Supportive Care in Cancer

, Volume 14, Issue 3, pp 201–209 | Cite as

Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer

  • Sonia Ancoli-IsraelEmail author
  • Lianqi Liu
  • Matthew R. Marler
  • Barbara A. Parker
  • Vicky Jones
  • Georgia Robins Sadler
  • Joel Dimsdale
  • Mairav Cohen-Zion
  • Lavinia Fiorentino
Original Article



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).


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.


Fatigue Sleep Circadian rhythms Quality of life Breast cancer 



Center for Epidemiological Studies–Depression scale


Confidence Intervals


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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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Sonia Ancoli-Israel
    • 1
    • 2
    • 3
    • 4
    Email author
  • Lianqi Liu
    • 1
    • 2
  • Matthew R. Marler
    • 1
    • 2
  • Barbara A. Parker
    • 3
    • 5
  • Vicky Jones
    • 6
  • Georgia Robins Sadler
    • 3
    • 4
    • 7
  • Joel Dimsdale
    • 1
    • 3
    • 4
  • Mairav Cohen-Zion
    • 4
  • Lavinia Fiorentino
    • 4
  1. 1.Department of PsychiatryUniversity of CaliforniaSan DiegoUSA
  2. 2.Veteran Affairs San Diego Healthcare SystemSan DiegoUSA
  3. 3.Rebecca and John Moores UCSD Cancer CenterSan DiegoUSA
  4. 4.SDSU/UCSD Joint Doctoral Program in Clinical PsychologySan DiegoUSA
  5. 5.Department of MedicineUniversity of CaliforniaSan DiegoUSA
  6. 6.Yakima Regional Cancer Care CenterYakimaUSA
  7. 7.Department of SurgeryUniversity of CaliforniaSan DiegoUSA

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