Sleep, fatigue, and affect in women receiving chemotherapy for cancer

Abstract

This study was the first to prospectively examine the incidence and characteristics of sleep disturbance among women in treatment for breast cancer and to determine whether a relationship exists between sleep problems, fatigue and affect in that group.;Sixty-seven outpatient women receiving chemotherapy for breast cancer were recruited from Memorial Sloan-Kettering Cancer Center, New York, NY. Participants completed daily measures of sleep quality, fatigue, and affect for seven days following the initial chemotherapy infusion.;The incidence of insomnia over the week ranged from 54--64 percent, a dramatically higher incidence than that documented in community-based surveys. Participants most commonly reported early morning awakenings, followed by difficulty maintaining sleep and difficulty initiating sleep. With respect to both physical and affective status, participants demonstrated a statistically significant decline in daytime functioning three days after the chemotherapy infusion, followed directly by a statistically significant decline in sleep quality the following night. Composite scores for global daytime functioning and global sleep quality were derived and plotted against one another for the entire week. Though not statistically significant, there was a trend for global daytime functioning scores to follow a similar trajectory as scores for global sleep quality during the upcoming night. That is, as daytime functioning improved, so too did sleep quality, and vice versa. The trend was only apparent on days when chemotherapy side effects and symptoms were most prominent (days 1--4). Following day four, when chemotherapy side effects and symptoms waned, there was no apparent relationship between daytime functioning and sleep quality.;Because of the limited sample size, the study did not employ more sophisticated time series analyses to verify cause-effect relationships between study variables. Nevertheless, the study provides preliminary evidence that sleep, fatigue, and affective disturbances relate to one another in cancer patients. Suggestions for future research are discussed.