title: A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer.
abstract: BACKGROUND
  Depression, fatigue, and sleep disturbances have been identified as a symptom cluster among breast cancer patients. However, few longitudinal studies have examined the temporal relations between these symptoms surrounding diagnosis and treatment.
  
  
  OBJECTIVE
  The present study investigated the co-occurrence of and interrelations between nonsomatic depressive symptoms, fatigue, and sleep disturbances in breast cancer patients at three time points: before, after, and six to eight months following adjuvant chemotherapy treatment.
  
  
  METHODS
  Separate samples of premenopausal (n = 67) and postmenopausal (n = 67) breast cancer patients completed self-report measures of depression, fatigue, and sleep disturbances at all three time points. Path analysis was used to explore within- and cross-symptom paths across time.
  
  
  RESULTS
  Depression, fatigue, and sleep disturbances were correlated within each time point. Continuity paths, whereby prior levels of symptom severity tended to predict subsequent severity of the same symptom at the subsequent time point, were significant in both samples, except for depression in the premenopausal sample. Instead, significant cross-symptom paths emerged whereby baseline fatigue predicted postchemotherapy depression, and postchemotherapy fatigue predicted depression at follow-up in the premenopausal patients. No significant cross-symptom paths emerged for the postmenopausal sample.
  
  
  CONCLUSIONS
  Findings supported the notion that depression, fatigue, and sleep disturbances manifest as a symptom cluster. Fatigue may precede nonsomatic symptoms of depression among premenopausal breast cancer patients and represents a potential intervention target.
authors.affiliation: University of Vermont, Burlington, Vermont, USA. Electronic address: Sheau-Yan.Ho@uvm.edu.
authors.forename: Sheau-Yan
authors.initials: SY
authors.lastname: Ho
authors.affiliation: University of Vermont, Burlington, Vermont, USA.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Rohan
authors.affiliation: University of Vermont, Burlington, Vermont, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Parent
authors.affiliation: Columbia University Medical Center, New York, New York, USA.
authors.forename: Felice A
authors.initials: FA
authors.lastname: Tager
authors.affiliation: Columbia University Medical Center, New York, New York, USA.
authors.forename: Paula S
authors.initials: PS
authors.lastname: McKinley
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D017024:Chemotherapy, Adjuvant; D003863:Depression / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D005221:Fatigue / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D017698:Postmenopause; D017697:Premenopause; D057566:Self Report; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy
keywords: Cancer; depression; fatigue; oncology; sleep disturbance; symptom cluster