Anxiety, Fatigue, and Coping
First some context: it would be impossible to be diagnosed with breast cancer, undergo cancer surgery, and not feel anxious. Through the years, I have learned not to make any assumptions about a woman's usual state of mind based on her mood and coping when I meet her in the early days of breast cancer. No one is at her best, and most of us are quite overwhelmed with anxiety and sadness. There are two general kinds of anxiety which mental health people think of as "trait anxiety" and "state anxiety". Trait anxiety refers to something that is part of a person's personality and baseline coping; some people are just generally anxious. State anxiety refers to anxiety that is generated by an event or situation, and surely a cance dignosis would quality.
If you would like a bit more of an explanation, click here.
The second part of today's equation is fatigue. Again, we have different baselines of fatigue and energy level. Some people sleep better than others, and we maintain different schedules and routines. There are people who are always tired, and others who are generally well-rested and energetic. Add a new cancer diagnosis and it is safe to assume that everyone is sleeping less well, ruminating in the middle of the night, and feeling more depleted and tired. For some women, this state of exhaustion is a real hindrance to functioning, worse than anything that can be helped with a cup of coffee or a short walk or a nap. (And this leads to an aside: I recently read a study that asked people, who were feeling tired, to do one of those three things. The people who took a ten minute walk felt best.)
This is an article from PsychoOncology about the relationships between anxiety, fatigue, and coping after surgery. Bottom line: women who had trait anxiety had a more difficult time. Here is the abstract and then a link to read more:
What is the relationship between trait anxiety and depressive symptoms, fatigue, and low sleep quality following breast cancer surgery?
J. P. M. Lockefeer1* and J. De Vries2,3 1Department of Medical Psychology, TweeSteden Hospital, Tilburg, The Netherlands 2Centre of Research on Psychology in Somatic Diseases, Department of Medical Psychology and Neuropsychology, Tilburg University, Tilburg, The Netherlands 3Department of Medical Psychology, St Elisabeth Hospital, Tilburg, The Netherlands Abstract
Background: Depressive symptoms, fatigue, and low sleep quality are common symptoms during and after breast cancer (BC) treatment. In the present study, the relationship between trait anxiety and these symptoms in a long follow-up period was examined.
Methods: This was a prospective study. Participants, composed of 163 women with BC and 224 women with benign breast problems (BBPs), completed questionnaires on depressive symptoms, fatigue, and sleep quality before diagnosis and 1, 3, 6, 12, and 24 months after diagnosis (BBP group) or surgical treatment (BC group). In addition, patients completed a questionnaire on trait anxiety before diagnosis.
Results and Conclusions: Trait anxiety was the most signi?cant predictor for depressive symptoms ( p < 0.001) and lower sleep quality ( p = 0.040) at 2-year follow-up. For fatigue, fatigue at baseline and trait anxiety together was the most important predictor ( p < 0.001). Linear mixed model analyses showed that there was an interaction effect of time with trait anxiety and with diagnosis for depressive symptoms ( p = 0.001 and p < 0.001) and fatigue ( p = 0.004 and p < 0.001). There was no interaction effect of time with trait anxiety or diagnosis for sleep quality ( p = 0.055 and p = 0.225). Together with diagnosis, trait anxiety was an important determinant of depressive symptoms, fatigue, and low sleep quality following diagnosis of BBP or BC and seemed to be a common factor in these persisting symptoms.