Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer
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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.
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).
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.
KeywordsFatigue Sleep Circadian rhythms Quality of life Breast cancer
Center for Epidemiological Studies–Depression scale
Functional Assessment of Cancer Therapy–Breast
Functional Outcome of Sleep Questionnaire
Multidimensional Fatigue Symptom Inventory–Short Form
Pittsburgh Sleep Quality Index
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.
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