Journal of Behavioral Medicine

, Volume 27, Issue 5, pp 425–444

Ecological Momentary Assessment of Fatigue Following Breast Cancer Treatment

  • Shelly L. Curran
  • Abbie O. Beacham
  • Michael A. Andrykowski
Article

Abstract

Fatigue is a common and debilitating symptom often experienced during and following cancer treatment. An Ecological Momentary Assessment (EMA) approach was used to examine the diurnal pattern of off-treatment fatigue in breast cancer survivors. Twenty-five breast cancer (BC) survivors 6–26 months posttreatment and age-matched groups of healthy women (HC; n = 25) and women with benign breast problems (BBP; n = 24) completed four daily diary measures of fatigue, pain, and mood for 5 consecutive days. Type of activity engaged in at the time of the diary assessments, as well as daily pedometer activity level, and nightly sleep duration were also assessed. While BC survivors reported greater levels of fatigue relative to BBP and HC groups, no group differences in mood, activity type or level, sleep duration, or diurnal pattern of fatigue were evident. The results confirm that fatigue may continue to be experienced long after conclusion of cancer treatment while questioning its clinical significance, provide insight into potential etiological mechanisms underlying off-treatment fatigue in, and demonstrate the value of EMA approaches to the study of cancer-related fatigue.

fatigue cancer ecological momentary assessment pain mood 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. Andrykowski, M. A., Curran, S. L., and Lightner, R. (1998). Off-treatment fatigue in breast cancer survivors: a controlled comparison. J. Behav. Med. 21(1): 1–18.Google Scholar
  2. Atkinson, A., Barsevick, A., Cella, D., Cimprich, B., Cleeland, C., Donnelly, J., Eisenberger, M.V, Escalante, C., Hinds, P., Jacobsen, P. B., Kaldor, P., Knight, S. J., Peterman, A., Piper, B. F., Rugo, H., Sabbatini, P., and Stahl, C. (2000). NCCN Practice guidelines for cancer-related fatigue. Oncology 14(11A): 151–161.Google Scholar
  3. Baumstark, K. E., and Buckelew, S. P. (1992). Fibromyalgia: Clinical signs, research findings, treatment implications, and future directions. Ann. Behav. Med. 14: 282–291.Google Scholar
  4. Berger, A. M. (1998) Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncol. Nurs. Forum 25: 51–62.Google Scholar
  5. Berglund, G., Bolund, C., Fornander, T., Rutqvist, L. E., Sjoden, P. O. (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
  6. Blesch, K. S., Paice, J. A., Wickham, R., Harte, N., Schnoor, D. K., Purl, S., Rehwalt, M., Kopp, P. L., Manson, S., Coveny, S. B., McHale, M., and Cahill, M. (1991). Correlates of fatigue in people with breast or lung cancer. Oncol. Nurs. Forum 18(1): 81–87.Google Scholar
  7. Bower, J. E., Ganz, P.A., Desmond, K. A., Rowland, J. H., Meyerowitz, B. E., and Belin, T. R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. J. Clin. Oncol. 18(4): 743–753.Google Scholar
  8. Broeckel, J. A., Jacobsen, P. B., Horton, J., Balducci, L., and Lyman, G. H. (1998). Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. J. Clin. Oncol. 16(5): 1689–1696.Google Scholar
  9. Cella, D., Davis, K., Breitbart, W., and Curt, G. (2001). Cancer-related fatigue: Prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J. Clin. Oncol. 19: 3385–3391.Google Scholar
  10. Cella, D., Lai, J., Chang, C., Peterman, A., and Slavin, M. (2002). Fatigue in cancer patients compared with fatigue in the general United States population. Cancer 94: 528–538.Google Scholar
  11. Cella, D., Peterman, A., Passik, S., Jacobsen, P., and Breitbart, W. (1998). Progress toward guidelines for the management of fatigue. Oncology 12(11A): 369–377.Google Scholar
  12. De Jong, N., Courtens, A. M., Abu-Saad, H. H., and Schouten, H. C. (2002). Fatigue in patients with breast cancer receiving adjuvant chemotherapy: A review of the literature. Cancer Nurs. 25: 283–297.Google Scholar
  13. Dimeo, F., Stieglitz, R. D., Novelli-Fisher, U., Fetscher, S., and Keul, J. (1999). Effects of physical activity on fatigue and psychologic status of cancer patients during chemotherapy. Cancer 85(10): 2273–2277.Google Scholar
  14. Ferrell, B. R., Grant, M. M., Funk, B. M., Otis-Green, S. A., and Garcia, N. J. (1998). Quality of life in breast cancer survivors: implications for developing support services. Oncol. Nurs. Forum. 25(5): 887–895.Google Scholar
  15. Gaston-Johansson, F., Fall-Dickson, J. M., Bakos, A. B. and Kennedy, M. J. (1999). Fatigue, pain, and depression in pre-autotransplant breast cancer patients. Cancer Pract. 7(5): 240–247.Google Scholar
  16. Glaus, A. (1993). Assessment of fatigue in cancer and non-cancer patients and in healthy individuals. Support Care Cancer. 1: 305–315.Google Scholar
  17. Glaus, A. (1998). Fatigue – an orphan topic in patients with cancer?Eur. J. Cancer 34: 1649–1651.Google Scholar
  18. Greene, D., Nail, L. M., Fieler, V. K., Dudgeon, D., and Jones, L. S. (1994). A comparison of patient-reported side effects among three chemotherapy regimens for breast cancer. Cancer Pract. 2: 57–62.Google Scholar
  19. Holley, S. (2000). Cancer-related fatigue – suffering a different fatigue. Cancer Pract. 8: 87–95.Google Scholar
  20. Irvine, D. M., Vincent, L., Bubela, N., Thompson, L., and Graydon, J. (1991). Acritical appraisal of the research literature investigating fatigue in the individual with cancer. Cancer Nursing. 14(4): 188–199.Google Scholar
  21. Irvine, D. M., Vincent, L., Graydon, J., 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(5): 367–378.Google Scholar
  22. Jacobsen, P. B., Hann, D. M., Azzarello, L. M., Horton, J., Balducci, L., and Lyman, G. H. (1999). Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. J. Pain Sympt. Manage. 18(4): 233–242.Google Scholar
  23. Litt, M., Cooney, N., and Morse, P. (1998). Ecological Momentary Assessment (EMA) with treated alcoholics: Methodological problems and potential solutions. Health Psychol. 17: 48–52.Google Scholar
  24. Masse, L. C., Ainsworth, B. E., Tortolero, S., Levin, S., Fulton, J. E., Henderson, K. A., and Mayo, K. (1998). Measuring physical activity in midlife, older and minority women: Issues from an expert panel. J. Women's Health. 27(1): 57–67.Google Scholar
  25. Mast, M. E. (1998). Correlates of fatigue in survivors of breast cancer. Cancer Nurs. 21(2): 136–142.Google Scholar
  26. Mock, V., Pickett, M., Ropka, M. E., Lin, E. M., Stewart, K. J., Rhodes, V. A., McDaniel, R., Grimm, P. M., Krumm, S., and McCorkle, R. (2001). Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Pract. 9(3): 119–127.Google Scholar
  27. Nail L. and Winningham, M. (1993). Fatigue. In S. L. Groenwalk, M. Frogge, M. Goodman, and C. Yarbro (Eds.), Cancer Nursing: Principles and Practice, 3rd ed., Jones & Bartlett, Boston, pp. 608–619.Google Scholar
  28. Okuyama, T., Akechi, T., Kugaya, A., Okamura, H., Imoto, S., Nakano, T., Mikami, I., Hosaka, T., and Uchitomi, Y. (2000). Factors correlated with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale. Support. Care Cancer 8(3): 215–222.Google Scholar
  29. Patterson, S. M., Krantz, D. S., Montgomery, L. C., Duester, 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
  30. Piper, B. F. (1989). Fatigue: Current bases for practice. In S. Funk, E. M. Tornquist, M. T. Champagne, L. A. Copp, and R. A. Wiese (eds.), Key Aspects of Comfort: Management of Pain, Fatigue, and Nausea, Springer, New York, pp. 187–198.Google Scholar
  31. Richardson, A. and Ream, E. (1996). The experience of fatigue and other symptoms in patients receiving chemotherapy. Eur. J. Cancer Care 5(Suppl. 2): 24–30.Google Scholar
  32. Schwartz, A. L. (2000). Daily fatigue patterns and effect of exercise in women with breast cancer. Cancer Pract. 8(1): 16–24.Google Scholar
  33. Stone, A. A., Broderick, J. E., Porter, L. S., and Kaell, A. T. (1997). The experience if rheumatoid arthritis pain and fatigue: Examining momentary reports and correlates over one week. Arthritis Care Res. 10(3): 185–193.Google Scholar
  34. Stone, A. A., Broderick, J. E., Porter, 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
  35. Stone, A. A., and Shiffman, S. (1994). Ecological momentary assessment (EMA) in behavioral medicine. Ann. Behav. Med. 16: 199–202.Google Scholar
  36. Stone, A. A. and Shiffman, S. (2002). Capturing momentary, self-report data: A proposal for reporting guidelines. Ann. Behav. Med. 24(3): 236–243.Google Scholar
  37. Tross, S., and Holland, J. C. (1990). Psychological sequelae in cancer survivors. In J. C. Holland and J. H. Rowland (eds.), Handbook of Psychooncology, Oxford University Press, New York, pp. 101–115.Google Scholar
  38. van Eck, M. M., and Nicolson, N. A. (1994). Perceived stress and salivary cortisol in daily life. Ann. Behav. Med. 16: 221–227.Google Scholar
  39. Voorrips, L. E., Ravelli, A. C., Dongelmans, P. C., Deurenberg, P., and Van Staveren, W. A. (1991). A physical activity questionnaire for the elderly. Med. Sci. Sports Exercise 23: 974–979.Google Scholar
  40. Watson, D., Clark, L. A., and Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. J. Pers. Soc. Psychol. 54: 1063–1070.Google Scholar
  41. 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, V. L., Mooney, K. H., and Piper, B. (1994). Fatigue and the cancer experience: The state of the knowledge. Oncol. Nurs. Forum 21: 23–36.Google Scholar
  42. Wood, C., and Magnello, M. E. (1992). Diurnal changes in perceptions of energy and mood. R. Soc. Med. 85(4): 191–194.Google Scholar
  43. Wood, C., Magnello, M. E., and Sharpe, M. C. (1992). Fluctuations in perceived energy and mood among patients with chronic fatigue syndrome. R. Soc. Med. 85(4): 195–198.Google Scholar

Copyright information

© Springer Science+Business Media, Inc. 2004

Authors and Affiliations

  • Shelly L. Curran
    • 1
  • Abbie O. Beacham
    • 2
  • Michael A. Andrykowski
    • 1
  1. 1.Department of Behavioral ScienceUniversity of Kentucky College of MedicineLexingtonKentucky
  2. 2.Department of Psychological and Brain SciencesUniversity of LouisvilleLouisvilleKentucky

Personalised recommendations