Impact of a Multimodal and Combination Therapy on Self-Regulation and Internal Coherence in German Breast Cancer Survivors With Chronic Cancer-Related Fatigue: A Mixed-Method Comprehensive Cohort Design Study

摘要

Background: Recent studies have proved the relevance of salutogenetic variables for fatigue management in breast cancersurvivors with cancer-related fatigue (CRF). This comprehensive cohort design study is the first to examine the impact of 2multimodal therapies, multimodal therapy (MT) and combined therapy (CT), compared with standard aerobic training (AT) onsalutogenetic variables (self-regulation and internal coherence) and distress in breast cancer survivors with CRF. Methods: Atotal of 105 patients started the therapies and n = 84 completed the Self-regulation Scale, the Internal Coherence Scale, theCancer Fatigue Scale, and the Hospital Anxiety and Depression Scale at baseline, 10 weeks after treatment (T1) and n = 81after 6 months (T2). Patient satisfaction and qualitative feedback regarding therapy quality was assessed at T1. A general linearmodel including allocation type, therapy arm (MT/CT/AT), and bias-adjusting propensity scores tested the superiority of bothmultimodal therapies versus AT for all questionnaires at T1 and T2. Results: MT and CT were superior to AT to improve selfregulation and patients’ satisfaction at T1. Additionally, CT showed superiority for self-regulation at T2 (all P .05). Comparedwith AT, internal coherence was significantly higher for patients in the MT arms at T2, respectively (all P .01). Pearson’scorrelations between self-regulation, internal coherence, and CRF improved from baseline to T2 (Mean r = ?0.60). Qualitativefeedback confirmed patients’ benefits in several health-related categories. Conclusions: Self-regulation and internal coherenceare manipulable variables with relevant CRF associations. They can be positively affected by multimodal therapies. Alongsidepatients’ satisfaction and qualitative feedback they help refine treatment.