Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life.
OBJECTIVE
To describe the occurrence of fatigue in a large sample of breast cancer survivors relative to general population norms and to identify demographic, medical, and psychosocial characteristics of fatigued survivors.


METHODS
Breast cancer survivors in two large metropolitan areas completed standardized questionnaires as part of a survey study, including the RAND 36-item Health Survey, Center for Epidemiological Studies-Depression Scale, Breast Cancer Prevention Trial Symptom Checklist, Medical Outcomes Study Sleep Scale, and demographic and treatment-related measures.


RESULTS
On average, the level of fatigue reported by the breast cancer survivors surveyed (N = 1,957) was comparable to that of age-matched women in the general population, although the breast cancer survivors were somewhat more fatigued than a more demographically similar reference group. Approximately one third of the breast cancer survivors assessed reported more severe fatigue, which was associated with significantly higher levels of depression, pain, and sleep disturbance. In addition, fatigued women were more bothered by menopausal symptoms and were somewhat more likely to have received chemotherapy (with or without radiation therapy) than nonfatigued women. In multivariate analyses, depression and pain emerged as the strongest predictors of fatigue.


CONCLUSIONS
Although the majority of breast cancer survivors in this large and diverse sample did not experience heightened levels of fatigue relative to women in the general population, there was a subgroup of survivors who did report more severe and persistent fatigue. We identified characteristics of these women that may be helpful in elucidating the mechanisms underlying fatigue in this population, as well as directing intervention efforts.
Bower
J E
JE
Norman Cousins Center in Psychoneuroimmunology, Departments of Biostatistics and Psychiatry and Biobehavioral Sciences, Schools of Public Health and Medicine, University of California, Los Angeles, CA, USA.
Ganz
P A
PA
Desmond
K A
KA
Rowland
J H
JH
Meyerowitz
B E
BE
Belin
T R
TR
D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003863:Depression / Q000453:epidemiology; D004219:District of Columbia / Q000453:epidemiology; D005221:Fatigue / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005544:Forecasting; D006304:Health Status; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D015141:Los Angeles / Q000453:epidemiology; D008593:Menopause / Q000502:physiology; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000453:epidemiology; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012893:Sleep Wake Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data*
D000970:Antineoplastic Agents