic Review of Non-Pharmacological Therapies for Cancer Patients. Psychological Bulletin, 134, 700-741. https://doi.org/10.1037/a0012825
Kurtz, M. E., Kurtz, J. C., Given, C. W., & Given, B. A. (2008). Patient Optimism and Mastery—Do They Play a Role in Cancer Patients' Management of Pain and Fatigue? Journal of Pain and Symptom Management, 36, 1-10. https://doi.org/10.1016/j.jpainsymman.2007.08.010
Levkovich, I., Cohen, M., Pollack, S., Drumea, K., & Fried, G. (2015). Cancer-Related Fatigue and Depression in Breast Cancer Patients Postchemotherapy: Different Associations with Optimism and Stress Appraisals. Palliat Support Care, 13, 1141-1151. https://doi.org/10.1017/S147895151400087X
Loge, J. H., Ekeberg, O., & Kaasa, S. (1998). Fatigue in the General Norwegian Population: Normative Data and Associations. Journal of Psychosomatic Research, 45, 53-65. https://doi.org/10.1016/S0022-3999(97)00291-2
Matthews, E. E., Schmiege, S. J., Cook, P. F., & Sousa, K. H. (2012). Breast Cancer and Symptom Clusters during Radiotherapy. Cancer Nursing, 35, E1-11. https://doi.org/10.1097/NCC.0b013e3182277222
Minton, O., & Stone, P. (2008). How Common Is Fatigue in Disease-Free Breast Cancer Survivors? A Systematic Review of the Literature. Breast Cancer Research and Treatment, 112, 5-13. https://doi.org/10.1007/s10549-007-9831-1
Pachman, D. R., Barton, D. L., Swetz, K. M., & Loprinzi, C. L. (2012). Troublesome Symptoms in Cancer Survivors: Fatigue, Insomnia, Neuropathy, and Pain. Journal of Clinical Oncology, 30, 3687-3696. https://doi.org/10.1200/JCO.2012.41.7238
Reinertsen, K. V., Cvancarova, M., Loge, J. H., Edvardsen, H., Wist, E., & Fossa, S. D. (2010). Predictors and Course of Chronic Fatigue in Long-Term Breast Cancer Survivors. Journal of Cancer Survivorship, 4, 405-414. https://doi.org/10.1200/JCO.2012.41.7238
Ronaldson, A., Poole, L., Kidd, T., Leigh, E., Jahangiri, M., & Steptoe, A. (2014). Optimism Measured Pre-Operatively Is Associated with Reduced Pain Intensity and Physical Symptom Reporting after Coronary Artery Bypass Graft Surgery. Journal of Psychosomatic Research, 77, 278-282. https://doi.org/10.1016/j.jpsychores.2014.07.018
Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing Optimism from Neuroticism (And Trait Anxiety, Self-Mastery, and Self-Esteem): A Reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063-1078. https://doi.org/10.1037/0022-3514.67.6.1063
Schou, I., Ekeberg, O., & Ruland, C. M. (2005). The Mediating Role of Appraisal and Coping in the Relationship between Optimism-Pessimism and Quality of Life. Psychooncology, 14, 718-727. https://doi.org/10.1002/pon.896
Schou, I., Ekeberg, O., Ruland, C. M., Sandvik, L., & Karesen, R. (2004). Pessimism as a Predictor of Emotional Morbidity One Year Following Breast Cancer Surgery. Psychooncology, 13, 309-320. https://doi.org/10.1002/pon.747
Snekkevik, H., Eriksen, H. R., Tangen, T., Chalder, T., & Reme, S. E. (2014). Fatigue and Depression in Sick-Listed Chronic Low Back Pain Patients. Pain Medicine, 15, 1163-1170. https://doi.org/10.1111/pme.12435
Toien, K., Myhren, H., Bredal, I. S., Skogstad, L., Sandvik, L., & Ekeberg, O. (2010). Psychological Distress after Severe Trauma: A Prospective 1-Year Follow-Up Study of a Trauma Intensive Care Unit Population. The Journal of Trauma, 69, 1552-1559. https://doi.org/10.1097/TA.0b013e3181e125f3
Tomlinson, D., Diorio, C., Beyene, J., & Sung, L. (2014). Effect of Exercise on Cancer-Related Fatigue: A Meta-Analysis. American Journal of Physical Medicine & Rehabilitation, 93, 675-686. https://doi.org/10.1097/PHM.0000000000000083
Wagner, L. I., & Cella, D. (2004). Fatigue and Cancer: Causes, Prevalence and Treatment Approaches. British Journal of Cancer, 91, 822-828. https://doi.org/10.1038/sj.bjc.6602012
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x