Abstract
Goals
Previous investigations have shown that women undergoing chemotherapy for breast cancer experience both disturbed sleep and fatigue. However, most of the previous research examined women either during or after chemotherapy. This study examined sleep, fatigue, and circadian rhythms in women with breast cancer before the start of chemotherapy.
Patients and methods
Eighty five women with Stages I–IIIA breast cancer who were scheduled to begin adjuvant or neoadjuvant anthracycline-based chemotherapy participated. Each had sleep/wake activity recorded with actigraphy for 72 consecutive hours and filled out questionnaires on sleep, fatigue, depression, and functional outcome.
Main results
On average, the women slept for about 6 h a night and napped for over an hour during the day. Sleep was reported to be disturbed and fatigue levels were high. Circadian rhythms were robust, but women who were more phase-delayed reported more daily dysfunction (p<0.01).
Conclusions
The data from the current study suggest that the women with breast cancer likely experience both disturbed sleep and fatigue before the beginning of chemotherapy. Although their circadian rhythms are robust, breast cancer patients with more delayed rhythms experience more daily dysfunction secondary to fatigue. These data suggest that strategies to improve disturbed sleep and to phase-advance circadian rhythms prior to initiation of chemotherapy may be beneficial in improving daily function in breast cancer patients.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00520-005-0861-0/MediaObjects/s00520-005-0861-0fmb1.gif)
Similar content being viewed by others
Abbreviations
- CES-D:
-
Center for Epidemiological Studies–Depression scale
- CI:
-
Confidence Intervals
- FACT-B:
-
Functional Assessment of Cancer Therapy–Breast
- FOSQ:
-
Functional Outcome of Sleep Questionnaire
- MFSI-SF:
-
Multidimensional Fatigue Symptom Inventory–Short Form
- PSQI:
-
Pittsburgh Sleep Quality Index
References
Ancoli-Israel S, Clopton P, Klauber MR, Fell R, Mason WJ (1997) Use of wrist activity for monitoring sleep/wake in demented nursing home patients. Sleep 20:24–27
Ancoli-Israel S, Cole R, Alessi CA, Chambers M, Moorcroft WH, Pollak C (2003) The role of actigraphy in the study of sleep and circadian rhythms. Sleep 26:342–392
Ancoli-Israel S, Moore P, Jones V (2001) The relationship between fatigue and sleep in cancer patients: a review. Eur J Cancer Care 10:245–255
Anderson KO, Getto CJ, Mendoza TR, Palmer SN, Wang XS, Reyes-Gibby CC, Cleeland C (2003) Fatigue and sleep disturbance in patients with cancer, patients with clinical depression, and community-dwelling adults. J Pain Symptom Manage 25:307–318
Andrykowski MA, Curran SL, Lightner R (1998) Off-treatment fatigue in breast cancer survivors: a controlled comparison. J Behav Med 21:1–18
Berger AM (1998) Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncol Nurs Forum 25:51–62
Berglund G, Bolund C, Fornander T et al (1991) Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients. Cancer 27:1075–1081
Beszterczey A, Lipowski ZJ (1977) Insomnia in cancer patients. Can Med Assoc J 116:355
Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR (2000) Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 18:743–753
Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G (1997) Reliability and validity of the functional assessment of cancer therapy–B (FACT-B) quality of life instrument. J Clin Oncol 15:974–986
Broeckel J, Jacobsen PB, Horton J, Balducci L, Lyman GH (1998) Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. J Clin Oncol 16:1689–1696
Buysse DJ, Reynolds CFI, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213
Buysse DJ, Reynolds CRI, Monk TH, Hoch CC, Yeager AL, Kupfer DJ (1991) Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI). Sleep 14(4):331–338
Carskadon MA, Dement WC, Mitler MM, Guilleminault C, Zarcone VP, Spiegel R (1976) Self-reports versus sleep laboratory findings in 122 drug-free subjects with complaints of chronic insomnia. Am J Psychiatr 133:1382–1388
Cella DF (1996) Quality of life outcomes: measurement and validation. Oncology 10:233–246
Cimprich B (1999) Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nurs 22:185–194
Cole RJ, Kripke DF, Gruen W, Mullaney DJ, Gillin JC (1992) Automatic sleep/wake identification from wrist activity. Sleep 15:461–469
de Jong N, Candel MJ, Schouten HC, Abu-Saad HH, Courtens AM (2004) Prevalence and course of fatigue in breast cancer patients receiving adjuvant chemotherapy. Ann Oncol 15:896–905
de Jong N, Courtens AM, Abu-Saad HH, Schouten HC (2002) Fatigue in patients with breast cancer receiving adjuvant chemotherapy: a review of the literature. Cancer Nurs 25:283–297
Ganz P, Coscarelli A, Fred C et al (1996) Breast cancer survivors: psychosocial concerns and quality of life. Breast Cancer Res Treat 38:183–199
Ganz PA, Day R, Ware JE, Redmond C, Fisher B (1995) Base-line quality-of-life assessment in the National Surgical Adjuvant Breast and Bowel Project Breast-Cancer Prevention Trial. J Natl Cancer Inst 87:1372–1382
Ganz PA, Kwan L, Stanton AL, Krupnick JL, Rowland JH, Meyerowitz BE, Bower JE, Belin TR (2004) Quality of life at the end of primary treatment of breast cancer: first results from the moving beyond cancer randomized trial. J Natl Cancer Inst 96:376–387
Glaus A (1998) Fatigue in patients with cancer: analysis and assessment. Recent Results Cancer Res 145:1–172
Holland JC, Plumb M (1977) A comparative study of depressive symptoms in patients with advanced cancer. Proc Am Assoc Cancer Res 18:201
Hu D, Silberfarb PM (1991) Management of sleep problems in cancer patients. Oncology 5:23–27
Jacobsen PB, Hann DM, Azzarello LM, Horton J, Balducci L, Lyman GH (1999) Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. J Pain Symptom Manage 18:233–242
Jacobsen PB, Stein K (1999) Is fatigue a long-term side effect of breast cancer treatment? Cancer Control 6:256–263
Kaye J, Kaye K, Madow L (1983) Sleep patterns in patients with cancer and patients with cardiac disease. J Psychol 114:107–113
Knobf MT (1986) Physical and psychological distress associated with adjuvant chemotherapy in women with breast cancer. J Clin Oncol 4:678–684
Martin J, Marler MR, Shochat T, Ancoli-Israel S (2000) Circadian rhythms of agitation in institutionalized patients with Alzheimer’s disease. Chronobiol Int 17:405–418
McCorkle R, Young K (1978) Development of a symptom distress scale. Cancer Nurs 1:373–378
Miaskowski C, Lee KA (1999) Pain, fatigue and sleep disturbances in oncology outpatients receiving radiation therapy for bone metastasis: a pilot study. J Pain Symptom Manage 17:320–332
Mormont MC, De Prins J, Levi F (1995) Assessment of activity rhythms by wrist actigraphy: preliminary results in 30 patients with colorectal cancer. Biol Rhythm Res 6:423
Pater JL, Zee B, Palmer M, Johnston D, Osoba D (1997) Fatigue in patients with cancer: results with National Cancer Institute of Canada Clinical Trials Group studies employing the EORTC QLQ-C30. Support Care Cancer 5:410–413
Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401
Redeker NS, Lev EL, Ruggiero J (2000) Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract 14:275–290
Richardson A (1995) Fatigue in cancer patients: a review of the literature. Eur J Cancer Care 4:20–32
SAS Institute Inc. (1999) SAS/STAT User’s Guide, Version 8. 1–3884
Silberfarb PM, Hauri PJ, Oxman TE, Schnurr PP (1993) Assessment of sleep in patients with lung cancer and breast cancer. J Clin Oncol 11:997–1004
Smets EMA, Garssen B, Cull A, de Haes JC (1996) Application of the multidimensional fatigue inventory in cancer patients receiving radiotherapy. Br J Cancer 73:241–245
Stein KD, Martin SC, Hann DM, Jacobsen PB (1998) A multidimensional measure of fatigue for use with cancer patients. Cancer Pract 6:143–152
Strang P, Qvarner H (1990) Cancer-related pain and its influence on quality of life. Anticancer Res 10:109–112
Visser MRM, Smets EMA (1998) Fatigue, depression and quality of life in cancer patients: how are they related? Support Care Cancer 6:101–108
Weaver TE, Laizner AM, Evans LK, Maislin G, Chugh DK, Lyon K, Smith PL, Schwartz AR, Redline S, Pack AI, Dinges DF (1999) An instrument to measure functional status outcome for disorders of excessive sleepiness. Sleep 20:835–843
Winningham ML, Nail LM, Burke MB, Brophy L, Cimprich B, Jones LS, Pickard-Holley S, Rhodes V, St. Pierre B, Beck S, Glass EC, Mock VL, Mooney KH, Piper B (1994) Fatigue and the cancer experience; the state of the knowledge. Oncol Nurs Forum 21:23–36
Yellen BY, Cella DF, Webster K, Blendowski C, Kaplan E, Sarokhan B (1997) Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage 13:63–74
Acknowledgements
Supported by NCI CA85264, NIA AG08415, NCI R25 CA 65745, the UCSD General Clinical Research Center (MO1-RR00827), the Rebecca and John Moores UCSD Cancer Center (NCI P30 CA-23100), the Department of Veterans Affairs VISN-22 Mental Illness Research, Education and Clinical Center (MIRECC), and the Research Service of the Veterans Affairs San Diego Healthcare System.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ancoli-Israel, S., Liu, L., Marler, M.R. et al. Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer 14, 201–209 (2006). https://doi.org/10.1007/s00520-005-0861-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-005-0861-0