Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TRFatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 18: 743-753

Norman Cousins Center in Psychoneuroimmunology, Departments of Biostatistics and Psychiatry and Biobehavioral Sciences, Schools of Public Health and Medicine, University of California, Los Angeles, CA, USA.
Journal of Clinical Oncology (Impact Factor: 18.43). 03/2000; 18(4):743-53.
Source: PubMed


To describe the occurrence of fatigue in a large sample of breast cancer survivors relative to general population norms and to identify demographic, medical, and psychosocial characteristics of fatigued survivors.
Breast cancer survivors in two large metropolitan areas completed standardized questionnaires as part of a survey study, including the RAND 36-item Health Survey, Center for Epidemiological Studies-Depression Scale, Breast Cancer Prevention Trial Symptom Checklist, Medical Outcomes Study Sleep Scale, and demographic and treatment-related measures.
On average, the level of fatigue reported by the breast cancer survivors surveyed (N = 1,957) was comparable to that of age-matched women in the general population, although the breast cancer survivors were somewhat more fatigued than a more demographically similar reference group. Approximately one third of the breast cancer survivors assessed reported more severe fatigue, which was associated with significantly higher levels of depression, pain, and sleep disturbance. In addition, fatigued women were more bothered by menopausal symptoms and were somewhat more likely to have received chemotherapy (with or without radiation therapy) than nonfatigued women. In multivariate analyses, depression and pain emerged as the strongest predictors of fatigue.
Although the majority of breast cancer survivors in this large and diverse sample did not experience heightened levels of fatigue relative to women in the general population, there was a subgroup of survivors who did report more severe and persistent fatigue. We identified characteristics of these women that may be helpful in elucidating the mechanisms underlying fatigue in this population, as well as directing intervention efforts.

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Available from: Julia Rowland, Oct 13, 2015
    • "Medical Outcomes Study Sleep Scale (MOS-SS; Hays et al., 2005): The MOS-SS is a validated scale comprising 12 items, including questions about sleep disturbance, sleep adequacy, daytime somnolence, snoring, waking up short of breath or with a headache, and sleep quantity. MOS-SS has been used as an instrument to investigate disrupted sleep in cancer populations (Bower et al., 2000; Thomas et al., 2010). It is validated for a 1-week recall, which is what we used in the present study and a previous study (Nakamura et al., 2011). "
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    ABSTRACT: Cancer survivors experience high levels of distress, associated with a host of negative psychological states, including anxiety, depression, and fear of recurrence, which often lead to sleep problems and reduction in quality of life (QOL) and well-being. As a neuropeptide hormone associated with affiliation, calmness, and well-being, oxytocin may be a useful biological measure of changes in health outcomes in cancer survivors. In this exploratory study, which comprised a subset of participants from a larger study, we evaluated (a) the feasibility and reliability of salivary oxytocin (sOT) levels in cancer survivors and (b) the effects of 2 sleep-focused mind-body interventions, mind-body bridging (MBB) and mindfulness meditation (MM), compared with a sleep hygiene education (SHE) control, on changes in sOT levels in 30 cancer survivors with self-reported sleep disturbance. Interventions were conducted in 3 sessions, once per week for 3 weeks. Saliva samples were collected at baseline, postintervention (~1 week after the last session), and at the 2-month follow-up. In this cancer survivor group, we found that intra-individual sOT levels were fairly stable across the 3 time points, of about 3 months' duration, and mean baseline sOT levels did not differ between females and males and were not correlated with age. Correlations between baseline sOT and self-report measures were weak; however, several of these relationships were in the predicted direction, in which sOT levels were negatively associated with sleep problems and depression and positively associated with cancer-related QOL and well-being. Regarding intervention effects on sOT, baseline-subtracted sOT levels were significantly larger at postintervention in the MBB group as compared with those in SHE. In this sample of cancer survivors assessed for sOT, at postintervention, greater reductions in sleep problems were noted for MBB and MM compared with that of SHE, and increases in mindfulness and self-compassion were observed in the MBB group compared with those in SHE. The findings in this exploratory study suggest that sOT may be a reliable biological measure over time that may provide insight into the effects of mind-body interventions on health outcomes in cancer survivors. © The Author(s) 2015.
    Integrative Cancer Therapies 04/2015; 14(4). DOI:10.1177/1534735415580675 · 2.36 Impact Factor
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    • "Research suggests that approximately 25% to 33% experience persistent fatigue through 10 years after cancer diagnosis (Bower, 2014). For example, in a cohort of 1,957 breast cancer survivors between 1 and 5 years after diagnosis, 35% had fatigue in the higher than normal range (Bower et al., 2000). Furthermore, in subsequent evaluation 5 years later, fatigue persisted in 21% of the sample, and overall, 34% reported fatigue 5 to 10 years after diagnosis (Bower et al. 2006). "
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    ABSTRACT: The number of individuals living with a history of cancer is estimated at 13.7 million in the United States and is expected to rise with the aging of the population. With expanding attention to the psychosocial and physical consequences of surviving illness, psychological science and evidence-based practice are making important contributions to addressing the pressing needs of cancer survivors. Research is demonstrating that adults diagnosed with cancer evidence generally positive psychosocial adjustment over time; however, a subset is at risk for compromised psychological and physical health stemming from long-term or late effects of cancer and its treatment. In this article, we characterize survivorship after medical treatment completion during the periods of reentry, early survivorship, and long-term survivorship. We describe the major psychosocial and physical sequelae facing adults during those periods, highlight promising posttreatment psychosocial and behavioral interventions, and offer recommendations for future research and evidence-based practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    American Psychologist 02/2015; 70(2):159-174. DOI:10.1037/a0037875 · 6.87 Impact Factor
    • "Inadultcancer,fatigueandsleepdisordershavebeenreported bysurvivorsofvarioustypesofcancer,monthstoyearsfollowing treatment[99] [100].Asthesurvivalrateofchildhoodcancerin- creases,reportsofongoingsleepdisordersandfatigueduringthe yearsfollowingtreatmentandintoadulthood,arealsoemergingin thispopulation.Thesleepproblemsinitiatedearlyinthediagnosis andtreatmentofcancershavethepotentialtobecomechronicvia perpetuationofbehavioursthathavedevelopedtocompensatefor sleeplossduringillness,includingdaytimenapping,bedsharing withparents,spendinglengthyperiodsoftimeinbedwithout sleeping,andgoingtobedearlierand/orgettinguplater[101]. Thesebehaviourscontributetopoorsleep-relatedhabitsanddysregulationofthesleepewakecycle ,resultinginthedifficultiesin fallingasleepandstayingasleepovernight. "
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    ABSTRACT: Cancer in children has detrimental effects on sleep patterns and sleep quality, which in turn impacts on the perception of, and the ability to cope with, the emotional and physical challenges associated with both the disease and its treatment. This places an added burden on their quality of life that can last many years beyond diagnosis and treatment. In addition to the effect of the cancer itself, surgery, chemotherapy and radiotherapy can all contribute both short and long term to sleep disruption. Sleep disorders have also been associated with pain, fatigue, medication and hospitalisation in children suffering from cancer. This review will explore the relationship between childhood cancer and associated sleep disorders, in the acute stage of diagnosis, during treatment and in the years following. We will discuss the possible causes and the current treatment modalities used to treat sleep disorders in children with cancer, and in childhood cancer survivors. It has been estimated that the recent advances in treatment have improved the overall five year survival rate for all childhood cancers to over 80%, with some cancers achieving a near 100% cure rate such as early stage Wilms' tumour. Thus, recognition and appropriate treatment of associated sleep disorders is essential to optimise long term quality of life. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Sleep Medicine Reviews 01/2015; 24C:71-82. DOI:10.1016/j.smrv.2015.01.001 · 8.51 Impact Factor
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