The role of early maladaptive schemas and acceptance regarding chronic fatigue in oncology patients after treatment

Approximately one third of cancer survivors experience chronic cancer-related fatigue (CCRF). This study examined the role of acceptance and early maladaptive schemas (EMSs) unrelenting standards, self-sacrifice and abandonment in perpetuating CCRF after cancer. We hypothesized that EMSs are positively correlated with CCRF severity and negatively correlated with the degree of acceptance. Moreover, we hypothesized the possible role of acceptance as mediator and the role of EMSs as moderator. Cancer survivors ( n = 121, aged 18–70) were randomly recruited from various cancer clinics at Zuyderland Medical Centre. Using a cross-sectional design, fatigue (CIS), early maladaptive schemas (YSQ-S3), acceptance (FMI), and anxiety/depressive symptoms (HADS) were assessed 6 months to 5 years post-curative treatment. Hypotheses were tested using multivariable linear regression analyses. All three EMSs showed significant positive associations with CCRF (unrelenting standards Pearson r = 0.305, p < 0.001; self-sacrifice Pearson r = 0.287, p = 0.001; abandonment Spearman r = 0.233, p = 0.01). EMS unrelenting standards also reduces acceptance levels (multivariable-adjusted B = −1.12; 95% CI = −1.84 to −0.39). Acceptance turned out to mediate the relationship between EMS unrelenting standards and CCRF (direct effect B = 2.37; 95% CI = −0.90 to 5.73; indirect effect B = 4.17; 95% CI = 2.20 to 6.77). No moderation effect was found. EMSs, particularly unrelenting standards, may perpetuate CCRF, while acceptance is negatively related to fatigue symptoms. Early screening incorporating EMSs could improve CCRF detection and treatment outcomes. During treatment of CCRF it would be interesting to target the mediating role of acceptance by acceptance-based interventions.