Living as a Survivor: Sleep Disturbance, Fatigue, Depressive Mood, and Cognitive Dysfunction After Breast Cancer Treatment

Abstract

Background: Many cancer survivors endure multiple symptoms while striving to return to a normal life. Those symptoms often co-occur and exacerbate one another; however, their interplay is not fully understood.

Objective: This study aimed to examine the occurrence and concurrence of sleep disturbance, fatigue, depressive mood, and cognitive dysfunction in posttreatment breast cancer survivors.

Methods: The data for this descriptive analysis were collected as part of the screening for a clinical trial. The occurrences of sleep disturbance, depressive mood, and cognitive dysfunction were each determined by the cutoff scores of the Pittsburgh Sleep Quality Index, Center for Epidemiological Studies Depression Scale, and Montreal Cognitive Assessment, respectively; fatigue was determined by meeting the International Classification of Diseases cancer-related fatigue criteria.

Results: A convenience sample of 81 women completed chemotherapy or/and radiation for stage I-III breast cancer an average of 23.1 (±SD = 9.0) months ago. Sleep disturbance (85%) was most prevalent, followed by fatigue (67%), depressive mood (46%), and cognitive dysfunction (29%). Of the survivors, 80% reported 2 or more co-occurring symptoms. Worsened subjective sleep quality, sleep disturbance, and daytime dysfunction significantly increased the risk of fatigue by 5.3, 4.3, and 4.3 times (all P < .001) and depression by 2.0, 2.7, and 3.0 times (all P < .05), respectively.

Conclusion: Sleep disturbance significantly increased the risk of survivors' fatigue and/or depressive mood after cancer treatment completion.

Implication for practice: Effectively managing sleep disturbance and improving the individual's sleep perception may subsequently reduce fatigue and/or depressive mood among breast cancer survivors. Nonpharmacological strategies for managing multiple posttreatment symptoms are needed.