title: Fatigue, depression, sleep, and activity during chemotherapy: daily and intraday variation and relationships among symptom changes.
abstract: BACKGROUND
  Previous research suggests that cancer patients frequently experience multiple symptoms during chemotherapy; however, relationships among symptom changes are largely unknown.
  
  
  OBJECTIVE
  The aim of the current study was to examine daily and intraday changes and interrelationships among fatigue, depression, and objectively measured disruptions in sleep and activity during chemotherapy.
  
  
  METHODS
  Participants were 78 women with gynecologic cancer. Fatigue, depression, sleep, and activity were assessed the week before and the week after the participants' first three infusions.
  
  
  RESULTS
  Significant changes in fatigue, depression, sleep, and activity were observed over time. Before infusions, increases in fatigue were associated with increases in depression. After infusions, increases in fatigue were associated with increases in depression and minutes awake at night, as well as decreases in daytime activity and regularity of sleep/activity patterns (ps < .05).
  
  
  CONCLUSIONS
  This study is among the first to track daily and intraday changes in symptoms and interrelationships during chemotherapy. Results indicate that symptoms are interrelated and return to baseline levels after infusions.
authors.affiliation: Moffitt Cancer Center, Tampa, FL 33612, USA. heather.jim@moffitt.org
authors.forename: Heather S L
authors.initials: HS
authors.lastname: Jim
authors.forename: Brent
authors.initials: B
authors.lastname: Small
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Faul
authors.forename: Jamie
authors.initials: J
authors.lastname: Franzen
authors.forename: Sachin
authors.initials: S
authors.lastname: Apte
authors.forename: Paul B
authors.initials: PB
authors.lastname: Jacobsen
mesh_terms: D056044:Actigraphy; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003863:Depression / Q000209:etiology* / Q000523:psychology; D005221:Fatigue; D005260:Female; D005833:Genital Neoplasms, Female / Q000150:complications / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology* / Q000523:psychology; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents