Advertisement

Journal of Behavioral Medicine

, Volume 21, Issue 1, pp 1–18 | Cite as

Off-Treatment Fatigue in Breast Cancer Survivors: A Controlled Comparison

  • Michael A. Andrykowski
  • Shelly L. Curran
  • Robin Lightner
Article

Abstract

Fatigue is a common and distressing symptom following cancer treatment. Research examining “off-treatment” fatigue has been weakened by limited assessments of fatigue and lack of suitable comparison groups. The extent of off-treatment fatigue following treatment for breast cancer (BC) was examined. Women with BC (n = 88; mean, 28 months posttreatment) and age-matched women (n = 88) with benign breast problems (BBP), completed a set of fatigue questionnaires at an Initial assessment and a 4-month Follow-up assessment. The BC group reported more fatigue, more weakness, and less vitality relative to the BBP group at both assessments. No relationship was found in the BC group between fatigue and extent of treatment or time since treatment completion. While the results document the existence of off-treatment fatigue following BC, elucidation of the psychobiological processes underlying this symptom and development of clinical management strategies remain as challenges for future research.

CANCER FATIGUE WEAKNESS PSYCHOSOCIAL QUALITY OF LIFE 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Adams, F., Quesada, J. R., and Gutterman, J. U. (1984). Neuropsychiatric manifestations of human leukocyte interferon therapy in patients with cancer. JAMA 252: 938–941.Google Scholar
  2. Aistars, J. (1987). Fatigue in the cancer patient: A conceptual approach to a clinical problem. Oncol. Nurs. Forum 14: 25–29Google Scholar
  3. Andrykowski, M. A., Brady, M. J., and Hunt, J. W. (1993). Positive psychosocial adjustment in potential bone marrow transplant recipients: Cancer as a psychosocial transition. Psycho-Oncology 2: 261–276.Google Scholar
  4. Andrykowski, M. A., Greiner, C. B., Altmaier, E. M., Burish, T. G., Antin, J. H., Gingrich, R., McGarigle , C., and Henslee-Downey, P. J. (1995). Quality of life following bone marrow transplantation: Findings from a multicentre study. Br. J. Cancer 71: 1322–1329.Google Scholar
  5. Bartley, S. H. (1976). What do we call fatigue? In Simonson, E., and Weiner, P. C. (eds.), Psychological Aspects and Physiological Correlates of Work and Fatigue, Charles C Thomas, Springfield , IL, pp. 409–416.Google Scholar
  6. Berglund, G., Bolund, C., Fornander, T., Rutquist, L. E., and Sjödén, P.-0. (1991). Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients. Eur. J. Cancer 27: 1075–1081.Google Scholar
  7. Blesch, K., Paice, J. A., Wickham, R., Harte, N., Schnoor, D. K., Purl, S., Rehwait, M., Kopp, P., Manson, S., Coveny, S., Mchale, M., and Cahill, M. (1991). Correlates of fatigue in people with breast or lung cancer. Oncol. Nurs. Forum 18: 81–87.Google Scholar
  8. Bloom, J. R., Gorsky, R. D., Fobair, P., Hoppe, R., Cox, R. S., Varghese, A., and Spiegel, D. (1990). Physical performance at work and at leisure: Validation of a measure of biological energy in survivors of Hodgkin's disease. J. Psychosoc. Oncol. 8: 49–63.Google Scholar
  9. Bradburn, N. M., Rips, L. J., and Shevell, S. K. (1987). Answering autobiographical questions: The impact of memory and inference. Science 236: 157–161.Google Scholar
  10. Bruera, E., Brenneis, C., Michaud, M., Rafter, J., Magnan, A., Tennant, A., Hanson, J., and Macdonald, R. N. (1989). Association between asthenia and nutritional status, lean body mass, anemia, psychological status, and tumor mass in patients with advanced breast cancer. J. Pain Symptom Manage. 4: 59–63.Google Scholar
  11. Bush, N. E., Haberman, M., Donaldson, G., and Sullivan, K. M. (1995). Quality of life of 125 adults surviving 6–18 years after bone marrow transplantation. Soc. Sci. Med. 40: 479–490.Google Scholar
  12. Buysse, D. J., Reynolds, C. F., III, Monk, T. H., Berman, S. R., and Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatr. Res. 28: 193–213.Google Scholar
  13. Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., and Wallace, E. P. (1993). Development of a fatigue scale. J. Psychosom. Res. 37: 147–153.Google Scholar
  14. Cimprich, B. (1992). Attentional fatigue following breast cancer surgery. Res. Nurs. Health 15: 199–207.Google Scholar
  15. de Haes, J. C. J. M., van Knippenberg, F. C. E., and Neijt, J. P. (1990). Measuring psychological and physical distress in cancer patients: Structure and application of the Rotterdam Symptom Checklist. Br. J. Cancer 62: 1034–1038.Google Scholar
  16. Demark-Wahnefried, W., Winer, E. P., and Rimer, B. K. (1993). Why women gain weight with adjuvant chemotherapy for breast cancer. J. Clin. Oncol. 11: 1418–1429.Google Scholar
  17. Devlen, J., Maguire, P., Philips, P., Crowther, D., and Chambers, H. (1987). Psychological problems associated with diagnosis and treatment of lymphomas. 1. Retrospective; 2. Prospective. Br. Med. J. 295: 953–957.Google Scholar
  18. Eardley, A. (1986). Patients and radiotherapy: 3. Patients' experiences after discharge. Radiography 52: 17–19.Google Scholar
  19. Fobair, P., Hoppe, R. T., Bloom, J., Cox, R., Varghese, A., and Spiegel, D. (1986). Psychosocial problems among survivors of Hodgkin's disease. J. Clin. Oncol. 4: 805–814.Google Scholar
  20. Glaus, A. (1993). Assessment of fatigue in cancer and non-cancer patients and in healthy individuals. Support. Care Cancer 1: 305–315.Google Scholar
  21. Graydon, J. E., Bubela, N., Irvine , D., and Vincent, L. (1995). Fatigue-reducing strate gies used by patients receiving treatment for cancer. Cancer Nurs. 18: 23–28.Google Scholar
  22. Greenberg, D. B., Sawicka, J., Eisenthal, S., and Ross, D. (1992). Fatigue syndrome due to localized radiation. J. Pain Symptom Manage. 7: 38–45.Google Scholar
  23. Greenberg, D. B., Gray, J. L., Mannix, C. M., Eisenthal , S., and Carey, M. (1993). Treatment-related fatigue and serum interluekin-1 levels in patients during external beam irradiation for prostate cancer. J. Pain Symptom Manage. 8: 196–200.Google Scholar
  24. Irvine, D. M., Vincent, L., Bubela, N., Thompson, L., and Graydon, J. (1991). A critical appraisal of the research literature investigating fatigue in the individual with cancer. Cancer Nurs. 14: 188–199.Google Scholar
  25. Irvine, D., Vincent, L., Graydon, J. E., Bubela, N., and Thompson, L. (1994). The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy: A comparison with the fatigue experienced by healthy individuals. Cancer Nurs. 17: 367–378.Google Scholar
  26. King, K. B., Nail, L. M., Kreamer, K., Strohl R. A., and Johnson, J. E. (1985). Patients' description of the experience of receiving radiation therapy. Oncol. Nurs. Forum 12: 55–61.Google Scholar
  27. Knobf, M. T. (1986). Physical and psychologic distress associated with adjuvant chemotherapy in women with breast cancer. J. Clin. Oncol. 4: 678–684.Google Scholar
  28. Kobashi-Schoot, J. A. M., Hanewald, G. J. F. P., van Dam, F. S. A. M., and Bruning, P. F. (1985). Assessment of malaise in cancer treated with radiotherapy. Cancer Nurs. 8: 306–314.Google Scholar
  29. Larson, P., Lindsey, A., Dodd, M., Brecht, M., and Packer, A. (1993). Influence of age on problems expe rienced by patients with lung cancer undergoing radiation therapy. Oncol. Nurs. Forum 20: 473–480.Google Scholar
  30. Love, R., Leventhal, H., Easterling, M. and Nerenz, D. (1989). Side effects and emotional distress during cancer chemotherapy. Cancer 63: 604–612.Google Scholar
  31. Mahler, D. A., and Franco, M. J. (1996). Clinical applications of cardiopulmonary exercise testing. J. Cardiopul. Rehab. 16: 357–365.Google Scholar
  32. Malone, M., Harris, A. L., and Luscombe, D. K. (1994). Assessment of the impact of cancer on work, recreation, home management and sleep using a general health status measure. J. Royal Soc. Med. 87: 386–389.Google Scholar
  33. McCorkle, R., and Quint-Benoliel, J. (1983). Symptom distress, current concerns and mood disturbance after diagnosis of life-threatening disease. Soc. Sci. Med. 17: 431–438.Google Scholar
  34. McCorkle, R., and Young, K. (1978). Development of a symptom distress scale. Cancer Nurs. 1: 373–378.Google Scholar
  35. McNair, P. M., Lorr, M., and Droppelman, L. (1981). POMS Manual, 2nd ed., Educational and Industrial Testing Service, San Diego.Google Scholar
  36. Nail, L. M. (1993). Coping with intra cavitary radiation treatment for gynecologic cancer. Cancer Pract. 1: 218–224.Google Scholar
  37. Oberst, M. T., Hughes, S. H., Chang, A. S., and McCubbin, M. A. (1991). Self-care burden, stress appraisal, and mood among persons receiving radiotherapy. Cancer Nurs. 14: 71–78.Google Scholar
  38. Patterson, S. M., Krantz, D. S., Montgomery, L. C., Deuster, P. A., Hedges, S. M., and Nebel, L. E. (1993). Automated physical activity monitoring: Validation and comparison with physiological and self-report measures. Psychophysiology 30: 296–305.Google Scholar
  39. Piper, B. F. (1989). Fatigue: Current bases of practice. In Funk, G., Tornquist, E. M., Champagne, M. T., Copp, L. A., and Wiese, R. A. (eds.) , Key Aspects of Comfort: Management of Pain, Fatigue, and Nausea, Springer, New York, pp. 187–198.Google Scholar
  40. Piper, B., Lindsey, A., and Dodd, M. (1987). Fatigue me chanisms in cancer patients: Developing nursing theory. Oncol. Nurs. Forum 14(6): 17–23.Google Scholar
  41. Piper, B. F., Lindsey, A. M., Dodd, M. J., Ferketich, S., Paul, S. M., and Weller, S. (1989). The development of an instrument to measure the subjective dimension of fatigue. In Funk, S. G., Tornquist, E. M., Champagne , M. T., Copp, L. A., and Wiese, R. A. (eds.), Key aspects of comfort: Management of pain, fatigue, and nausea, Springer, New York, pps. 199–208.Google Scholar
  42. Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Appl. Psychol. Measure. 1: 385–401.Google Scholar
  43. Rhodes, V. A., Watson, P. M., and Hanson, B. M. (1988). Patients' descriptions of the influence of tiredness and weakness on self-care activities. Cancer Nurs. 11: 186–194.Google Scholar
  44. Ryden, M. (1977). Energy: A crucial consideration in the nursing process. Nurs. Forum 16: 71–82.Google Scholar
  45. Siegel, S. (1956). Nonparametric Statistics for the Behavioral Sciences, McGraw Hill, New York.Google Scholar
  46. Silberfarb, P. M., Hauri, P. J., Oxman, T. E., and Schnurr, P. (1993). Assessment of sleep in patients with lung cancer and breast cancer. J. Clin. Oncol. 11: 997–1004.Google Scholar
  47. Sisto, S. A., LaManca, J., Cordero, D. L., Bergen, M. T., Ellis, S. P., Drastal, S., Boda, W. L., Tapp, W. N., and Natelson, B.H. (1996). Metabolic and cardiovascular effects of a progressive exe rcise test in patients with chronic fatigue syndrome. Am. J. Med. 100: 634–640.Google Scholar
  48. Smets, E. M. A., Garssen, B., Schuster-Vitterhoeve, A. L. J., and de Haes, J. C. J. M. (1994). Fatigue in cancer patients. Br. J. Cancer 68: 220–224.Google Scholar
  49. Stone, A. A., and Shiffman, S. (1994). Ecological mome ntary assessme nt in behavioral medicine. Ann. Behav. Med. 16: 199–202.Google Scholar
  50. Stone, A. A., Brode rick, J. E., Porte r, L. S., Krupp, L., Gnys, M., Paty, J. A., and Shiffman, S. (1994). Fatigue and mood in chronic fatigue syndrome patients: Results of a momentary assessment protocol examining fatigue and mood levels and diurnal patterns. Ann. Behav. Med. 16: 228–234.Google Scholar
  51. St. Pierre, B. A., Kaspar, G. E., and Lindsay, A. M. (1992). Fatigue mechanisms in patients with cancer: Effects of tumor necrosis factor and exercise on skele tal muscle. Oncol. Nurs. Forum 19: 419–425.Google Scholar
  52. Vercoulen, J. H. M. M., Swanink, C. M. A., Fennis, J. F. M., Galama, J. M. D., and van der Meer, J. W. M. (1994). Dimensional assessmen t of chronic fatigue syndrome. J. Psychosom. Res. 35: 383–392.Google Scholar
  53. Voorripps, L. E., Ravelli, A. C., Dongelmans, P. C., Duerenberg, P., and Van Staveren, W. A. (1991). A physical activity questionnaire for the elderly. Med. Sci. Sports Exer. 23: 974–979.Google Scholar
  54. Ware, J. E., Jr., and Sherbourne, C. D. (1992). The MOS 36-item Short Form Health Survey (SF-36). I. Conceptual framework and item selection. Med. Care 30: 473–483.Google Scholar
  55. Whaley, M. H., Woodall, T., Kaminsky, L. A., and Emmett, J. D. (1997). Reliability of perce ive d e xe rtion during grade d exe rcise te sting in appare ntly healthy adults. J. Cardiopul. Rehab. 17: 37–42.Google Scholar
  56. Winningham, M. L., Nail, L. M., Burke , M. B., Brophy, L., Cimprich, B., Jones, L. S., Pickard-Holley, S., Rhodes, V., St. Pierre, B., Beck, S., Glass, E. C., Mock, U. L., Mooney, K. H., and Piper, B. (1994). Fatigue and the cancer expe rience: The state of the knowledge. Oncol. Nurs. Forum 21: 23–36.Google Scholar

Copyright information

© Plenum Publishing Corporation 1998

Authors and Affiliations

  • Michael A. Andrykowski
  • Shelly L. Curran
  • Robin Lightner

There are no affiliations available

Personalised recommendations