title: Cancer-related fatigue, depressive symptoms, and functional status: a mediation model.
abstract: BACKGROUND
  Patients with cancer grapple with a confusing array of disease- and treatment-related symptoms while trying to maintain functioning in usual roles and daily activities. Research is needed to sort out and identify symptom clusters as a basis for a rational approach to symptom management.
  
  
  OBJECTIVE
  The aim of this study was to test, through secondary analysis, a mediation hypothesis about the direct and indirect relationships between fatigue and depressive symptoms through a pathway involving functional status.
  
  
  METHODS
  Data from the experimental and control groups of a randomized clinical intervention trial for fatigue management, collected after the second chemotherapy treatment or during the last week of radiotherapy, were analyzed. The mediation pathway from fatigue to depressive symptoms through functional status was tested separately for groups receiving either an energy conservation intervention or a control intervention, equating for time and attention.
  
  
  RESULTS
  For the control group, the results indicate support for partial mediation. The previously significant relationship between fatigue and depressive symptoms was reduced after functional status was controlled, accounting for 43% of the total mediated effect. The mediation hypothesis was not supported in the energy conservation group, indicating that the intervention may have changed the role of functional status in mediating the effect of fatigue on depressive symptoms.
  
  
  CONCLUSIONS
  In the control group, when routine activities became more difficult because of fatigue, individuals had more depressive symptoms. The results suggest that functional status is an important factor to consider in symptom management for fatigue. An appropriate intervention for fatigue would have two targets: the fatigue and strategies to reduce the likelihood of impaired functioning that could result in elevated depressive symptoms.
authors.affiliation: Nursing Research, Fox Chase Cancer Center, 510 Township Line Road, Cheltenham, PA 19012, USA. Andrea.Barsevick@fccc.edu
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Barsevick
authors.forename: William N
authors.initials: WN
authors.lastname: Dudley
authors.forename: Susan L
authors.initials: SL
authors.lastname: Beck
mesh_terms: D000203:Activities of Daily Living; D000970:Antineoplastic Agents / Q000009:adverse effects; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D011878:Radiotherapy / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents