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Goyal N, Levine BJ, Crawford SL, Avis NE. Sleep disturbance among breast cancer survivors and controls from midlife to early older adulthood: Pink SWAN. J Cancer Surviv 2024; 18:489-498. [PMID: 35982358 PMCID: PMC9938082 DOI: 10.1007/s11764-022-01247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/09/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE To compare sleep disturbance from 5 years pre- to 5 years post-diagnosis between breast cancer survivors (BCS) and women without cancer over the same period and to identify BCS subgroups exhibiting different sleep trajectories. METHODS Analyses included data from 152 BCS and 2163 controls from 20 years of follow-up in the longitudinal Study of Women's Health Across the Nation (SWAN), a multi-racial/ethnic cohort study. SWAN participants were assessed approximately annually from 1995 to 2015 using a standardized protocol. Pink SWAN focused on women who reported no cancer at SWAN enrollment and developed incident breast cancer after enrollment or did not develop breast cancer. Nonparametric locally weighted scatterplot smoothing plots and linear mixed models were used to compare the prevalence of the most frequently reported sleep problem, frequently waking several times a night (a sleep maintenance problem) during the previous 2 weeks, between BCS and controls in the 5 years pre- to 5 years post-diagnosis. We characterized heterogeneity among BCS on this sleep problem using group-based trajectories and examined pre-diagnosis variables as predictors of group membership. RESULTS No differences were found between BCS and controls in prevalence of frequent nighttime awakenings either before or after diagnosis. Among BCS, three trajectory groups were identified. Thirty-seven percent of BCS had consistently low prevalence of waking several times per night, 30% had high prevalence, and 33% had increasing prevalence which started 2 years pre-diagnosis. Prevalence of pre-diagnosis vasomotor symptoms, anxiety, depressive symptoms, and smoking differed among these groups. CONCLUSION Among mid-aged women diagnosed with breast cancer, this diagnosis did not trigger/amplify a sleep maintenance problem. The majority of BCS had similar levels of this sleep problem from pre- to post-diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Although sleep maintenance problems were not amplified by a cancer diagnosis, a subset of BCS may have sleep issues that should be monitored and treated, as indicated.
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Affiliation(s)
- Neha Goyal
- Helen Diller Family Comprehensive Cancer Center, University of California-San Francisco, San Francisco, CA, USA
| | - Beverly J Levine
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Sybil L Crawford
- Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MB, USA
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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Romanovska V, Block A, Paul SM, Cooper BA, Hammer MJ, Conley YP, Levine JD, Kober KM, Miaskowski C. Exploration of the Relationships Between Stress and Distinct Pain and Sleep Disturbance Profiles in Patients Undergoing Chemotherapy. Cancer Nurs 2024; 47:E108-E122. [PMID: 36584234 PMCID: PMC10300234 DOI: 10.1097/ncc.0000000000001185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Unrelieved pain and sleep disturbance are common symptoms in oncology patients. Increased stress may be an underlying cause for both symptoms. OBJECTIVES The purposes of this study were to identify subgroups of outpatients with distinct pain and sleep disturbance profiles and to evaluate differences among these subgroups in demographic and clinical characteristics. Differences in global stress, cancer-specific stress, and cumulative life stress, as well as resilience and coping, were evaluated. METHODS Patients (N = 1343) completed self-report questionnaires for demographic and clinical characteristics and stress, resilience, and coping. Latent profile analysis was used to identify subgroups of patients with distinct pain and sleep disturbance profiles. Differences among the subgroups were determined using parametric and nonparametric tests. RESULTS Three distinct profiles were identified (ie, No Pain + Moderate Sleep Disturbance (SD) (27.6%), Moderate Pain + Moderate SD (38.6%), Severe Pain + High SD (33.8%)). Compared with the other 2 classes, Severe Pain + High SD class was younger, had fewer years of education, was more likely to be female, more likely to live alone, less likely to be employed, and had a higher level of comorbidity. This class had the highest stress scores and was more likely to report higher rates of adverse childhood experiences. CONCLUSION Over 70% of our sample reported clinically meaningful levels of both symptoms, and 33.8% reported relatively high rates of adverse childhood experiences. IMPLICATION FOR PRACTICE Clinicians need to perform routine assessments, particularly of adverse childhood experiences, and initiate appropriate referrals.
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Affiliation(s)
- Vita Romanovska
- Author Affiliations: School of Nursing (Mss Romanovska and Block, Drs Paul, Cooper, Kober, and Miaskowski) and School of Medicine (Drs Levine and Miaskowski), University of California, San Francisco; Dana Farber Cancer Institute (Dr Hammer), Boston, Massachusetts; and School of Nursing, University of Pittsburgh (Dr Conley), Pennsylvania
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Chen K, Beeraka NM, Zhang X, Sinelnikov MY, Plotnikova M, Zhao C, Basavaraj V, Zhang J, Lu P. Recent Advances in Therapeutic Modalities Against Breast Cancer-Related Lymphedema: Future Epigenetic Landscape. Lymphat Res Biol 2023; 21:536-548. [PMID: 37267206 PMCID: PMC10753987 DOI: 10.1089/lrb.2022.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Background: Lymphedema is a significant postsurgical complication observed in the majority of breast cancer patients. These multifactorial etiopathogenesis have a significant role in the development of novel diagnostic/prognostic biomarkers and the development of novel therapies. This review aims to ascertain the epigenetic alterations that lead to breast cancer-related lymphedema (BCRL), multiple pathobiological events, and the underlying genetic predisposing factors, signaling cascades pertinent to the lapses in effective prognosis/diagnosis, and finally to develop a suitable therapeutic regimen. Methods and Results: We have performed a literature search in public databases such as PubMed, Medline, Google Scholar, National Library of Medicine and screened several published reports. Search words such as epigenetics to induce BCRL, prognosis/diagnosis, primary lymphedema, secondary lymphedema, genetic predisposing factors for BRCL, conventional therapies, and surgery were used in these databases. This review described several epigenetic-based predisposing factors and the pathophysiological consequences of BCRL, which affect the overall quality of life, and the interplay of these events could foster the progression of lymphedema in breast cancer survivors. Prognosis/diagnostic and therapy lapses for treating BCRL are highly challenging due to genetic and anatomical variations, alteration in the lymphatic vessel contractions, and variable expression of several factors such as vascular endothelial growth factor (VEGF)-E and vascular endothelial growth factor receptor (VEGFR) in breast cancer survivors. Conclusion: We compared the efficacy of various conventional therapies for treating BCRL as a multidisciplinary approach. Further substantial research is required to decipher underlying signaling epigenetic pathways to develop chromatin-modifying therapies pertinent to the multiple etiopathogenesis to explore the correlation between the disease pathophysiology and novel therapeutic modalities to treat BCRL.
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Affiliation(s)
- Kuo Chen
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Narasimha M. Beeraka
- Raghavendra Institute of Pharmaceutical Education and Research (RIPER), Anantapuramu, Andhra Pradesh, India
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Xinliang Zhang
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Mikhail Y. Sinelnikov
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Maria Plotnikova
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Cuiping Zhao
- The 80th Army Hospital of the Chinese People's Liberation Army, Weifang, China
| | - Vijaya Basavaraj
- Department of Pathology, JSS Medical College, JSS Academy of Higher Education & Research (JSS AHER), Mysuru, Karnataka, India
| | - Jin Zhang
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Pengwei Lu
- Department of Breast Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Calvo-Schimmel A, Paul SM, Cooper BA, Shin J, Harris C, Oppegaard K, Hammer MJ, Cartwright F, Conley YP, Kober KM, Levine JD, Miaskowski C. Oncology Outpatients With Worse Anxiety and Sleep Disturbance Profiles Are at Increased Risk for a Higher Symptom Burden and Poorer Quality of Life. Cancer Nurs 2023; 46:417-431. [PMID: 35688433 PMCID: PMC9729413 DOI: 10.1097/ncc.0000000000001139] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Anxiety and sleep disturbance are frequent symptoms during chemotherapy. OBJECTIVES Purposes were to identify subgroups of oncology outpatients with distinct joint anxiety and sleep disturbance profiles, as well as evaluate for differences in demographic and clinical characteristics, sleep disturbance characteristics, severity of common symptoms, and quality-of-life outcomes among these subgroups. METHODS Oncology outpatients (n = 1331) completed self-report measures of anxiety and sleep disturbance 6 times over 2 chemotherapy cycles. Latent profile analysis was done to identify subgroups of patients with distinct joint anxiety and sleep disturbance profiles. RESULTS Three profiles were identified (ie, no anxiety and low sleep disturbance (59.7%), moderate anxiety and high sleep disturbance (32.5%), high anxiety and very high sleep disturbance (7.8%)). Compared with the no anxiety and low sleep disturbance class, the other 2 classes were younger; less likely to be married; had a lower annual household income; and had childcare responsibilities. Patients in the 2 worse profiles had problems with both sleep initiation and maintenance. These patients reported higher levels of depressive symptoms, trait and state anxiety, and evening fatigue, as well as lower levels of morning and evening energy, cognitive function, and poorer quality of life. CONCLUSIONS More than 40% of patients had moderate or high levels of anxiety and high or very high levels of sleep disturbance. Modifiable risk factors associated with these profiles may be used to develop targeted interventions for 1 or both symptoms. IMPLICATIONS FOR PRACTICE Clinicians need to assess for the co-occurrence of anxiety and sleep disturbance.
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Affiliation(s)
- Alejandra Calvo-Schimmel
- Author affiliations: School of Nursing, University of California, San Francisco (Drs Calvo-Schimmel, Paul, Cooper, Kober, and Miaskowski and Mss Shin, Harris, and Oppegaard); Dana Farber Cancer Institute, Boston, Massachusetts (Dr Hammer); Department of Nursing, Mount Sinai Medical Center, New York (Dr Cartwright); School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Conley); and School of Medicine, University of California, San Francisco (Drs Levine and Miaskowski)
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Davis JK, Mark S, Mackin L, Paul SM, Cooper BA, Conley YP, Hammer MJ, Levine JD, Miaskowski C. Sleep disturbance and decrements in morning energy contribute to a higher symptom burden in oncology patients. Sleep Med 2023; 108:124-136. [PMID: 37354746 DOI: 10.1016/j.sleep.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE/BACKGROUND An emerging area of research is the relationship between sleep disturbance and decrements in energy. Given the paucity of research on the co-occurrence of these two symptoms, study purposes were to identify subgroups of oncology patients with distinct joint sleep disturbance AND morning energy profiles and evaluate for differences among the subgroups in demographic, clinical, and sleep disturbance characteristics, as well as the severity of other common symptoms and QOL outcomes. PATIENTS/METHODS Patients (n = 1336) completed measures of sleep disturbance and energy 6 times over two cycles of chemotherapy. All of the other measures were completed at enrollment. Latent profile analysis was used to identify the distinct joint sleep disturbance and morning energy profiles. RESULTS Three distinct profiles were identified (i.e., Low Sleep Disturbance and High Morning Energy (Normal, 20.6%), Moderate Sleep Disturbance and Low Morning Energy (Moderately Severe, 52.1%), Very High Sleep Disturbance and Very Low Morning Energy (Very Severe, 27.3%). Compared to Normal class, other two classes were more likely to be female, less likely to be employed, and had higher comorbidity burden and poorer functional status. Symptom scores and QOL outcomes exhibited a dose response effect (i.e., as the profile worsened, symptom scores increased and QOL scores decreased). CONCLUSIONS Given the associations between sleep disturbance and decrements in energy and a higher symptom burden, poorer QOL outcomes, and increased mortality, assessment of these two symptoms needs to be a high priority for clinicians and appropriate interventions initiated.
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Affiliation(s)
| | - Sueann Mark
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Lynda Mackin
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA, USA.
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Drozd C, Curtit E, Jacquinot Q, Marquine C, Mansi L, Chaigneau L, Dobi E, Viot J, Meynard G, Paillard MJ, Goujon M, Roux P, Vernerey D, Gillet V, Bourdin H, Galli S, Meneveau N, Mougin F. A randomized trial to evaluate the effects of a supervised exercise program on insomnia in patients with non-metastatic breast cancer undergoing chemotherapy: design of the FATSOMCAN study. BMC Cancer 2023; 23:449. [PMID: 37198562 DOI: 10.1186/s12885-023-10902-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Up to 70% of breast cancer patients report symptoms of insomnia during and after treatment. Despite the ubiquity of insomnia symptoms, they are under-screened, under-diagnosed and poorly managed in breast cancer patients. Sleep medications treat symptoms but are ineffective to cure insomnia. Other approaches such as cognitive behavioral therapy for insomnia, relaxation through yoga and mindfulness are often not available for patients and are complex to implement. An aerobic exercise program could be a promising treatment and a feasible option for insomnia management in breast cancer patients, but few studies have investigated the effects of such a program on insomnia. METHODS This multicenter, randomized clinical trial evaluate the effectiveness of a moderate to high intensity physical activity program (45 min, 3 times per week), lasting 12 weeks, in minimizing insomnia, sleep disturbances, anxiety/depression, fatigue, and pain, and in enhancing cardiorespiratory fitness. Patients with breast cancer be recruited from six hospitals in France and randomly allocated to either the "training" or the "control" group. Baseline assessments include questionnaires [Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index questionnaire (PSQI), Hospital Anxiety Depression Scale (HADS), Epworth Sleepiness Scale (ESS)], home polysomnography (PSG), and 7-day actigraphy coupled with completion of a sleep diary. Assessments are repeated at the end of training program and at six-month follow-up. DISCUSSION This clinical trial will provide additional evidence regarding the effectiveness of physical exercise in minimizing insomnia during and after chemotherapy. If shown to be effective, exercise intervention programs will be welcome addition to the standard program of care offered to patients with breast cancer receiving chemotherapy. TRIAL REGISTRATION National Clinical Trials Number (NCT04867096).
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Affiliation(s)
- Chloé Drozd
- Sports Science Faculty, University of Franche-Comté, Besançon, 25000, France.
- Research Unit EA3920, University of Franche-Comté, Besançon, 25000, France.
- Sleep Medicine Center, Ellipse, Besançon, 25000, France.
| | - Elsa Curtit
- Department of Medical Oncology, University Hospital, Besançon, 25000, France
- INSERM U1098 RIGHT, University of Franche-Comté, Besançon, France
| | - Quentin Jacquinot
- Research Unit EA3920, University of Franche-Comté, Besançon, 25000, France
- Regional Federative Cancer Institute of Franche-Comté, Besançon, France
| | - Charlène Marquine
- Sports Science Faculty, University of Franche-Comté, Besançon, 25000, France
| | - Laura Mansi
- Department of Medical Oncology, University Hospital, Besançon, 25000, France
- INSERM U1098 RIGHT, University of Franche-Comté, Besançon, France
| | - Loïc Chaigneau
- Department of Medical Oncology, University Hospital, Besançon, 25000, France
| | - Erion Dobi
- Department of Medical Oncology, University Hospital, Besançon, 25000, France
| | - Julien Viot
- Department of Medical Oncology, University Hospital, Besançon, 25000, France
| | - Guillaume Meynard
- Department of Medical Oncology, University Hospital, Besançon, 25000, France
| | | | - Morgan Goujon
- Department of Medical Oncology, University Hospital, Besançon, 25000, France
| | - Pauline Roux
- Department of Physiology-Functional Explorations, University Hospital, Besançon, 25000, France
| | - Dewi Vernerey
- Methodology and Quality of Life Unit, UMR 1098, University Hospital, Besançon, 25000, France
| | | | - Hubert Bourdin
- Research Unit EA481, Unit of Sleep Disorder, University of Franche-Comté, Besançon, 25000, France
| | - Silvio Galli
- Department of Neurology, University Hospital, Besançon, 25000, France
| | - Nathalie Meneveau
- Department of Medical Oncology, University Hospital, Besançon, 25000, France
| | - Fabienne Mougin
- Sports Science Faculty, University of Franche-Comté, Besançon, 25000, France
- Research Unit EA3920, University of Franche-Comté, Besançon, 25000, France
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Calvo-Schimmel A, Paul SM, Cooper BA, Harris C, Shin J, Oppegaard K, Hammer MJ, Dunn LB, Conley YP, Kober KM, Levine JD, Miaskowski C. Oncology oOutpatients with wWorse dDepression and sSleep dDisturbance pProfiles aAre at iIncreased rRisk for a hHigher sSymptom bBurden and pPoorer qQuality of lLife oOutcomes. Sleep Med 2022; 95:91-104. [DOI: 10.1016/j.sleep.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
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Distinct Sleep Disturbance Profiles in Patients With Gastrointestinal Cancers Receiving Chemotherapy. Cancer Nurs 2022; 45:E417-E427. [PMID: 34183521 PMCID: PMC8712619 DOI: 10.1097/ncc.0000000000000975] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Patients with gastrointestinal cancers experience moderate to high levels of sleep disturbance during chemotherapy that decreases their functional status and quality of life (QOL). OBJECTIVE The objectives of this study were to identify subgroups of patients with gastrointestinal cancers with distinct sleep disturbance profiles and evaluate for differences among these subgroups in demographic, clinical, and sleep characteristics, as well as co-occurring symptoms and QOL outcomes. METHODS Patients (n = 405) completed questionnaires 6 times over 2 cycles of chemotherapy. Latent profile analysis was used to identify subgroups of patients with distinct sleep disturbance profiles. RESULTS Three distinct sleep disturbance profiles (ie, low, high, very high) were identified. Compared with the low class, patients in the other 2 classes were significantly younger and less likely to be married and to exercise on a regular basis and received a higher number of previous treatments. Compared with the low class, patients in the other 2 classes reported higher levels of anxiety, depressive symptoms, morning and evening fatigue, and pain and lower levels of attentional function and QOL scores at enrollment. CONCLUSIONS This study is the first to use latent profile analysis to identify subgroups of patients with gastrointestinal cancers with distinct sleep disturbance profiles. Findings provide new insights on the associations between sleep disturbance and multiple co-occurring symptoms in these patients. IMPLICATIONS FOR PRACTICE Clinicians can identify patients who are at the highest risk for sleep disturbance and recommend a variety of sleep hygiene interventions (eg, establishment of a bedtime routine), as well as initiate interventions for other co-occurring symptoms.
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Nielsen AWM, Lundorff M, Nielsen HM, Alsner J, Vrou Offersen B, Kristensen MH, Zachariae R. Symptom trajectories in breast cancer survivors: growth mixture analysis of patient-reported pain, fatigue, insomnia, breast and arm symptoms. Acta Oncol 2021; 60:1659-1667. [PMID: 34582319 DOI: 10.1080/0284186x.2021.1981550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Variations in symptom development among breast cancer (BC) survivors are understudied. We examined: (Q1) Symptom trajectories of pain, fatigue, insomnia, breast, and arm symptoms in BC survivors, (Q2) possible patterns or cluster-like associations between trajectory classification of different symptoms, and (Q3) characteristics of survivors assigned to high-burden symptom trajectories. MATERIAL AND METHODS Participants were 968 women (mean age = 59.6 years) treated for early-stage BC and followed across a three-year postoperative period. As part of routine follow-up procedures, patients reported symptom burden and functioning levels at each hospital visit using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) and the BC-specific module (QLQ-BR-23). Growth mixture modeling (GMM) analysis was used to differentiate potential subgroups of individuals with similar longitudinal symptom patterns, i.e., symptom trajectories (Q1). With this approach, groups experiencing persistent, highly distressing cancer- and treatment-related late effects (LEs) may be identified. Latent class analysis (LCA) was used for Q2 and logistic regression analysis for Q3. RESULTS GMM identified two relatively parallel trajectories across the tested symptoms: The majority of the sample exhibited a low-burden symptom trajectory (74.4-89.2%) and a minority by a high-burden symptom trajectory (10.8-25.6%). LCA revealed that approximately one in five women (18.8%) were likely to be members of the high-burden symptom trajectory across all tested symptoms. In addition to a high probability of being burdened over time across multiple symptoms, these women were also characterized by poorer self-reported physical and social functioning. CONCLUSION A substantial minority followed a high-burden symptom trajectory for several years following BC treatment. Associations were found in trajectory classification across symptoms, indicating that cancer-related LEs appear in clusters of multiple concurrent symptoms.
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Affiliation(s)
| | - Marie Lundorff
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | | | - Jan Alsner
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Robert Zachariae
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Bean HR, Diggens J, Ftanou M, Weihs KL, Stanton AL, Wiley JF. Insomnia and Fatigue Symptom Trajectories in Breast Cancer: A Longitudinal Cohort Study. Behav Sleep Med 2021; 19:814-827. [PMID: 33470847 DOI: 10.1080/15402002.2020.1869005] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: Insomnia and fatigue are common, although not inevitable, during breast cancer. This study is one of the first aiming to describe distinct trajectory classes of insomnia and fatigue symptoms, and their correlates, from diagnosis through treatment.Methods: This longitudinal cohort study was conducted at a comprehensive cancer center and community oncology practices. Participants (N = 460) were women diagnosed with any stage of breast cancer in the previous 4 months. Primary outcomes for this ancillary study of the existing cohort were self-reported insomnia and fatigue symptoms assessed repeatedly across 12 months.Results: Four distinct classes of insomnia symptoms emerged: persistently very high, clinically elevated symptoms (13.7%); high, clinically elevated symptoms (65.9%); stable low (17.2%) or very low (2.6%) symptoms. Five fatigue symptom classes included high, increasing fatigue (9.6%), two recovery classes starting at high (26.3%), or moderate (18.0%) severity at diagnosis, stable low (33.3%) or very low (12.2%) classes. In multivariate analyses, higher depressive symptoms, anxiety, and chronic life stress were associated with being in the very high insomnia class versus the low symptom class. Oncologic factors were not associated with insomnia class membership. Receiving chemotherapy was linked significantly to high and recovery fatigue symptom classes versus the low class. Higher chronic life stress was associated with more persistent fatigue symptoms.Conclusions: Distinct classes of insomnia and fatigue symptoms were evident; 79.6% of the women had clinically elevated, persistent insomnia symptoms, 53.9% had elevated fatigue. A substantial minority evidenced low symptoms, suggesting targeted or stepped-care approaches to symptom management.
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Affiliation(s)
- Helena R Bean
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University
| | - Justine Diggens
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne
| | - Maria Ftanou
- Psychosocial Oncology Program, Peter MacCallum Cancer Centre, Melbourne.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne
| | - Karen L Weihs
- Department of Psychiatry, University of Arizona.,University of Arizona Cancer Center
| | - Annette L Stanton
- Department of Psychology, University of California Los Angeles.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles
| | - Joshua F Wiley
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University
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Duivon M, Giffard B, Desgranges B, Perrier J. Are Sleep Complaints Related to Cognitive Functioning in Non-Central Nervous System Cancer? A Systematic Review. Neuropsychol Rev 2021; 32:483-505. [PMID: 34355305 DOI: 10.1007/s11065-021-09521-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/19/2021] [Indexed: 12/24/2022]
Abstract
Patients with non-central nervous system (CNS) cancer frequently report cognitive complaints, that are recurrent and affect their quality of life. In order to improve supportive care of these cognitive difficulties, it is important to identify associated factors. Sleep disturbance is a good candidate to study, as patients with non-CNS cancer frequently report sleep disorders, and sleep plays a key role in cognitive functioning. The objective of the present systematic review was to summarize the results of studies evaluating the relationship between cognition and sleep in non-CNS cancer, and to highlight the need for further studies. PubMed [Medline] and Scopus databases were screened from April to November 2020 for studies published in English evaluating the association between cognition and sleep in adults with non-CNS cancer. The characteristics and risk of bias for each of the 30 included studies have been reported. Greater cognitive complaints in patients with non-CNS cancer were related to poorer self-reported sleep quality in almost all studies (n = 22/24). By contrast, around half of the studies reported a significant association between poorer neuropsychological performances and sleep complaints (n = 5/11). The studies were found to have several limitations, such as the lack of a control group, which would have shed the light on the period of occurrence of this association (e.g. after cancer diagnosis or after cancer treatments). Our review also identified factors that may influence the relationship between cognition and sleep. Recommendations are given for improving the methodology of future studies and extending the impact of their results.
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Affiliation(s)
- Mylène Duivon
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, GIP Cyceron, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Bénédicte Giffard
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, GIP Cyceron, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France.,Ligue Contre Le Cancer, Cancer & Cognition Platform, 14076, Caen, France
| | - Béatrice Desgranges
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, GIP Cyceron, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France
| | - Joy Perrier
- Normandie Univ, UNICAEN, PSL Research University, EPHE, INSERM, CHU de Caen, GIP Cyceron, U1077, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000, Caen, France.
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Factors associated with sleep disturbances in women undergoing treatment for early-stage breast cancer. Support Care Cancer 2021; 30:157-166. [PMID: 34244851 PMCID: PMC8270775 DOI: 10.1007/s00520-021-06373-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/19/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to examine factors associated with sleep disturbance in women receiving adjuvant therapy for breast cancer. METHODS This study employed a cross-sectional design using data collected at 3 months post-surgery from an ongoing longitudinal parent study. Participant data were divided into adjuvant treatment groups (chemotherapy, radiation, and aromatase inhibitors) and no adjuvant treatment groups. Symptoms were measured using patient self-report measures. Analysis of variance was used to assess between adjuvant treatment group differences in sleep disturbance. Regression analysis was performed to assess the relationship between sleep disturbance and other symptoms within adjuvant treatment groups. RESULTS The sample included 156 women diagnosed with early-stage breast cancer. There were significant differences in levels of reported sleep disturbance between treatment groups (p = 0.049), with significantly higher levels of sleep disturbances in those receiving radiation compared to those receiving no adjuvant treatment (p = 0.038) and in those receiving chemotherapy and those receiving no adjuvant treatment (p = 0.027). Increased sleep disturbance was found to be a significant predictor for increased pain severity, nausea severity, anxiety, depressive symptoms, fatigue, decreased physical function, and decreased ability to participate in social roles and activities. Co-occurring symptoms with sleep disturbance differed between adjuvant treatment groups. Sleep disturbance was also associated with younger age (p = 0.008). CONCLUSIONS Patients undergoing chemotherapy or radiation for breast cancer report higher levels of sleep disturbance than those not receiving adjuvant therapy. Sleep disturbance is associated with other symptoms experienced by patients with cancer and thus requires continual assessment and future research into effective interventions.
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Riley KE, Garland SN, Mao JJ, Applebaum AJ, Li QS, Gehrman PR, DuHamel KN, Verrico Z. Hyperarousal and Insomnia in Survivors of Cancer. Int J Behav Med 2021; 28:683-691. [PMID: 33629219 DOI: 10.1007/s12529-021-09962-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cancer survivors are prone to insomnia due to the physical and psychological sequelae of cancer and treatment. Individuals with insomnia may present symptoms of hyperarousal. Cancer survivors with insomnia and trait hyperarousal may require different clinical treatments than patients with insomnia without trait hyperarousal. To our knowledge, no study has examined these factors previously. This study examined the relation between insomnia and trait hyperarousal in cancer survivors. METHODS The sample included 160 individuals with previous cancer diagnoses who met DSM-5 criteria for insomnia disorder. Measures were collected with cross-sectional batteries of questionnaires, including the Insomnia Severity Index (ISI) and Hyperarousal Scale (HAS). This study is based on baseline data collected in a randomized clinical trial comparing CBT-I to acupuncture for cancer survivors with insomnia (Garland, Gehrman, Barg, Xie, & Mao, 2016). RESULTS Hyperarousal was positively associated with insomnia (ISI total score) in bivariate correlations (r = .350, p < .01) and linear regressions (F = 22.06, p < .001). In bivariate correlations, hyperarousal was related to perceptions about the consequences of disturbed sleep rather than reported sleep patterns. For example, hyperarousal was positively related to reported satisfaction (r = .159, p < .05) and worry about sleep (r = .415, p < .01), but not to falling asleep, staying asleep, or awakening too early. In regressions, younger age, insomnia duration, and worry about sleep were uniquely associated with hyperarousal when adjusting for insomnia (B = 0.200, B = 0.177, B = -0.182, p < .05). CONCLUSIONS Hyperarousal is associated with psychological appraisal of insomnia rather than reported sleep pattern. Younger age and longer duration of insomnia are associated with trait hyperarousal. These findings suggest targeting trait hyperarousal with amplified psychological treatment may lead to more personalized, effective treatment for insomnia.
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Affiliation(s)
- Kristen E Riley
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA.,Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuyen Rd, Piscataway, NJ, 08854, USA
| | - Sheila N Garland
- Department of Psychology, Memorial University of Newfoundland, 232 Elizabeth Avenue, St. John's, St. John's, Newfoundland and Labrador, A1B 3X9, Canada
| | - Jun J Mao
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Allison J Applebaum
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Q Susan Li
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Philip R Gehrman
- Perelman School of Medicine, University of Pennsylvania, 3600 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Katherine N DuHamel
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, NY, 10022, New York, USA
| | - Zoe Verrico
- Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuyen Rd, Piscataway, NJ, 08854, USA.
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14
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Santoso AMM, Jansen F, Lissenberg-Witte BI, Baatenburg de Jong RJ, Langendijk JA, Leemans CR, Smit JH, Takes RP, Terhaard CHJ, van Straten A, Verdonck-de Leeuw IM. Sleep quality trajectories from head and neck cancer diagnosis to six months after treatment. Oral Oncol 2021; 115:105211. [PMID: 33581506 DOI: 10.1016/j.oraloncology.2021.105211] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/11/2021] [Accepted: 01/25/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Patients with head and neck cancer (HNC) often report disturbances in their sleep quality, impairing their quality of life. This study aims to examine the trajectories of sleep quality from diagnosis up to 6-month after treatment, as well as the pre-treatment risk factors for poor sleep trajectories. MATERIALS AND METHODS Sleep quality (Pittsburgh sleep quality index) was measured shortly after diagnosis (pre-treatment), and at 3 and 6 months after finishing treatment. Patients were categorized into 5 trajectory groups. We examined the association of sleep quality trajectories with sociodemographic and clinical characteristics, coping style, HNC symptoms, and psychological distress. RESULTS Among 412 included patients, about a half either had a persistent good sleep (37.6%) or an improving (16.5%) trajectory. About a third had a persistent poor sleep (21.8%) or worsening (10.9%) sleep trajectory. The remaining patients (13.1%), alternated between good and poor sleep. Using persistent good sleep as a reference outcome, persistent poor sleepers were more likely to be woman (odds ratio [OR] = 1.98, 95% confidence interval [CI] 1.01-3.90), use painkillers prior to treatment (OR = 2.52, 95% CI 1.33-4.77), and have more pre-treatment anxiety symptoms (OR = 1.26, 95% CI 1.15-1.38). CONCLUSION Unfavorable sleep quality trajectories are prevalent among HNC patients from pre-treatment to 6-month after treatment. A periodic sleep evaluation starting shortly after HNC diagnosis is necessary to identify persistent sleep problems, especially among high-risk group.
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Affiliation(s)
- Angelina M M Santoso
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Cancer Center Amsterdam Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands
| | - Femke Jansen
- Cancer Center Amsterdam Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology - Head and Neck Surgery, Amsterdam, the Netherlands
| | - Birgit I Lissenberg-Witte
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C René Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology - Head and Neck Surgery, Amsterdam, the Netherlands
| | - Johannes H Smit
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Robert P Takes
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Annemieke van Straten
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands; Cancer Center Amsterdam Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology - Head and Neck Surgery, Amsterdam, the Netherlands.
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15
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Shahrokhi M, Ghaeli P, Arya P, Shakiba A, Noormandi A, Soleimani M, Esfandbod M. Comparing the Effects of Melatonin and Zolpidem on Sleep Quality, Depression, and Anxiety in PatientsWithColorectalCancerUndergoingChemotherapy. Basic Clin Neurosci 2021; 12:105-114. [PMID: 33995933 PMCID: PMC8114863 DOI: 10.32598/bcn.12.1.1650.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/25/2019] [Accepted: 11/21/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction: Patients with cancer may have many complications involving their psychosomatic systems, such as sleep disturbance, depression, and anxiety. Thus, many research studies were conducted to reduce these complications. Zolpidem, as a short-term non-benzodiazepine treatment of insomnia, and melatonin as a chronobiological functionregulatory hormone, are commonly used for improving sleep quality. This randomized clinical trial aims to compare the effects of zolpidem and melatonin on sleep quality, depression, and anxiety in patients with colorectal cancer. Methods: In this single-blinded trial, 90 patients with colorectal cancer undergoing chemotherapy who had obtained a score of 5 or higher on the Pittsburgh Sleep Quality Index (PSQI) were randomly divided into two groups (n=45). One group was treated with 10 mg zolpidem at bedtime, and the other group received 6 mg melatonin at bedtime for 30 days. PSQI on weeks 0, 4, 8, Groningen sleep quality scale, Hamilton rating scale for depression, and Hamilton anxiety rating scale questionnaires were performed to assess patients on weeks 0, 4, and 8. The outcome was then analyzed, and P≤0.05 was considered statistically significant. Results: Both zolpidem and melatonin had significant impacts on sleep quality in week 4 (P<0.05). After stopping the treatments, the conditions were noticeably reversed on week 8 (P<0.05). Zolpidem and melatonin were relatively similar in affecting sleep duration, latency, efficiency, and disturbance. None of the two study medications had any considerable influence on anxiety and depression. Conclusion: Melatonin and zolpidem are promising agents for treating sleep complications and, to some extent, depression, and anxiety in cancer patients, according to the present study. However, further clinical trials are recommended to confirm the results of this study.
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Affiliation(s)
- Maryam Shahrokhi
- Department of clinical pharmacy, Faculty of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Padideh Ghaeli
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Pantea Arya
- Department of Psychiatry, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alia Shakiba
- Psychiatry and Psychoogy Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Noormandi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Soleimani
- Department of Psychiatry, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Esfandbod
- Hematology-Oncology and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Kohler C, Chang M, Allemann-Su YY, Vetter M, Jung M, Jung M, Conley Y, Paul S, Kober KM, Cooper BA, Smoot B, Levine JD, Miaskowski C, Katapodi MC. Changes in Attentional Function in Patients From Before Through 12 Months After Breast Cancer Surgery. J Pain Symptom Manage 2020; 59:1172-1185. [PMID: 31953207 PMCID: PMC7239765 DOI: 10.1016/j.jpainsymman.2020.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
CONTEXT Although approximately 75% of patients with breast cancer report changes in attentional function, little is known about how demographic, clinical, symptom, and psychosocial adjustment (e.g., coping) characteristics influence changes in the trajectories of attentional function over time. OBJECTIVES This study evaluated interindividual variability in the trajectories of self-reported attentional function and determined which demographic, clinical, symptom, and psychosocial adjustment characteristics were associated with initial levels and with changes in attentional function from before through 12 months after breast cancer surgery. METHODS Before surgery, 396 women were enrolled. Attentional Function Index (AFI) was completed before and nine times within the first 12 months after surgery. Hierarchical linear modeling was used to determine which characteristics were associated with initial levels and trajectories of attentional function. RESULTS Given an estimated preoperative AFI score of 6.53, for each additional month, the estimated linear rate of change in AFI score was an increase of 0.054 (P < 0.001). Higher levels of comorbidity, receipt of adjuvant chemotherapy, higher levels of trait anxiety, fatigue, and sleep disturbance, and lower levels of energy and less sense of control were associated with lower levels of attentional function before surgery. Patients who had less improvements in attentional function over time were nonwhite, did not have a lymph node biopsy, had received hormonal therapy, and had less difficulty coping with their disease. CONCLUSION Findings can be used to identify patients with breast cancer at higher risk for impaired self-reported cognitive function and to guide the prescription of more personalized interventions.
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Affiliation(s)
- Carmen Kohler
- Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Ming Chang
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland
| | - Yu-Yin Allemann-Su
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland
| | - Marcus Vetter
- Medical Oncology, University Hospital Basel, Basel, Switzerland
| | - Miyeon Jung
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Misook Jung
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Yvette Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Steven Paul
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Kord M Kober
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Betty Smoot
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jon D Levine
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California, USA.
| | - Maria C Katapodi
- Department of Clinical Research, Nursing Science, University of Basel, Basel, Switzerland; School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
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17
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Tejada M, Viele C, Kober KM, Cooper BA, Paul SM, Dunn LB, Hammer MJ, Wright F, Conley YP, Levine JD, Miaskowski C. Identification of subgroups of chemotherapy patients with distinct sleep disturbance profiles and associated co-occurring symptoms. Sleep 2020; 42:5541565. [PMID: 31361899 DOI: 10.1093/sleep/zsz151] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/31/2019] [Indexed: 01/09/2023] Open
Abstract
STUDY OBJECTIVES Purposes of this study were to identify subgroups of patients with distinct sleep disturbance profiles and to evaluate for differences in demographic, clinical, and various sleep characteristics, as well for differences in the severity of co-occurring symptoms among these subgroups. METHODS Outpatients with breast, gynecological, gastrointestinal, or lung cancer (n = 1331) completed questionnaires six times over two chemotherapy cycles. Self-reported sleep disturbance was evaluated using the General Sleep Disturbance Scale (GSDS). Latent profile analysis was used to identify distinct subgroups. RESULTS Three latent classes with distinct sleep disturbance profiles were identified (Low [25.5%], High [50.8%], Very High [24.0%]) across the six assessments. Approximately 75% of the patients had a mean total GSDS score that was above the clinically meaningful cutoff score of at least 43 across all six assessments. Compared to the Low class, patients in High and Very High classes were significantly younger, had a lower functional status, had higher levels of comorbidity, and were more likely to be female, more likely to have childcare responsibilities, less likely to be employed, and less likely to have gastrointestinal cancer. For all of the GSDS subscale and total scores, significant differences among the latent classes followed the expected pattern (Low < High < Very High). For trait and state anxiety, depressive symptoms, morning and evening fatigue, decrements in attentional function, and decrements in morning and evening energy, significant differences among the latent classes followed the expected pattern (Low < High < Very High). CONCLUSIONS Clinicians need to perform in-depth assessments of sleep disturbance and co-occurring symptoms to identify high-risk patients and recommend appropriate interventions.
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Affiliation(s)
- Maria Tejada
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Carol Viele
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Kord M Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
| | - Laura B Dunn
- Department of Physiological Nursing, School of Medicine, Stanford University, Stanford, CA
| | | | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, NY
| | | | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA
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18
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Wiggins AT, Pavlik EJ, Andrykowski MA. Psychological Response to a False Positive Ovarian Cancer Screening Test Result: Distinct Distress Trajectories and Their Associated Characteristics. Diagnostics (Basel) 2019; 9:diagnostics9040128. [PMID: 31557857 PMCID: PMC6963193 DOI: 10.3390/diagnostics9040128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022] Open
Abstract
Routine screening for ovarian cancer (OC) can yield an abnormal result later deemed benign. Such false positive (FP) results have been shown to trigger distress, which generally resolves over time. However, women might differ in the trajectory of the distress experience. Women participating in a routine OC screening program (n = 373) who received an abnormal screening result completed a baseline assessment prior to a follow-up screening test to clarify the nature of their abnormal result. All women were subsequently informed that no malignancy was present, and follow-up assessments were completed one and four months post-baseline. Demographic, clinical, dispositional (optimism, monitoring), and social environmental (social constraint, social support) variables were assessed at baseline. OC-specific distress was assessed at all three assessments. Trajectory analyses identified three distress trajectories differing in the baseline level of distress. A high decreasing trajectory, representing about 25% of women, was characterized by high levels of distress at baseline with distress declining over time, but still elevated at four-month follow-up. In contrast, a no distress trajectory group, representing about 30% of women, was characterized by essentially no distress at any time point. Principal risk factors for membership in the high decreasing trajectory group included a family history of OC, lower dispositional optimism, and greater social constraint. These risk factors could be used to target resources efficiently towards managing women at risk for potentially clinically-significant distress after receipt of an FP OC screening test.
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Affiliation(s)
- Amanda T Wiggins
- Nursing Instruction, University of Kentucky College of Nursing, Lexington, KY 40536, USA.
| | - Edward J Pavlik
- Department of Obstetrics and Gynecology, University of Kentucky College of Medicine, Lexington, KY 40506, USA.
| | - Michael A Andrykowski
- Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, KY 40536, USA.
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Fox RS, Ancoli-Israel S, Roesch SC, Merz EL, Mills SD, Wells KJ, Sadler GR, Malcarne VL. Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy. Support Care Cancer 2019; 28:845-855. [PMID: 31161437 DOI: 10.1007/s00520-019-04834-w] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/23/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Sleep disturbance and cancer-related fatigue (CRF) are among the most commonly reported symptoms associated with breast cancer and its treatment. This study identified symptom cluster groups of breast cancer patients based on multidimensional assessment of sleep disturbance and CRF prior to and during chemotherapy. METHODS Participants were 152 women with stage I-IIIA breast cancer. Data were collected before chemotherapy (T1) and during the final week of the fourth chemotherapy cycle (T2). Latent profile analysis was used to derive groups of patients at each timepoint who scored similarly on percent of the day/night asleep per actigraphy, the Pittsburgh Sleep Quality Index global score, and the five subscales of the Multidimensional Fatigue Symptom Inventory-Short Form. Bivariate logistic regression evaluated if sociodemographic/medical characteristics at T1 were associated with group membership at each timepoint. RESULTS Three groups (Fatigued with sleep complaints, Average, Minimal symptoms) were identified at T1, and five groups (Severely fatigued with poor sleep, Emotionally fatigued with average sleep, Physically fatigued with average sleep, Average, Minimal symptoms) at T2. The majority of individuals in a group characterized by more severe symptoms at T1 were also in a more severe symptom group at T2. Sociodemographic/medical variables at T1 were significantly associated with group membership at T1 and T2. CONCLUSIONS This study identified groups of breast cancer patients with differentially severe sleep disturbance and CRF symptom profiles prior to and during chemotherapy. Identifying groups with different symptom management needs and distinguishing groups by baseline sociodemographic/medical variables can identify patients at risk for greater symptom burden.
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Affiliation(s)
- Rina S Fox
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sonia Ancoli-Israel
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
- University of California, San Diego, San Diego, CA, USA
| | - Scott C Roesch
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Erin L Merz
- California State University, Dominguez Hills, Carson, CA, USA
| | - Sarah D Mills
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kristen J Wells
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Georgia Robins Sadler
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA
- University of California, San Diego, San Diego, CA, USA
| | - Vanessa L Malcarne
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, San Diego, CA, USA.
- Moores Cancer Center, University of California, San Diego, San Diego, CA, USA.
- University of California, San Diego, San Diego, CA, USA.
- San Diego State University, San Diego, CA, USA.
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20
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Whisenant M, Wong B, Mitchell SA, Beck SL, Mooney K. Symptom Trajectories Are Associated With Co-occurring Symptoms During Chemotherapy for Breast Cancer. J Pain Symptom Manage 2019; 57:183-189. [PMID: 30453052 PMCID: PMC6348053 DOI: 10.1016/j.jpainsymman.2018.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 12/20/2022]
Abstract
CONTEXT Symptoms are reported to co-occur during treatment for breast cancer. We previously identified three patterns of fatigue and two patterns of disturbed sleep, depressed mood, and anxiety in women undergoing chemotherapy for breast cancer using a Latent Growth Mixture Model. OBJECTIVES The purpose of this study was to explore whether membership in symptom classes of fatigue, disturbed sleep, depressed mood, and anxiety is associated with other symptoms at moderate-to-severe levels. METHODS Using data from three longitudinal studies, Wilcoxon rank-sum tests and Jonckheere-Terpstra tests for trend were used to distinguish between classes of women on co-occurring symptoms. Summative scores were calculated, including the number of days subjects reported moderate-to-severe levels (4 or higher on a 0-10 scale) of seven symptoms during two cycles of chemotherapy and compared to class membership. RESULTS Participants (n = 166) in the higher fatigue severity class reported more days with moderate-to-severe disturbed sleep, depressed mood, anxiety, nausea, and trouble thinking. Women in the higher severity disturbed sleep class reported more days with moderate-to-severe fatigue, depressed mood, anxiety, and trouble thinking. Women in the higher depressed mood severity class reported more days with moderate-to-severe fatigue, disturbed sleep, anxiety, and nausea. Women in the higher anxiety severity class reported more days with moderate-to-severe fatigue, disturbed sleep, and depressed mood. CONCLUSION Moderate-to-severe symptoms co-occur during cancer treatment for breast cancer. The dynamic process of multiple symptoms may be altered by future identification of a shared etiology.
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Affiliation(s)
- Meagan Whisenant
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Bob Wong
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Sandra A Mitchell
- Outcomes Research Branch, National Cancer Institute, Rockville, Maryland, USA
| | - Susan L Beck
- College of Nursing, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - Kathi Mooney
- College of Nursing, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
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21
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Sultan A, Kumar Pati A, Choudhary V, Parganiha A. Repeated chemotherapy cycles produced progressively worse and enduring impairments in the sleep–wake profile of hospitalized breast cancer patients. BIOL RHYTHM RES 2018. [DOI: 10.1080/09291016.2018.1559415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Armiya Sultan
- Chronobiology and Animal Behavior Laboratory, School of Studies in Life Sciences, Pt. Ravishankar Shukla University, Raipur, India
| | - Atanu Kumar Pati
- Chronobiology and Animal Behavior Laboratory, School of Studies in Life Sciences, Pt. Ravishankar Shukla University, Raipur, India
- Center for Translational Chronobiology, Pt. Ravishankar Shukla University, Raipur, India
- Gangadhar Meher University, Sambalpur, India
| | - Vivek Choudhary
- Regional Cancer Center, Dr. B.R. Ambedkar Memorial Hospital, Raipur, India
| | - Arti Parganiha
- Chronobiology and Animal Behavior Laboratory, School of Studies in Life Sciences, Pt. Ravishankar Shukla University, Raipur, India
- Center for Translational Chronobiology, Pt. Ravishankar Shukla University, Raipur, India
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Optimism outweighs neuroticism and anxiety sensitivity to predict insomnia symptoms in women after surgery for breast cancer. Support Care Cancer 2018; 27:2903-2909. [PMID: 30560420 DOI: 10.1007/s00520-018-4610-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/11/2018] [Indexed: 01/05/2023]
Abstract
PURPOSE Insomnia symptoms are common among women who have undergone surgery for breast cancer. Personality traits are also believed to have an impact on sleep. However, there are no reports to address the effects of personality traits on sleep in women with breast cancer. This study examined the separate and competing roles of neuroticism, anxiety sensitivity, and optimism in predicting post-surgery insomnia symptoms. METHODS Women with breast cancer (n = 749) were enrolled the week prior to surgery and required to complete a demographic questionnaire, the Chinese version of Neuroticism subscale of NEO-Five Factor Inventory (CV-N-NEO-FFI), Anxiety Sensitivity Index-3 (CV-ASI-3), and Life Orientation Test-Revised (CV-LOT-R). Four weeks post-surgery, the Chinese version of Insomnia Severity Index (CV-ISI) was administered to evaluate insomnia symptoms. RESULTS Neuroticism (β = 0.317, p < 0.001), anxiety sensitivity (β = 0.220, p < 0.001), and optimism (β = - 0.332, p < 0.001) could predict post-surgery insomnia symptoms. When putting them together into one stepwise regression, optimism (β = - 0.215, p < 0.001) became the statistically most important predictor for insomnia symptoms. Optimism suppressed the predictions of insomnia symptoms provided by neuroticism (β = 0.114, p < 0.001) and anxiety sensitivity (β = 0.079, p < 0.001). CONCLUSION Neuroticism and anxiety sensitivity positively predicted insomnia, but optimism negatively predicted insomnia. In particular, optimism plays a more important role in post-surgery insomnia symptoms in women with breast cancer compared to neuroticism and anxiety sensitivity. Sleep intervention in women with breast cancer should focus on enhancing their optimism level.
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Garland SN, Eriksen W, Song S, Dearing J, Barg FK, Gehrman P, Mao JJ. Factors that shape preference for acupuncture or cognitive behavioral therapy for the treatment of insomnia in cancer patients. Support Care Cancer 2018; 26:2407-2415. [PMID: 29423681 PMCID: PMC6158018 DOI: 10.1007/s00520-018-4086-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/29/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE Patient preference is an essential component of patient-centered supportive cancer care; however, little is known about the factors that shape preference for treatment. This study sought to understand what factors may contribute to patient preference for two non-pharmacological interventions, acupuncture or cognitive behavioral therapy for insomnia (CBT-I). METHODS We conducted individual, open-ended, semi-structured interviews among cancer survivors who had completed active treatment and met the diagnostic criteria for insomnia disorder. Two forms of codes were used for analysis: a priori set of codes derived from the key ideas and a set of codes that emerged from the data. RESULTS Among 53 participants, the median age was 60.7 (range 27-83), 30 participants (56.6%) were female, and 18 (34%) were non-white. We identified three themes that contributed to an individual's treatment preference: perception of the treatment's evidence base, experience with the treatment, and consideration of personal factors. Participants gave preference to the treatment perceived as having stronger evidence. Participants also reflected on positive or negative experiences with both of the interventions, counting their own experiences, as well as those of trusted sources. Lastly, participants considered their own unique circumstances and factors such as the amount of work involved, fit with personality, or fit with their "type" of insomnia. CONCLUSIONS Knowledge of the evidence base, past experience, and personal factors shaped patient preference regardless of whether they accurately represent the evidence. Acknowledging these salient factors may help inform patient-centered decision-making and care.
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Affiliation(s)
- Sheila N Garland
- Departments of Psychology and Oncology, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Whitney Eriksen
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Song
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua Dearing
- Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Frances K Barg
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Philip Gehrman
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jun J Mao
- The Bendheim Center for Integrative Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Halle IH, Westgaard TK, Wahba A, Oksholm T, Rustøen T, Gjeilo KH. Trajectory of sleep disturbances in patients undergoing lung cancer surgery: a prospective study. Interact Cardiovasc Thorac Surg 2017; 25:285-291. [PMID: 28486702 DOI: 10.1093/icvts/ivx076] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 02/15/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Patients with lung cancer report sleep difficulties to be frequent and bothersome symptoms. This study describes the trajectory of sleep from before and up to 12 months after surgery for lung cancer. Further, it investigates possible associations between sleep disturbance, demographic and clinical characteristics before surgery. METHODS This study is part of a longitudinal multicentre study. Sleep disturbance was measured by The General Sleep Disturbance Scale (GSDS) that investigates frequencies of sleep difficulties (21 items) and a total sum score ≥43 indicates a clinically meaningful level of sleep disturbance (score range 0-147). Linear mixed models were used to study changes in sleep from baseline to 1, 5, 9 and 12 months after surgery. RESULTS The percentage of patients (n = 264) reporting sleep disturbances was 60.9% at baseline, 68.5% at Month 1, 55.4% at Month 5, 51.3% at Month 9 and 49.7% at Month 12. The increase to and decrease from Month 1 was the only significant alteration in the occurrence of sleep disturbance. The patients reported most problems within the subscales sleep quantity, early awakenings and sleep quality. Factors associated with sleep disturbance were lower age, use of pain medication and psychotropic medication and higher comorbidity score. CONCLUSIONS Lung cancer patients sleep poorly, before as well as after surgery. There is a need to address sleeping disturbance routinely in clinical practice and screening for sleeping problems is indicated. Further studies are warranted concerning factors that contribute to sleep disturbance and how they best can be treated.
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Affiliation(s)
- Ingrid Helene Halle
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Therese Krystad Westgaard
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Alexander Wahba
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trine Oksholm
- VID Specialized University, Haraldsplass, Bergen, Norway.,Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Tone Rustøen
- Department of Nursing Science, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Kari Hanne Gjeilo
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim, Norway
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25
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Whisenant M, Wong B, Mitchell SA, Beck SL, Mooney K. Distinct Trajectories of Fatigue and Sleep Disturbance in Women Receiving Chemotherapy for Breast Cancer. Oncol Nurs Forum 2017; 44:739-750. [PMID: 29052653 PMCID: PMC5856248 DOI: 10.1188/17.onf.739-750] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE/OBJECTIVES To examine self-reported severity of fatigue and disturbed sleep experienced daily by women with breast cancer during multiple cycles of chemotherapy, exploring potential classes of women experiencing similar symptom trajectories.
. DESIGN In a secondary analysis, classes of women experiencing similar patterns of fatigue and disturbed sleep were identified.
. SETTING Oncology clinics in the United States.
. SAMPLE 166 women with breast cancer receiving chemotherapy.
. METHODS Severity scores were self-reported daily using an automated system. Classes of fatigue and disturbed sleep severity were identified using latent growth mixture modeling.
. MAIN RESEARCH VARIABLES Fatigue, disturbed sleep, age, stage of disease, education, employment, marital status, chemotherapy regimen, hours lying down, and missed work.
. FINDINGS Three fatigue classes were identified. CONCLUSIONS Patterns of symptom trajectories for fatigue and disturbed sleep were distinguished by baseline symptom severity.
. IMPLICATIONS FOR NURSING Identification of women at risk for fatigue and disturbed sleep may allow clinicians to intensify symptom management.
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Fontes F, Severo M, Gonçalves M, Pereira S, Lunet N. Trajectories of sleep quality during the first three years after breast cancer diagnosis. Sleep Med 2017; 34:193-199. [DOI: 10.1016/j.sleep.2017.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/09/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
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Wright F, Cooper BA, Conley YP, Hammer MJ, Chen LM, Paul SM, Levine JD, Miaskowski C, Kober KM. Distinct Evening Fatigue Profiles in Oncology Outpatients Receiving Chemotherapy. FATIGUE-BIOMEDICINE HEALTH AND BEHAVIOR 2017; 5:131-144. [PMID: 29725554 DOI: 10.1080/21641846.2017.1322233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Fatigue is the most common and debilitating symptom experienced by oncology patients during chemotherapy (CTX). Fatigue severity demonstrates a large amount of inter-individual and diurnal variability. Purpose Study purposes were to evaluate for subgroups of patients with distinct evening fatigue profiles and evaluate how these subgroups differed on demographic, clinical, and symptom characteristics. Methods Outpatients with breast, gastrointestinal, gynecological, or lung cancer (n=1332) completed questionnaires six times over two cycles of CTX. Lee Fatigue Scale (LFS) evaluated evening fatigue severity. Latent profile analysis was used to identify distinct evening fatigue profiles. Results Four distinct evening fatigue classes (i.e., Low (14.0%), Moderate (17.2%), High (36.0%), Very High (32.8%)) were identified. Compared to the Low class, patients in the Very High evening fatigue class were: younger, female, had childcare responsibilities, had more years of education, had a lower functional status, had a higher comorbidity burden, and were diagnosed with breast cancer. Patients in the Very High class reported higher levels of depressive symptoms, sleep disturbance, and evening fatigue at enrollment. Conclusions Findings provide new insights into modifiable risk factors for higher levels of evening fatigue. Clinicians can use this information to identify higher risk patients and plan appropriate interventions.
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Affiliation(s)
- Fay Wright
- School of Nursing, Yale University, New Haven, CT
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, CA
| | | | | | - Lee-May Chen
- School of Medicine, University of California, San Francisco, CA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA
| | - Jon D Levine
- School of Medicine, University of California, San Francisco, CA
| | | | - Kord M Kober
- School of Nursing, University of California, San Francisco, CA
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Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy. Support Care Cancer 2017; 25:2485-2494. [PMID: 28281049 DOI: 10.1007/s00520-017-3655-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/20/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE In a sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer who received at least two cycles of chemotherapy (CTX), the purposes were to evaluate for inter-individual differences in the severity of sleep disturbance and determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of sleep disturbance. METHODS A total of 1331 patients completed study questionnaires in their homes, at six time points over two cycles of CTX (prior to CTX administration, approximately 1 week after CTX administration, and approximately 2 weeks after CTX administration). Questionnaires included demographic, clinical, and symptom assessments (i.e., General Sleep Disturbance Scale, Lee Fatigue Scale, Center for Epidemiological Studies-Depression Scale, Spielberger State-Trait Anxiety Inventories, Attentional Function Index). Hierarchical linear modeling based on full maximum likelihood estimation was performed. RESULTS Characteristics associated with higher initial levels of sleep disturbance included higher body mass index, poorer functional status, higher trait anxiety, higher depressive symptoms, and higher evening fatigue. Characteristics associated with the worse trajectories of sleep disturbance were higher levels of education and higher sleep disturbance at enrollment. Characteristics associated with both higher initial levels and worse trajectories of sleep disturbance were higher morning fatigue and worse attentional function. CONCLUSIONS A large amount of inter-individual variability exists in sleep disturbance during CTX. The modifiable and non-modifiable characteristics found in this study can be used to identify higher risk patients and provide earlier interventions to reduce sleep disturbance.
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Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev 2017; 1:CD010802. [PMID: 28045199 PMCID: PMC6465041 DOI: 10.1002/14651858.cd010802.pub2] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Breast cancer is the cancer most frequently diagnosed in women worldwide. Even though survival rates are continually increasing, breast cancer is often associated with long-term psychological distress, chronic pain, fatigue and impaired quality of life. Yoga comprises advice for an ethical lifestyle, spiritual practice, physical activity, breathing exercises and meditation. It is a complementary therapy that is commonly recommended for breast cancer-related impairments and has been shown to improve physical and mental health in people with different cancer types. OBJECTIVES To assess effects of yoga on health-related quality of life, mental health and cancer-related symptoms among women with a diagnosis of breast cancer who are receiving active treatment or have completed treatment. SEARCH METHODS We searched the Cochrane Breast Cancer Specialised Register, MEDLINE (via PubMed), Embase, the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1), Indexing of Indian Medical Journals (IndMED), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal and Clinicaltrials.gov on 29 January 2016. We also searched reference lists of identified relevant trials or reviews, as well as conference proceedings of the International Congress on Complementary Medicine Research (ICCMR), the European Congress for Integrative Medicine (ECIM) and the American Society of Clinical Oncology (ASCO). We applied no language restrictions. SELECTION CRITERIA Randomised controlled trials were eligible when they (1) compared yoga interventions versus no therapy or versus any other active therapy in women with a diagnosis of non-metastatic or metastatic breast cancer, and (2) assessed at least one of the primary outcomes on patient-reported instruments, including health-related quality of life, depression, anxiety, fatigue or sleep disturbances. DATA COLLECTION AND ANALYSIS Two review authors independently collected data on methods and results. We expressed outcomes as standardised mean differences (SMDs) with 95% confidence intervals (CIs) and conducted random-effects model meta-analyses. We assessed potential risk of publication bias through visual analysis of funnel plot symmetry and heterogeneity between studies by using the Chi2 test and the I2 statistic. We conducted subgroup analyses for current treatment status, time since diagnosis, stage of cancer and type of yoga intervention. MAIN RESULTS We included 24 studies with a total of 2166 participants, 23 of which provided data for meta-analysis. Thirteen studies had low risk of selection bias, five studies reported adequate blinding of outcome assessment and 15 studies had low risk of attrition bias.Seventeen studies that compared yoga versus no therapy provided moderate-quality evidence showing that yoga improved health-related quality of life (pooled SMD 0.22, 95% CI 0.04 to 0.40; 10 studies, 675 participants), reduced fatigue (pooled SMD -0.48, 95% CI -0.75 to -0.20; 11 studies, 883 participants) and reduced sleep disturbances in the short term (pooled SMD -0.25, 95% CI -0.40 to -0.09; six studies, 657 participants). The funnel plot for health-related quality of life was asymmetrical, favouring no therapy, and the funnel plot for fatigue was roughly symmetrical. This hints at overall low risk of publication bias. Yoga did not appear to reduce depression (pooled SMD -0.13, 95% CI -0.31 to 0.05; seven studies, 496 participants; low-quality evidence) or anxiety (pooled SMD -0.53, 95% CI -1.10 to 0.04; six studies, 346 participants; very low-quality evidence) in the short term and had no medium-term effects on health-related quality of life (pooled SMD 0.10, 95% CI -0.23 to 0.42; two studies, 146 participants; low-quality evidence) or fatigue (pooled SMD -0.04, 95% CI -0.36 to 0.29; two studies, 146 participants; low-quality evidence). Investigators reported no serious adverse events.Four studies that compared yoga versus psychosocial/educational interventions provided moderate-quality evidence indicating that yoga can reduce depression (pooled SMD -2.29, 95% CI -3.97 to -0.61; four studies, 226 participants), anxiety (pooled SMD -2.21, 95% CI -3.90 to -0.52; three studies, 195 participants) and fatigue (pooled SMD -0.90, 95% CI -1.31 to -0.50; two studies, 106 participants) in the short term. Very low-quality evidence showed no short-term effects on health-related quality of life (pooled SMD 0.81, 95% CI -0.50 to 2.12; two studies, 153 participants) or sleep disturbances (pooled SMD -0.21, 95% CI -0.76 to 0.34; two studies, 119 participants). No trial adequately reported safety-related data.Three studies that compared yoga versus exercise presented very low-quality evidence showing no short-term effects on health-related quality of life (pooled SMD -0.04, 95% CI -0.30 to 0.23; three studies, 233 participants) or fatigue (pooled SMD -0.21, 95% CI -0.66 to 0.25; three studies, 233 participants); no trial provided safety-related data. AUTHORS' CONCLUSIONS Moderate-quality evidence supports the recommendation of yoga as a supportive intervention for improving health-related quality of life and reducing fatigue and sleep disturbances when compared with no therapy, as well as for reducing depression, anxiety and fatigue, when compared with psychosocial/educational interventions. Very low-quality evidence suggests that yoga might be as effective as other exercise interventions and might be used as an alternative to other exercise programmes.
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Affiliation(s)
- Holger Cramer
- University of Duisburg‐EssenDepartment of Internal and Integrative Medicine, Kliniken Essen‐Mitte, Faculty of MedicineAm Deimelsberg 34aEssenGermany45276
| | - Romy Lauche
- University of Technology SydneyAustralian Research Centre in Complementary and Integrative Medicine235‐253 Jones StreetUltimoAustralia2007
| | - Petra Klose
- University of Duisburg‐EssenDepartment of Internal and Integrative Medicine, Kliniken Essen‐Mitte, Faculty of MedicineAm Deimelsberg 34aEssenGermany45276
| | - Silke Lange
- University of Duisburg‐EssenDepartment of Internal and Integrative Medicine, Kliniken Essen‐Mitte, Faculty of MedicineAm Deimelsberg 34aEssenGermany45276
| | - Jost Langhorst
- University of Duisburg‐EssenDepartment of Integrative Gastroenterology, Kliniken Essen‐Mitte, Faculty of MedicineAm Deimelsberg 34aEssenGermany45276
| | - Gustav J Dobos
- University of Duisburg‐EssenDepartment of Internal and Integrative Medicine, Kliniken Essen‐Mitte, Faculty of MedicineAm Deimelsberg 34aEssenGermany45276
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Efficacy, feasibility, and acceptability of a novel technology-based intervention to support physical activity in cancer survivors. Support Care Cancer 2016; 25:1291-1300. [DOI: 10.1007/s00520-016-3523-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/05/2016] [Indexed: 11/24/2022]
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Wang Y, Zhu X, Li L, Yi J, He J. What Factors Affect the Insomnia Symptom Trajectories in Women With Nonmetastatic Breast Cancer? J Pain Symptom Manage 2016; 52:850-858. [PMID: 27515406 DOI: 10.1016/j.jpainsymman.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/12/2016] [Accepted: 07/29/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to identify the trajectories of insomnia symptoms in Chinese women with nonmetastatic breast cancer and further determine the effects of sociodemographic, disease, and psychological variables on different insomnia symptoms. METHODS A total of 287 female breast cancer patients were recruited to complete measures of cognitive emotion regulation strategies, perceived social support, and insomnia symptoms at six time points from the week after diagnosis to four months after surgery. RESULTS Four distinct classes of insomnia symptom trajectories were identified using growth mixture modeling and were named low sustained class (n = 128, 44.60%), high sustained class (n = 33, 11.50%), moderate sustained class (n = 64, 22.30%), and decreasing class (n = 62, 21.60%). Patients in these trajectory classes differed in demographic characteristics (age, education, employment, and monthly income), pathologic stage, and psychological characteristics (perceived social support and cognitive emotion regulation strategies). Patients with less than nine years of education (adjusted odds ratio = 2.61-4.10) or higher levels of self-blame (adjusted odds ratio = 1.80-2.14) are most likely to belong to the high sustained, moderate sustained, and decreasing classes. CONCLUSION Four latent trajectories may be a reliable and valuable approach in analyzing insomnia symptoms in breast cancer patients. Heterogeneity should be considered to allow more attention to be paid on patients in high and moderate sustained class. Education and cognitive emotion regulation strategies are important factors for the onset and development of insomnia symptoms.
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Affiliation(s)
- Yuping Wang
- School of Humanities & Social Sciences, Xi'an Jiaotong University, Xi'an, Shaanxi, P.R. China; Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China; Medical Psychological Institute of Central South University, Changsha, Hunan, P.R. China.
| | - Lingyan Li
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Jinyao Yi
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Jincai He
- The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
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Jain S, Boyd C, Fiorentino L, Khorsan R, Crawford C. Are there efficacious treatments for treating the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients? A Rapid Evidence Assessment of the Literature (REAL(©)). BREAST CANCER-TARGETS AND THERAPY 2015; 7:267-91. [PMID: 26379445 PMCID: PMC4567232 DOI: 10.2147/bctt.s25014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose While fatigue, sleep disturbance, and depression often co-occur in breast cancer patients, treatment efficacy for this symptom cluster is unknown. A systematic review was conducted to determine whether there are specific interventions (ie, medical, pharmacological, behavioral, psychological, and complementary medicine approaches) that are effective in mitigating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients, using the Rapid Evidence Assessment of the Literature (REAL©) process. Methods Peer-reviewed literature was searched across multiple databases; from database inception – October 2011, using keywords pre-identified to capture randomized controlled trials (RCT) relevant to the research question. Methodological bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) 50 checklist. Confidence in the estimate of effect and assessment of safety were also evaluated across the categories of included interventions via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. Results The initial search yielded 531 citations, of which 41 met the inclusion criteria. Of these, twelve RCTs reported on all three symptoms, and eight of these were able to be included in the GRADE analysis. The remaining 29 RCTs reported on two symptoms. Studies were of mixed quality and many were underpowered. Overall, results suggest that there is: 1) promising evidence for the effectiveness of various treatment types in mitigating sleep disturbance in breast cancer patients; 2) mixed evidence for fatigue; 3) little evidence for treating depression; and 4) no clear evidence that treatment of one symptom results in effective treatment for other symptoms. Conclusion More high-quality studies are needed to determine the impact of varied treatments in mitigating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients. Furthermore, we encourage future studies to examine the psychometric and clinical validity of the hypothesized relationship between the symptoms in the fatigue–sleep disturbance–depression symptom cluster.
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Affiliation(s)
- Shamini Jain
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Lavinia Fiorentino
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
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Wright F, D'Eramo Melkus G, Hammer M, Schmidt BL, Knobf MT, Paul SM, Cartwright F, Mastick J, Cooper BA, Chen LM, Melisko M, Levine JD, Kober K, Aouizerat BE, Miaskowski C. Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue. J Pain Symptom Manage 2015; 50:176-89. [PMID: 25828559 PMCID: PMC4526314 DOI: 10.1016/j.jpainsymman.2015.02.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/06/2015] [Accepted: 02/18/2015] [Indexed: 11/25/2022]
Abstract
CONTEXT Fatigue is the most common symptom in oncology patients during chemotherapy. Little is known about the predictors of interindividual variability in initial levels and trajectories of morning fatigue severity in these patients. OBJECTIVES An evaluation was done to determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of morning fatigue and to compare findings with our companion paper on evening fatigue. METHODS A sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (n = 586) completed demographic and symptom questionnaires a total of six times over two cycles of chemotherapy. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling was used to answer the study objectives. RESULTS A large amount of interindividual variability was found in the morning fatigue trajectories. A piecewise model fit the data best. Patients with higher body mass index, who did not exercise regularly, with a lower functional status, and who had higher levels of state anxiety, sleep disturbance, and depressive symptoms reported higher levels of morning fatigue at enrollment. Variations in the trajectories of morning fatigue were predicted by the patients' ethnicity and younger age. CONCLUSION The modifiable risk factors that were associated with only morning fatigue were body mass index, exercise, and state anxiety. Modifiable risk factors that were associated with both morning and evening fatigue included functional status, depressive symptoms, and sleep disturbance. Using this information, clinicians can identify patients at higher risk for more severe morning fatigue and evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.
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Affiliation(s)
- Fay Wright
- Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, New York, USA
| | - Gail D'Eramo Melkus
- Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, New York, USA
| | - Marilyn Hammer
- Florence S. Downs PhD Program in Nursing Research and Theory Development, College of Nursing, New York University, New York, New York, USA
| | - Brian L Schmidt
- Department of Oral and Maxillofacial Surgery, School of Dentistry, New York University, New York, New York, USA
| | - M Tish Knobf
- Division of Acute Care/Health Systems, Yale School of Nursing, New Haven, Connecticut, USA
| | - Steven M Paul
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | | | - Judy Mastick
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Bruce A Cooper
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Lee-May Chen
- Department of Obstetrics and Gynecology, University of California at San Francisco, San Francisco, California, USA
| | - Michelle Melisko
- Department of Medicine, School of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Jon D Levine
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California at San Francisco, San Francisco, California, USA
| | - Kord Kober
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA
| | - Bradley E Aouizerat
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA; The Institute for Human Genetics, University of California at San Francisco, San Francisco, California, USA
| | - Christine Miaskowski
- Department of Physiologic Nursing, School of Nursing, University of California at San Francisco, San Francisco, California, USA.
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Chen ML, Liu LN, Miaskowski C, Chen SC, Lin YC, Wang JS. Presurgical symptom profiles predict quality of life 2 years after surgery in women with breast cancer. Support Care Cancer 2015; 24:243-251. [PMID: 26014617 DOI: 10.1007/s00520-015-2784-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/17/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Higher symptom burden in oncology patients is associated with poorer quality of life (QOL). However, the long-term predictive relationship between pre-treatment symptom profiles and QOL is unknown. The aim of this study was to identify subgroups of breast cancer patients based on their presurgical symptom profiles and to examine the predictive effect of group membership on QOL 2 years after surgery. METHODS Data were analyzed from a longitudinal study of women's (N = 198) symptoms after breast cancer surgery. Patient subgroups were identified by latent class analysis based on presurgical severity of five symptoms (i.e., attentional and physical fatigue, sleep disturbance, depression, and anxiety). Among these 198 women, quality of life 2 years after surgery was available for 97. Group differences in QOL were examined by general linear models. RESULTS We identified four distinct patient groups. Group A (All Low) had low levels of all symptoms. Group B (Low Fatigue and Moderate Mood) was characterized by low attentional and physical fatigue but moderate sleep disturbance, depression, and anxiety. Group C (All Moderate) was characterized by moderate levels of all five symptoms. Group D was characterized by moderate attentional and physical fatigue and severe sleep disturbance, depression, and anxiety (Moderate Fatigue and High Mood). Group D had significantly lower overall QOL scores 2 years after surgery than Group A (p = 0.002). CONCLUSIONS Breast cancer patients' presurgical symptom profile had a long-term predictive effect on QOL. Routine assessment of patients' pre-treatment symptom is suggested to identify high risk group.
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Affiliation(s)
- Mei-Ling Chen
- Graduate Institute of Nursing, College of Medicine, Chang Gung University, 259 Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, Taiwan.
| | - Li-Ni Liu
- Department of Nursing, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA
| | - Shin-Cheh Chen
- Department of Surgery, Chang Gung Memorial Hospital and School of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yung-Chang Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital and School of Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Jong-Shyan Wang
- Department of Rehabilitation Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Chemotherapy interruptions in relation to symptom severity in advanced breast cancer. Support Care Cancer 2015; 23:3183-91. [PMID: 25805451 DOI: 10.1007/s00520-015-2698-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 03/09/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE Interruptions in medical treatment such as dose delays, reductions, or stoppages can lead to suboptimal treatment of cancer. Knowing how and for whom symptom severity and symptom interference with activities of daily living (ADL) are associated with treatment interruptions can guide behavioral interventions for supportive care. The purpose of this analysis is to inform research and clinical practice by bringing attention to specific patient symptoms that may hinder dose completion. METHODS A secondary analysis of data collected in a randomized clinical trial (RCT) of reflexology for symptom management was performed. The trial enrolled women with advanced breast cancer undergoing treatment (N = 385). Outcome data were collected at baseline, weeks 5 and 11 using valid and reliable measures. Medical records provided data on treatment interruptions and metastasis. The association between alterations in medical treatment during the study period with symptom severity, symptom interference with ADLs, and metastatic status were tested using generalized estimating equation (GEE) models. RESULTS The relationship between dose delays and dose reductions and symptom severity was differential according to metastatic status, with the higher strength of association among women with distant metastasis compared to those with loco-regional disease (p = 0.02). The interaction of symptom interference and metastatic status was also significantly related to dose delays and reductions (p = 0.04). Severity of pain was a stronger predictor of dose delays or reductions among patients with distant metastasis compared to those with loco-regional disease (p < 0.01). CONCLUSION The analysis highlights the importance of understanding symptom outcomes that impact research, practice, and treatment decisions.
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Schreiber KL, Kehlet H, Belfer I, Edwards RR. Predicting, preventing and managing persistent pain after breast cancer surgery: the importance of psychosocial factors. Pain Manag 2014; 4:445-59. [DOI: 10.2217/pmt.14.33] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Merriman JD, Von Ah D, Miaskowski C, Aouizerat BE. Proposed mechanisms for cancer- and treatment-related cognitive changes. Semin Oncol Nurs 2014; 29:260-9. [PMID: 24183157 DOI: 10.1016/j.soncn.2013.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To review the proposed mechanisms of cognitive changes associated with non-central nervous system cancers and cancer treatment. DATA SOURCES Review and synthesis of databased publications and review articles. CONCLUSION Proposed mechanisms include cytokine upregulation, hormonal changes, neurotransmitter dysregulation, attentional fatigue, genetic predisposition, and comorbid symptoms. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses need to understand the multiple mechanisms that may contribute to the development of cancer- and treatment-related cognitive changes so that they can identify patients at high risk and help patients understand why these changes occur.
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Leung G, Baggott C, West C, Elboim C, Paul SM, Cooper BA, Abrams G, Dhruva A, Schmidt BL, Kober K, Merriman JD, Leutwyler H, Neuhaus J, Langford D, Smoot BJ, Aouizerat BE, Miaskowski C. Cytokine candidate genes predict the development of secondary lymphedema following breast cancer surgery. Lymphat Res Biol 2014; 12:10-22. [PMID: 24502445 PMCID: PMC3961780 DOI: 10.1089/lrb.2013.0024] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lymphedema (LE) is a frequent complication following breast cancer treatment. While progress is being made in the identification of phenotypic risk factors for the development of LE, little information is available on the molecular characterization of LE. The purpose of this study was to determine if variations in pro- and anti-inflammatory cytokine genes were associated with LE following breast cancer treatment. METHODS AND RESULTS Breast cancer patients completed a number of self-report questionnaires. LE was evaluated using bioimpedance spectroscopy. Genotyping was done using a custom genotyping array. No differences were found between patients with (n=155) and without LE (n=387) for the majority of the demographic and clinical characteristics. Patients with LE had a significantly higher body mass index, more advanced disease, and a higher number of lymph nodes removed. Genetic associations were identified for three genes (i.e., interleukin (IL4) 4 (rs2227284), IL 10 (rs1518111), and nuclear kappa factor beta 2 (NFKB2 (rs1056890)) associated with inflammatory responses. CONCLUSIONS These genetic associations suggest a role for a number of pro- and anti-inflammatory genes in the development of LE following breast cancer treatment.
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Affiliation(s)
- Geraldine Leung
- 1 School of Nursing, University of California , San Francisco, California
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Garland SN, Johnson JA, Savard J, Gehrman P, Perlis M, Carlson L, Campbell T. Sleeping well with cancer: a systematic review of cognitive behavioral therapy for insomnia in cancer patients. Neuropsychiatr Dis Treat 2014; 10:1113-24. [PMID: 24971014 PMCID: PMC4069142 DOI: 10.2147/ndt.s47790] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Individuals with cancer are disproportionately affected by sleep disturbance and insomnia relative to the general population. These problems can be a consequence of the psychological, behavioral, and physical effects of a cancer diagnosis and treatment. Insomnia often persists for years and, when combined with already high levels of cancer-related distress, may place cancer survivors at a higher risk of future physical and mental health problems and poorer quality of life. The recommended first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBT-I), a non-pharmacological treatment that incorporates cognitive and behavior-change techniques and targets dysfunctional attitudes, beliefs, and habits involving sleep. This article presents a comprehensive review of the literature examining the efficacy of CBT-I on sleep and psychological outcomes in cancer patients and survivors. The search revealed 12 studies (four uncontrolled, eight controlled) that evaluated the effects of CBT-I in cancer patients or survivors. Results suggest that CBT-I is associated with statistically and clinically significant improvements in subjective sleep outcomes in patients with cancer. CBT-I may also improve mood, fatigue, and overall quality of life, and can be successfully delivered through a variety of treatment modalities, making it possible to reach a broader range of patients who may not have access to more traditional programs. Future research in this area should focus on the translation of evidence into clinical practice in order to increase awareness and access to effective insomnia treatment in cancer care.
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Affiliation(s)
- Sheila N Garland
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Jillian A Johnson
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Josee Savard
- School of Psychology, Laval University, Quebec City, QC, Canada
| | - Philip Gehrman
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Michael Perlis
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Linda Carlson
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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Dhruva A, Aouizerat BE, Cooper B, Paul SM, Dodd M, West C, Wara W, Lee K, Dunn LB, Langford DJ, Merriman JD, Baggott C, Cataldo J, Ritchie C, Kober K, Leutwyler H, Miaskowski C. Differences in morning and evening fatigue in oncology patients and their family caregivers. Eur J Oncol Nurs 2013; 17:841-8. [PMID: 24012189 PMCID: PMC3867806 DOI: 10.1016/j.ejon.2013.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/10/2013] [Accepted: 06/21/2013] [Indexed: 01/13/2023]
Abstract
PURPOSE OF THE RESEARCH To identify distinct latent classes of individuals based on ratings of morning and evening fatigue; evaluate for differences in phenotypic characteristics, as well as symptom and quality of life scores, among these latent classes; and evaluate for an overlap in morning and evening fatigue class membership. PATIENTS AND METHODS In a sample of 167 oncology outpatients and 85 of their FCs, growth mixture modeling was used to identify distinct latent classes based on ratings of morning and evening fatigue obtained before, during, and after radiation therapy. Analyses of variance and Chi Square analyses were used to evaluate for differences among the morning and evening fatigue latent classes. RESULTS Three distinct latent classes for morning fatigue were identified. Participants in the High Morning Fatigue class (47%) were younger and had lower functional status. Three distinct latent classes for evening fatigue were identified. Participants in the High Evening Fatigue class (61%) were younger, more likely to be female, more likely to have children at home, and more likely to be a FC. Only 10.3% of participants were classified in both the Very Low Morning and Low Evening Fatigue classes and 41.3% were classified in both the High Morning and High Evening Fatigue classes. CONCLUSIONS Different characteristics were associated with morning and evening fatigue, which suggests that morning and evening fatigue may be distinct but related symptoms. Additional research is needed to elucidate the mechanisms that may underlie diurnal variability in fatigue.
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Affiliation(s)
- Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | - Bradley E. Aouizerat
- School of Nursing, University of California, San Francisco, CA, USA
- Institute for Human Genetics, University of California, San Francisco, CA, USA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Steven M. Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Marylin Dodd
- School of Nursing, University of California, San Francisco, CA, USA
| | - Claudia West
- School of Nursing, University of California, San Francisco, CA, USA
| | - William Wara
- California and Kaiser Permanente, San Francisco, CA, USA
| | - Kathryn Lee
- School of Nursing, University of California, San Francisco, CA, USA
| | - Laura B. Dunn
- School of Medicine, University of California, San Francisco, CA, USA
| | - Dale J. Langford
- School of Nursing, University of California, San Francisco, CA, USA
| | - John D. Merriman
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Janine Cataldo
- School of Nursing, University of California, San Francisco, CA, USA
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, CA, USA
| | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA
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Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ. Yoga for women diagnosed with breast cancer. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010802] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Alfaro E, Dhruva A, Langford DJ, Koetters T, Merriman JD, West C, Dunn LB, Paul SM, Cooper B, Cataldo J, Hamolsky D, Elboim C, Kober K, Aouizerat BE, Miaskowski C. Associations between cytokine gene variations and self-reported sleep disturbance in women following breast cancer surgery. Eur J Oncol Nurs 2013; 18:85-93. [PMID: 24012192 PMCID: PMC3946647 DOI: 10.1016/j.ejon.2013.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/27/2013] [Accepted: 08/04/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE OF THE RESEARCH To attempt to replicate the associations found in our previous study of patients and family caregivers between interleukin 6 (IL6) and nuclear factor kappa beta 2 (NFKB2) and sleep disturbance and to identify additional genetic associations in a larger sample of patients with breast cancer. METHODS AND SAMPLE Patients with breast cancer (n = 398) were recruited prior to surgery and followed for six months. Patients completed a self-report measure of sleep disturbance and provided a blood sample for genomic analyses. Growth mixture modeling was used to identify distinct latent classes of patients with higher and lower levels of sleep disturbance. KEY RESULTS Patients who were younger and who had higher comorbidity and lower functional status were more likely to be in the high sustained sleep disturbance class. Variations in three cytokine genes (i.e., IL1 receptor 2 (IL1R2), IL13, NFKB2) predicted latent class membership. CONCLUSIONS Polymorphisms in cytokine genes may partially explain inter-individual variability in sleep disturbance. Determination of high risk phenotypes and associated molecular markers may allow for earlier identification of patients at higher risk for developing sleep disturbance and lead to the development of more targeted clinical interventions.
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Affiliation(s)
- Emely Alfaro
- School of Nursing, University of California, San Francisco, CA, USA
| | - Anand Dhruva
- School of Medicine, University of California, San Francisco, CA, USA
| | - Dale J Langford
- School of Nursing, University of California, San Francisco, CA, USA
| | - Theresa Koetters
- School of Nursing, University of California, San Francisco, CA, USA
| | - John D Merriman
- School of Nursing, University of California, San Francisco, CA, USA
| | - Claudia West
- School of Nursing, University of California, San Francisco, CA, USA
| | - Laura B Dunn
- School of Medicine, University of California, San Francisco, CA, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bruce Cooper
- School of Nursing, University of California, San Francisco, CA, USA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, CA, USA
| | - Deborah Hamolsky
- School of Nursing, University of California, San Francisco, CA, USA
| | | | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA
| | - Bradley E Aouizerat
- School of Nursing, University of California, San Francisco, CA, USA; Institute for Human Genetics, University of California, San Francisco, CA, USA
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Miaskowski C, Cooper B, Paul SM, West C, Langford D, Levine JD, Abrams G, Hamolsky D, Dunn L, Dodd M, Neuhaus J, Baggott C, Dhruva A, Schmidt B, Cataldo J, Merriman J, Aouizerat BE. Identification of patient subgroups and risk factors for persistent breast pain following breast cancer surgery. THE JOURNAL OF PAIN 2012; 13:1172-87. [PMID: 23182226 PMCID: PMC3511823 DOI: 10.1016/j.jpain.2012.09.013] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Revised: 08/10/2012] [Accepted: 09/10/2012] [Indexed: 01/07/2023]
Abstract
UNLABELLED Study purposes were to determine the prevalence of persistent pain in the breast; characterize distinct persistent pain classes using growth mixture modeling; and evaluate for differences among these pain classes in demographic, preoperative, intraoperative, and postoperative characteristics. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the pain classes, were evaluated. Patients (n = 398) were recruited prior to surgery and followed for 6 months. Using growth mixture modeling, patients were classified into no (31.7%), mild (43.4%), moderate (13.3%), and severe (11.6%) pain groups based on ratings of worst breast pain. Differences in a number of demographic, preoperative, intraoperative, and postoperative characteristics differentiated among the pain classes. In addition, patients in the moderate and severe pain classes reported higher preoperative levels of depression, anxiety, and sleep disturbance than the no pain class. Findings suggest that approximately 25% of women experience significant and persistent levels of breast pain in the first 6 months following breast cancer surgery. PERSPECTIVE Persistent pain is a significant problem for 25% of women following surgery for breast cancer. Severe breast pain is associated with clinically meaningful decrements in functional status and quality of life.
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Differences in sleep disturbance, fatigue and energy levels between women with and without breast pain prior to breast cancer surgery. Breast 2012; 22:273-6. [PMID: 22858121 DOI: 10.1016/j.breast.2012.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 06/24/2012] [Accepted: 07/04/2012] [Indexed: 01/15/2023] Open
Abstract
The purpose of this study was to evaluate for differences in occurrence and severity ratings of sleep disturbance, fatigue, and decreased energy in women who reported breast pain prior to surgery for breast cancer. Of the 390 women who completed self-report measures for each symptom, 28.2% reported pain in their breast prior to surgery. A higher percentage of women in the pain group (i.e., 66.7% versus 53.5%) reported clinically meaningful levels of sleep disturbance. However, no between group differences were found in the severity of sleep disturbance, fatigue, or decreased energy. Findings from this study suggest that sleep disturbance, fatigue, and decreased levels of energy are significant problems for women prior to breast cancer surgery. Future studies need to evaluate for specific characteristics that place women at greater risk for these symptoms as well as the mechanisms that underlie these symptoms.
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