Distinct Trajectories of Fatigue and Sleep Disturbance in Women Receiving Chemotherapy for Breast Cancer

Purpose/Objectives: To examine self-reported severity of fatigue and disturbed sleep experienced daily by women with breast cancer during multiple cycles of chemotherapy, exploring potential classes of women experiencing similar symptom trajectories.


Design: In a secondary analysis, classes of women experiencing similar patterns of fatigue and disturbed sleep were identified.


Setting: Oncology clinics in the United States.


Sample: 166 women with breast cancer receiving chemotherapy. 


Methods: Severity scores were self-reported daily using an automated system. Classes of fatigue and disturbed sleep severity were identified using latent growth mixture modeling.


Main Research Variables: Fatigue, disturbed sleep, age, stage of disease, education, employment, marital status, chemotherapy regimen, hours lying down, and missed work.


Findings: Three fatigue classes were identified: mild decreasing (59% cycle 2, 64% cycle 3), low moderate decreasing (30% cycle 2, 25% cycle 3), and high moderate decreasing (11% both cycles). Two disturbed sleep classes were identified: mild decreasing (89% cycle 2, 81% cycle 3) and increasing (11% cycle 2, 19% cycle 3). Women in the high moderate decreasing fatigue class were more likely to have received doxorubicin (p = 0.02) and spent more hours lying down (p = 0.02).


Conclusions: Patterns of symptom trajectories for fatigue and disturbed sleep were distinguished by baseline symptom severity.


Implications for Nursing: Identification of women at risk for fatigue and disturbed sleep may allow clinicians to intensify symptom management.