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Exploring the interconnectedness of fatigue, depression, anxiety and potential risk and protective factors in cancer patients: a network approach.

Authors
  • Schellekens, Melanie P J1, 2
  • Wolvers, Marije D J3
  • Schroevers, Maya J4
  • Bootsma, Tom I3, 5
  • Cramer, Angélique O J6
  • van der Lee, Marije L3
  • 1 Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, Postbus 80, 3720 AB, Bilthoven, The Netherlands. [email protected] , (Netherlands)
  • 2 Department of Methodology and Statistics, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands. [email protected] , (Netherlands)
  • 3 Scientific Research Department, Centre for Psycho-Oncology, Helen Dowling Institute, Professor Bronkhorstlaan 20, Postbus 80, 3720 AB, Bilthoven, The Netherlands. , (Netherlands)
  • 4 Department of Health Psychology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. , (Netherlands)
  • 5 Department of Cultural Studies, School of Humanities and Digital Sciences, Tilburg University, Tilburg, The Netherlands. , (Netherlands)
  • 6 Department of Methodology and Statistics, School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands. , (Netherlands)
Type
Published Article
Journal
Journal of behavioral medicine
Publication Date
Aug 01, 2020
Volume
43
Issue
4
Pages
553–563
Identifiers
DOI: 10.1007/s10865-019-00084-7
PMID: 31435892
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Researchers have extensively studied fatigue, depression and anxiety in cancer patients. Several risk and protective factors have been identified for these symptoms. As most studies address these constructs, independently from other symptoms and potential risk and protective factors, more insight into the complex relationships among these constructs is needed. This study used the multivariate network approach to gain a better understanding of how patients' symptoms and risk and protective factors (i.e. physical symptoms, social withdrawal, illness cognitions, goal adjustment and partner support) are interconnected. We used cross-sectional data from a sample of cancer patients seeking psychological care (n = 342). Using network modelling, the relationships among symptoms of fatigue, depression and anxiety, and potential risk and protective factors were explored. Additionally, centrality (i.e. the number and strength of connections of a construct) and stability of the network were explored. Among risk factors, the relationship of helplessness and physical symptoms with fatigue stood out as they were stronger than most other connections in the network. Among protective factors, illness acceptance was most centrally embedded within the network, indicating it had more and stronger connections than most other variables in the network. The network identified key connections with risk factors (helplessness, physical symptoms) and a key protective factor (acceptance) at the group level. Longitudinal studies should explore these risk and protective factors in individual dynamic networks to further investigate their causal role and the extent to which such networks can inform us on what treatment would be most suitable for the individual cancer patient.

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