title: Biomarkers, fatigue, sleep, and depressive symptoms in women with breast cancer: a pilot study.
abstract: OBJECTIVE
  To evaluate the changes in reports of fatigue, sleep disturbances, and depressive symptoms and serum cortisol, melatonin, serotonin, and bilirubin during adjuvant chemotherapy in women with breast cancer and to determine whether any correlations exist between the symptom parameters and biomarkers.
  
  
  METHODS
  Prospective longitudinal, correlational, repeated-measures pilot study.
  
  
  METHODS
  Large southwestern, university-based, National Cancer Institute-designated cancer center.
  
  
  METHODS
  22 subjects (11 women with stage II breast cancer receiving adjuvant chemotherapy and 11 cancer-free women who were matched by age, ethnicity, and menopausal status).
  
  
  METHODS
  Questionnaires (fatigue, sleep, depressive symptoms), wrist sleep actigraphy, and laboratory analysis of serum samples. All subjects (i.e., women with breast cancer receiving chemotherapy and a comparison group of cancer-free women who were matched by age, ethnicity, and menopausal status) were admitted to a general clinical research center for two nights during cycles 1 and 4 for data collection.
  
  
  METHODS
  Biomarkers (serum cortisol, melatonin, serotonin, and bilirubin), fatigue, sleep, and depressive symptoms.
  
  
  RESULTS
  Mean fatigue scores of the subjects with cancer were significantly higher than the healthy comparison group. Subjects with cancer had a significantly lower mean actual sleep time compared to the comparison group at cycle 1. No significant difference was found between the groups at cycle 4. Depression scores also differed significantly between the cancer group and comparison group. Select biomarkers changed over time and were associated with subjective parameters of fatigue, sleep, and depressive symptoms.
  
  
  CONCLUSIONS
  Findings suggest that fatigue, sleep, and depressive symptoms are more prevalent in women with cancer than a cancer-free comparison group. Biomarkers changed over time and provide a possible explanatory mechanism for the three related symptoms.
  
  
  CONCLUSIONS
  Data help to explain a mechanism that may underlie fatigue, sleep, and depressive symptoms and provide a theoretical framework from which to establish evidence-based interventions for symptom management.
authors.affiliation: School of Nursing, Duke University, Durham, NC, USA. payne031@mc.duke.edu
authors.forename: Judith
authors.initials: J
authors.lastname: Payne
authors.forename: Barbara
authors.initials: B
authors.lastname: Piper
authors.forename: Ian
authors.initials: I
authors.lastname: Rabinowitz
authors.forename: Bridget
authors.initials: B
authors.lastname: Zimmerman
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D003863:Depression / Q000209:etiology*; D005221:Fatigue; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012893:Sleep Wake Disorders / Q000209:etiology*
chemical_list: D015415:Biomarkers