Predictors of Fatigue 30 Days After Completing Anthracycline Plus Taxane Adjuvant Chemotherapy for Breast Cancer

Kimberly K. Wielgus

Ann M. Berger

Melody Hertzog

anthyracyclines, fatigue
ONF 2009, 36(1), 38-48. DOI: 10.1188/09.ONF.38-48

Purposes/Objectives: To identify the predictors of fatigue 30 days after completing adjuvant chemotherapy for breast cancer and whether differences are observed between a behavioral sleep intervention and a healthy-eating attention control group in predicting fatigue.

Design: Descriptive, exploratory, secondary analysis of a randomized clinical trial.

Setting: Outpatient oncology patients in a midwestern U. S. city.

Sample: 96 women, ages 29-83 years, 72% married, 95% white, diagnosed with stage I-IIIA breast cancer, receiving adjuvant anthracycline and taxane chemotherapy.

Methods: Participants were randomized to a behavioral sleep intervention group or an attention control group. Participants completed data collection prior to and during the peak and rebound days of the initial chemotherapy treatment cycle and after the last treatment.

Main Research Variables: Fatigue, circadian rhythms of activity, objective and subjective sleep-wake, and objective and subjective activity-rest.

Findings: Predictors of fatigue were less total sleep time prior to treatment, higher fatigue prior to treatment and at the peak, and less energy upon awakening on rebound days. In the control group, predictors of higher fatigue were higher fatigue prior to treatment, higher body mass index, higher number of positive lymph nodes, and less daytime dysfunction. For the intervention group, lower peak activity at the peak of initial treatment differentially predicted fatigue.

Conclusions: Results suggest the sleep intervention group participants who maintained activity balanced with sleep at the peak of the initial treatment benefited most from the intervention.

Implications for Nursing: Nurses should screen for fatigue prior to initial chemotherapy treatment and at regular intervals, further assess for poor sleep in patients who report fatigue of 4 or higher (on a 0-10 scale), and use evidence-based guidelines to select appropriate interventions.

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