title: Nausea and disturbed sleep as predictors of cancer-related fatigue in breast cancer patients: a multicenter NCORP study.
abstract: Cancer-related fatigue (CRF) is a prevalent and distressing side effect of cancer and its treatment that remains inadequately understood and poorly managed. A better understanding of the factors contributing to CRF could result in more effective strategies for the prevention and treatment of CRF. The objectives of this study were to examine the prevalence, severity, and potential predictors for the early onset of CRF after chemotherapy cycle 1 in breast cancer patients.
  
  
  
  We report on a secondary data analysis of 548 female breast cancer patients from a phase III multi-center randomized controlled trial examining antiemetic efficacy. CRF was assessed by the Brief Fatigue Inventory at pre- and post-chemotherapy cycle 1 as well as by the four-day diary.
  
  
  
  The prevalence of clinically relevant post-CRF was 75%. Linear regression showed that pre-treatment CRF, greater nausea, disturbed sleep, and younger age were significant risk factors for post-CRF (adjusted R2= 0.39; P < 0.0001). Path modeling showed that nausea severity influenced post-CRF both directly and indirectly by influencing disturbed sleep. Similarly, pre-treatment CRF influenced post-CRF directly as well as indirectly through both nausea severity and disturbed sleep. Pearson correlations showed that changes in CRF over time were significantly correlated with concurrent changes in nausea severity (r = 0.41; P < 0.0001) and in disturbed sleep (r = 0.20; P < 0.0001).
  
  
  
  This study showed a high prevalence (75%) of clinically relevant CRF in breast cancer patients following their initial chemotherapy, and that nausea severity, disturbed sleep, pre-treatment CRF, and age were significant predictors of symptom.
authors.affiliation: Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642, USA. Anita_Peoples@urmc.rochester.edu.
authors.forename: Anita R
authors.initials: AR
authors.lastname: Peoples
authors.affiliation: Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Roscoe
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Block
authors.affiliation: Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Heckler
authors.affiliation: Department of Dermatology, University of Rochester Medical Center, 601 Elmwood Ave., Rochester, NY, 14642, USA.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Ryan
authors.affiliation: Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642, USA.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Mustian
authors.affiliation: Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642, USA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Janelsins
authors.affiliation: Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642, USA.
authors.forename: Luke J
authors.initials: LJ
authors.lastname: Peppone
authors.affiliation: Wichita NCORP, Wichita, KS, USA.
authors.forename: Dennis F
authors.initials: DF
authors.lastname: Moore
authors.affiliation: Metro Minnesota Community Oncology Research Consortium, Saint Louis Park, MN, USA.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Coles
authors.affiliation: Heartland Cancer Research NCORP, Decatur, IL, USA.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Hoelzer
authors.affiliation: Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642, USA.
authors.forename: Gary R
authors.initials: GR
authors.lastname: Morrow
authors.affiliation: Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd., Rochester, NY, 14642, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Dozier
mesh_terms: D001943:Breast Neoplasms / Q000150:complications* / Q000188:drug therapy; D020920:Dyssomnias / Q000209:etiology*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced*
keywords: Breast cancer; Cancer-related fatigue; Disturbed sleep; Nausea