title: Impact of autonomic and self-regulation on cancer-related fatigue and distress in breast cancer patients--a prospective observational study.
abstract: OBJECTIVE
  Cancer-related fatigue (CRF) has a major impact on the quality of life in breast cancer patients (BC). So far, only a few prospective studies have investigated the effect of adaptive salutogenic mechanisms on CRF. The aim of our study was to evaluate the possible prospective influence of autonomic Regulation (aR) and self-regulation (SR) on CRF and distress in long-term survivors.
  
  
  METHODS
  95 BC and 80 healthy female controls (C) had been included in the observational study between 2000 and 2001 and completed the questionnaires on aR, SR and Hospital Anxiety and Depression Scale (HADS). Of these, 62 BC, and 58 C participated in the re-evaluation 6.6 years later: 16 participants were deceased (14 BC and 2 C). During follow-up, participants were requested to answer questions involving (Cancer Fatigue Scales) CFS-D, aR, SR and HADS. Multiple regression analysis was used to evaluate the influence of aR, SR, age, Charlson co-morbidity-index and diagnosis on CFS-D and HADS, and to select further potentially relevant factors.
  
  
  RESULTS
  High aR values showed significant effects, namely inverse relationships with CFS-D, cognitive fatigue, anxiety and depression. SR showed a reduced influence on anxiety and depression (all p < 0.05).
  
  
  CONCLUSIONS
  Autonomic regulation might have an independent, reductive influence on global fatigue, cognitive fatigue and--together with self-regulation--it seems to have a protective influence on anxiety and depression. The connection between these parameters is still unclear and awaits further evaluation.
  
  
  CONCLUSIONS
  AR seems to be a prognostic factor in breast cancer survivors, capable of reducing cancer-related fatigue and self-regulation distress as well. Further research is necessary in order to show how aR can be improved by therapeutic interventions.
authors.affiliation: Research Institute Havelhöhe (FIH), Berlin, Germany, mkroez@havelhoehe.de.
authors.forename: M
authors.initials: M
authors.lastname: Kröz
authors.forename: M
authors.initials: M
authors.lastname: Reif
authors.forename: C
authors.initials: C
authors.lastname: Bartsch
authors.forename: C
authors.initials: C
authors.lastname: Heckmann
authors.forename: R
authors.initials: R
authors.lastname: Zerm
authors.forename: F
authors.initials: F
authors.lastname: Schad
authors.forename: M
authors.initials: M
authors.lastname: Girke
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000503:physiopathology*; D003863:Depression / Q000503:physiopathology*; D005221:Fatigue / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000503:physiopathology / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D017741:Survivors