title: Self-regulatory fatigue in hematologic malignancies: impact on quality of life, coping, and adherence to medical recommendations.
abstract: BACKGROUND
  Hematopoietic stem cell transplantation (HSCT) is an intensive cancer therapy entailing numerous physical, emotional, cognitive, and practical challenges. Patients' ability to adjust and cope with such challenges may depend on their ability to exert control over cognitive, emotional, and behavioral processes, that is, ability to self-regulate. Self-regulatory capacity is a limited resource that can be depleted or fatigued (i.e., "self-regulatory fatigue"), particularly in the context of stressful life events such as cancer diagnosis and treatment.
  
  
  OBJECTIVE
  This is one of the first studies to examine self-regulatory fatigue in a cancer population. The current study aimed to (1) extract items for a specific scale of self-regulatory capacity and (2) examine the impact of such capacity on adaptation in patients with hematologic malignancies preparing for HSCT.
  
  
  METHODS
  Factor analysis of four existing scales gauging psychological adjustment and well-being in 314 patients preparing for HSCT (63% male and 89% Caucasian) identified 23 items (α = 0.85) related to self-regulatory control or fatigue. This measure was then examined using existing clinical data obtained from 178 patients (57% male and 91% Caucasian) undergoing treatment for hematologic malignancies in relationship to quality of life, coping, and self-reported adherence to physicians' recommendations.
  
  
  RESULTS
  Controlling for pain severity, physical fatigue, and depression, self-regulatory fatigue scores were incrementally associated with decreased quality of life, use of avoidance coping strategies, and decreased adherence to physicians' recommendations.
  
  
  CONCLUSIONS
  These results emphasize the potential role of self-regulatory capacity in coping with and adjusting to hematologic cancers and future research is warranted.
authors.affiliation: Department of Psychiatry and Psychology, Rochester, MN 55905, USA. lsolbnes@umn.edu
authors.forename: Lise
authors.initials: L
authors.lastname: Solberg Nes
authors.forename: Shawna L
authors.initials: SL
authors.lastname: Ehlers
authors.forename: Christi A
authors.initials: CA
authors.lastname: Patten
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Gastineau
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000686:Amyloidosis / Q000523:psychology; D003863:Depression / Q000523:psychology; D005163:Factor Analysis, Statistical; D005221:Fatigue / Q000523:psychology*; D005260:Female; D019337:Hematologic Neoplasms / Q000523:psychology*; D006801:Humans; D007938:Leukemia / Q000523:psychology; D008223:Lymphoma / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology*; D011788:Quality of Life; D012927:Social Control, Informal