title: Sleep, fatigue, depression, and circadian activity rhythms in women with breast cancer before and after treatment: a 1-year longitudinal study.
abstract: OBJECTIVE
  Sleep disturbance, fatigue and depression are common complaints in patients with cancer, and often contribute to worse quality of life (QoL). Circadian activity rhythms (CARs) are often disrupted in cancer patients. These symptoms worsen during treatment, but less is known about their long-term trajectory.
  
  
  METHODS
  Sixty-eight women with stage I-III breast cancer (BC) scheduled to receive ≥4 cycles of chemotherapy, and age-, ethnicity-, and education-matched normal, cancer-free controls (NC) participated. Sleep was measured with actigraphy (nocturnal total sleep time [nocturnal TST] and daytime total nap time [NAPTIME]) and with the Pittsburgh Sleep Quality Index (PSQI); fatigue with the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF); depression with the Center of Epidemiological Studies-Depression (CES-D). CARs were derived from actigraphy. Several measures of QoL were administered. Data were collected at three time points: before (baseline), end of cycle 4 (cycle 4), and 1 year post-chemotherapy (1 year).
  
  
  RESULTS
  Compared to NC, BC had longer NAPTIME, worse sleep quality, more fatigue, more depressive symptoms, more disrupted CARs, and worse QoL at baseline (all p values <0.05). At cycle 4, BC showed worse sleep, increased fatigue, more depressive symptoms, and more disrupted CARs compared to their own baseline levels and to NC (all p values <0.05). By 1 year, BC's fatigue, depressive symptoms, and QoL returned to baseline levels but were still worse than those of NC, while NAPTIME and CARs did not differ from NC's.
  
  
  CONCLUSIONS
  Additional research is needed to determine if beginning treatment of these symptoms before the start of chemotherapy will minimize symptom severity over time.
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, USA, sancoliisrael@ucsd.edu.
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Lianqi
authors.initials: L
authors.lastname: Liu
authors.forename: Michelle
authors.initials: M
authors.lastname: Rissling
authors.forename: Loki
authors.initials: L
authors.lastname: Natarajan
authors.forename: Ariel B
authors.initials: AB
authors.lastname: Neikrug
authors.forename: Barton W
authors.initials: BW
authors.lastname: Palmer
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mills
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Parker
authors.forename: Georgia Robins
authors.initials: GR
authors.lastname: Sadler
authors.forename: Jeanne
authors.initials: J
authors.lastname: Maglione
mesh_terms: D056044:Actigraphy; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D002940:Circadian Rhythm; D003863:Depression / Q000209:etiology*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D011788:Quality of Life; D012890:Sleep / Q000502:physiology; D012893:Sleep Wake Disorders / Q000209:etiology*
references.citation: Oncol Nurs Forum. 2009 Jul;36(4):E205-14
references.pmid: 19581224
references.citation: Sleep. 1991 Aug;14(4):331-8
references.pmid: 1947597
references.citation: J Pain Symptom Manage. 2009 Apr;37(4):715-36
references.pmid: 19019626
references.citation: Sleep. 2003 May 1;26(3):342-92
references.pmid: 12749557
references.citation: Cancer Nurs. 2011 Jul-Aug;34(4):255-68
references.pmid: 21252646
references.citation: Support Care Cancer. 2002 May;10(4):329-36
references.pmid: 12029433
references.citation: Support Care Cancer. 2006 Mar;14(3):201-9
references.pmid: 16010529
references.citation: J Am Geriatr Soc. 2010 Feb;58(2):282-91
references.pmid: 20374404
references.citation: Clin Cancer Res. 2000 Aug;6(8):3038-45
references.pmid: 10955782
references.citation: J Pain Symptom Manage. 2004 Jan;27(1):14-23
references.pmid: 14711465
references.citation: Cancer Pract. 1998 May-Jun;6(3):143-52
references.pmid: 9652245
references.citation: J Cancer Surviv. 2012 Sep;6(3):305-14
references.pmid: 22484807
references.citation: J Clin Oncol. 1998 May;16(5):1689-96
references.pmid: 9586880
references.citation: J Pain Symptom Manage. 2007 Apr;33(4):398-409
references.pmid: 17397701
references.citation: Support Care Cancer. 2005 Dec;13(12):1010-7
references.pmid: 15864659
references.citation: Support Care Cancer. 2002 Jul;10(5):389-98
references.pmid: 12136222
references.citation: Psychooncology. 2009 Feb;18(2):187-94
references.pmid: 18677716
references.citation: J Clin Oncol. 2001 Feb 1;19(3):895-908
references.pmid: 11157043
references.citation: J Gerontol A Biol Sci Med Sci. 2004 Oct;59(10):1050-5
references.pmid: 15528777
references.citation: Gynecol Oncol. 2011 Nov;123(2):351-5
references.pmid: 21855973
references.citation: J Clin Oncol. 2000 Feb;18(4):743-53
references.pmid: 10673515
references.citation: Psychiatry Res. 1989 May;28(2):193-213
references.pmid: 2748771
references.citation: Eur J Oncol Nurs. 2010 Apr;14(2):101-10
references.pmid: 19897417
references.citation: J Natl Cancer Inst Monogr. 2004;(32):57-71
references.pmid: 15263042
references.citation: Support Care Cancer. 2010 Jan;18(1):105-14
references.pmid: 19381692
references.citation: J Pain Symptom Manage. 2006 Sep;32(3):245-54
references.pmid: 16939849
references.citation: Cancer. 2012 Apr 15;118(8 Suppl):2261-9
references.pmid: 22488700
references.citation: Sleep. 2001 Aug 1;24(5):583-90
references.pmid: 11480655
references.citation: Ann Behav Med. 2013 Jun;45(3):329-37
references.pmid: 23508468
references.citation: Breast Cancer Res Treat. 2008 May;109(2):379-87
references.pmid: 17674200
references.citation: J Surg Oncol. 2009 Jun 1;99(7):447-55
references.pmid: 19418493
references.citation: Chronobiol Int. 2010 Jan;27(2):363-77
references.pmid: 20370475
references.citation: Sleep. 1997 Oct;20(10):835-43
references.pmid: 9415942
references.citation: Sleep. 2009 Sep;32(9):1155-60
references.pmid: 19750920
references.citation: Oncol Nurs Forum. 2006 Jan 01;33(1):E18-26
references.pmid: 16470230
references.citation: Sleep Med Rev. 2006 Dec;10(6):419-29
references.pmid: 16963293
references.citation: Oncologist. 2007;12 Suppl 1:4-10
references.pmid: 17573451
references.citation: Stat Med. 2006 Nov 30;25(22):3893-904
references.pmid: 16381069
references.citation: Fatigue. 2013;1(1-2):12-26
references.pmid: 23412418