Correlates of Fatigue During and Following Adjuvant Breast Cancer Chemotherapy: a Pilot Study

Purpose/objectives: To examine patterns of and relationships between activity, sleep, symptom distress, health status, and fatigue during and following adjuvant breast cancer chemotherapy with doxorubicin and cyclophosphamide.

Design: Prospective, descriptive, repeated measures.

Setting: Midwestern, urban, oncology clinics.

Sample: 14 women, ages 32-69 (X = 52.4), with stage I or II breast cancer receiving four cycles of chemotherapy.

Methods: Wrist actigraph, modified Morin Sleep Diary, Symptom Experience Scale, Medical Outcomes Study-Short Form 36, and Piper Fatigue Scale were used to collect data two days prior to and during the 21-day cycle 3, and for three days at three weeks and two months following treatment 4.

Main Research Variables: Activity, sleep, symptom distress, health status, and fatigue.

Findings: Fluctuating patterns of lowered activity, disturbed sleep, mild-to-moderate symptom distress, and moderate fatigue were identified. Mean activity levels ranged from 65%-80% of norms during and following treatments. Patterns of sleep (total rest, sleep latency, wake after sleep onset, and sleep efficiency) differed from established norms. Patients experienced the highest levels of fatigue and symptom distress during the first four days after treatment 3. Correlates of fatigue were greater symptom distress, lower activity, and poorer physical and social health status; variables representing disturbed sleep trended toward associations with fatigue.

Conclusion: Activity, sleep, symptom distress, and health status cluster in patterns associated with either lower or higher fatigue.

Implications For Nursing Practice: Efforts to manage symptoms, remain active, and obtain quality sleep, especially in women with poorer health status, may assist in modifying fatigue.