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. 2020 Feb;28(2):845-855.
doi: 10.1007/s00520-019-04834-w. Epub 2019 Jun 3.

Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy

Rina S Fox  1   2 , Sonia Ancoli-Israel  1   3   4 , Scott C Roesch  1   5 , Erin L Merz  6 , Sarah D Mills  7 , Kristen J Wells  1   3   5 , Georgia Robins Sadler  1   3   4 , Vanessa L Malcarne  8   9   10   11
Affiliations

Sleep disturbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy

Rina S Fox et al. Support Care Cancer. 2020 Feb.

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.

Keywords: Cancer; Cancer-related fatigue; Latent profile analysis; Oncology; Sleep disturbance; Symptom cluster.

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Conflict of interest statement

Conflict of Interest

Sonia Ancoli-Israel consults for Merck, Eisai, Purdue, and Pfizer. All other authors have no conflicts of interest to disclose. The authors have full control of all primary data and agree to allow the journal to review these data if requested.

Figures

Figure 1.
Figure 1.
Standardized conditional response means (z-scores) for groups defined by sleep disturbance and cancer-related fatigue variables at T1. FSC = Fatigued with sleep complaints; MS = Minimal symptoms. Z-scores for percentage of the night spent asleep and the Vigor subscale of the MFSI-SF were reverse-coded, so higher scores indicate worse functioning across all indicators.
Figure 2.
Figure 2.
Standardized conditional response means (z-scores) for groups defined by sleep disturbance and cancer-related fatigue variables at T2. SFPS = Severe fatigue with poor sleep; EFAS = Emotional fatigue with average sleep; PFAS = Physical fatigue with average sleep; MS = Minimal symptoms. Z-scores for percentage of the night spent asleep and the Vigor subscale of the MFSI-SF were reverse-coded, so higher scores indicate worse functioning across all indicators.
See this image and copyright information in PMC

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