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Which Symptoms Come First? Exploration of Temporal Relationships Between Cancer-Related Symptoms over an 18-Month Period

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Anxiety, depression, insomnia, fatigue, and pain are frequently reported by cancer patients. These symptoms are highly interrelated. However, few prospective studies have documented the sequence with which symptoms occur during cancer care.

Purpose

This longitudinal study explored the temporal relationships between anxiety, depression, insomnia, fatigue, and pain over an 18-month period in a large population-based sample of nonmetastatic cancer patients (N = 828), using structural equation modeling.

Methods

The patients completed a battery of self-report scales at baseline and 2, 6, 10, 14, and 18 months later.

Results

The relationships between the same symptom at two consecutive assessments showed the highest coefficients (β = 0.29 to 0.78; all ps ≤ 0.05). Cross-loading parameters (β = 0.06 to 0.19; ps ≤ 0.05) revealed that fatigue frequently predicted subsequent depression, insomnia, and pain, whereas anxiety predicted insomnia.

Conclusions

Fatigue and anxiety appear to constitute important risk factors of other cancer-related symptoms and should be managed appropriately early during the cancer care trajectory.

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Acknowledgments

We sincerely thank the patients for their participation and Fred Sengmueller for revising the manuscript. This research was supported by a training award held by the first author from the Canadian Institutes of Health Research, a grant from the Canadian Institutes of Health Research (MOP-69073), and a research scientist award from the Fonds de la Recherche en Santé du Québec to the second author.

Conflict of Interest

The authors report no conflicts of interest.

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Authors and Affiliations

  1. School of Psychology, Université Laval, Québec, Québec, G1K 7P4, Canada

    Claudia Trudel-Fitzgerald B.A, Josée Savard Ph.D & Hans Ivers Ph.D

  2. Laval University Cancer Research Center, 11 Côte du Palais, Québec, Québec, G1R 2J6, Canada

    Claudia Trudel-Fitzgerald B.A, Josée Savard Ph.D & Hans Ivers Ph.D

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  1. Claudia Trudel-Fitzgerald B.A
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Correspondence to Josée Savard Ph.D.

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Trudel-Fitzgerald, C., Savard, J. & Ivers, H. Which Symptoms Come First? Exploration of Temporal Relationships Between Cancer-Related Symptoms over an 18-Month Period. ann. behav. med. 45, 329–337 (2013). https://doi.org/10.1007/s12160-012-9459-1

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