The Relationship of Fatigue and Meaning in Life in Breast Cancer Survivors

Paige Thompson

meaning, fatigue, quality of life
ONF 2007, 34(3), 653-660. DOI: 10.1188/07.ONF.653-660

Purpose/Objectives: To determine relationships among (a) cancer-related fatigue and meaning in life, (b) overall symptom distress and meaning in life, (c) fatigue and performance, and (d) overall symptom distress and performance in breast cancer survivors.

Design: Cross-sectional and correlational.

Setting: Community-based setting in eastern Pennsylvania.

Sample: 34 women who had completed their last treatment for breast cancer within the prior 16 months.

Methods: Data were collected using the Piper Fatigue Scale (PFS), Life Attitude Profile-Revised (LAP-R), Memorial Symptom Assessment Scale-Short Form (MSAS-SF), and Medical Outcomes Study-Short Form 36 (SF-36).

Main Research Variables: Fatigue and meaning in life.

Findings: One moderate negative correlation was found between the PFS sensory subscale and the choice or responsibleness dimension of the LAP-R. Significant moderate to strong negative correlations were found between the MSAS-SF total score and two subscale scores and the existential transcendence dimension of the LAP-R. Significant moderate to strong negative correlations were found between four subscales of the SF-36 representing performance and the MSAS-SF total score.

Conclusions: Meaning in life may influence fatigue and overall symptoms in breast cancer survivors.

Implications for Nursing: Assessment of meaning in life may be important in the management of fatigue and overall symptoms in women after treatment for breast cancer.

Jump to a section


    Armstrong, T.S., Cohen, M.Z., Eriksen, L.R., & Hickey, J.V. (2004). Symptom clusters in oncology patients and implications for symptom research in people with primary brain tumors. Journal of Nursing Scholarship, 36, 197-206.
    Arndt, V., Merx, H., Stegmaier, C., Ziegler, H., & Brenner, H (2004). Quality of life in patients with colorectal cancer one year after diagnosis compared with the general population: A population-based study. Journal of Clinical Oncology, 22, 4829-4836.
    Baumeister, R.F (1991). Meanings of life. New York: Guilford Press.
    Bell, R. (1985). Holy anorexia. Chicago: University of Chicago Press.
    Bender, C.M., Ergun, F.S., Rosenzweig, M.Q., Cohen, S.M., & Sereika, S.M. (2005). Symptom clusters in breast cancer across three phases of the disease. Cancer Nursing, 28, 219-225.
    Berger, A. (1998). Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncology Nursing Forum, 25, 51-62.
    Berger, A., & Higginbotham, P. (2000). Correlates of fatigue during and following adjuvant breast cancer chemotherapy: A pilot study. Oncology Nursing Forum, 27, 1443-1448.
    Bower, J.E., Ganz, P.A., Desmond, K.A., Rowland, J.H., Meyerowitz, B.E., & Belin, T.R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18, 743-753.
    Carter, H., MacLeod, R., Brander, P., & McPherson, K. (2004). Living with terminal illness: Patients' priorities. Journal of Advanced Nursing, 45, 611-620.
    Chang, V.T., Hwang, S.S., Feuerman, M., Kasimis, B.S., & Thaler, H.T. (2000). The Memorial Symptom Assessment Scale Short Form (MSASSF): Validity and reliability. Cancer, 89, 1162-1171.
    Coward, D.D. (1996). Self-transcendence and correlates in a healthy population. Nursing Research, 45, 116-121.
    Coward, D.D., & Kahn, D.L. (2004). Resolution of spiritual disequilibrium by women newly diagnosed with breast cancer [Online exclusive]. Oncology Nursing Forum, 31, E24-E31. Retrieved April 11, 2007, from
    Coward, D.D., & Kahn, D.L. (2005). Transcending breast cancer: Making meaning from diagnosis and treatment. Journal of Holistic Nursing, 23, 264-283.
    Eversley, R., Estrin, D., Dibble, S., Wardlaw, L., Pedrosa, M., & Favila-Penney, W. (2005). Post-treatment symptoms among ethnic minority breast cancer survivors. Oncology Nursing Forum, 32, 250-256.
    Ferrell, B.R., Grant, M., Dean, G.E., Funk, B., & Ly, J. (1996). "Bone tired": The experience of fatigue and its impact on quality of life. Oncology Nursing Forum, 23, 1539-1547.
    Fife, B.L. (1994). The conceptualization of meaning in illness. Social Science and Medicine, 38, 309-316.
    Frankl, V. (1984). Man's search for meaning. New York: Washington Square Press.
    Gelinas, C., & Fillion, L. (2004). Factors related to persistent fatigue following completion of breast cancer treatment. Oncology Nursing Forum, 31, 269-278.
    Gift, A.G., Jablonski, M.S., Stommel, M., & Given, C.W. (2004). Symptom clusters in elderly patients with lung cancer. Oncology Nursing Forum, 31, 202-212.
    Hwang, S.S., Chang, V.T., Rue, M., & Kasimis, B. (2003). Multidimensional independent predictors of cancer-related fatigue. Journal of Pain and Symptom Management, 26, 604-614.
    Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., & Thun, M.J. (2007). Cancer statistics, 2007. CA: A Cancer Journal for Clinicians, 57, 43-66.
    Kim, H., McGuire, D.B., Tulman, L., & Barsevick, A.M. (2005). Symptom clusters: Concept analysis and clinical implications for cancer nursing. Cancer Nursing, 28, 270-282.
    Knobf, M.T., & Sun, Y. (2005). A longitudinal study of symptoms and selfcare activities in women treated with primary radiotherapy for breast cancer. Cancer Nursing, 28, 210-218.
    Landmark, B.T., & Wahl, A. (2002). Living with newly diagnosed breast cancer: A qualitative study of 10 women with newly diagnosed breast cancer. Journal of Advanced Nursing, 40, 112-121.
    Lee, E. (2001). Fatigue and hope: Relationships to psychosocial adjustment in Korean women with breast cancer. Applied Nursing Research, 14(2), 87-93.
    Lenz, E.R., Pugh, L.C., Milligan, R.A., Gift, A., & Suppe, F. (1997). The middle-range theory of unpleasant symptoms: An update. Advances in Nursing Science, 19(3), 14-26.
    Loge, J.H., Abrahamsen, A.F., Ekeberg, O., & Kaasa, S. (2000). Fatigue and psychiatric morbidity among Hodgkin disease survivors. Journal of Pain and Symptom Management, 19, 91-99.
    Manning-Walsh, J.K. (2005). Psychospiritual well-being and symptom distress in women with breast cancer [Online exclusive]. Oncology Nursing Forum, 32, E56-E62. Retrieved April 11, 2007, from…
    Mast, M.E. (1998). Correlates of fatigue in survivors of breast cancer. Cancer Nursing, 21, 136-142.
    Monga, U., Kerrigan, A.J., Thornby, J., & Monga, T.N. (1999). Prospective study of fatigue in localized prostate cancer patients undergoing radiotherapy. Radiation Oncology Investigations, 7, 178-185.
    Moore, S.L. (1997). A phenomenological study of meaning in life in suicidal older adults. Archives of Psychiatric Nursing, 11(1), 29-36.
    O'Connor, A.P., Wicker, C.A., & Germino, B.B. (1990). Understanding the cancer patient's search for meaning. Cancer Nursing, 13, 167-175.
    Payne, J.K. (2002). The trajectory of fatigue in adult patients with breast and ovarian cancer receiving chemotherapy. Oncology Nursing Forum, 29, 1334-1340.
    Payne, J.K., Piper, B.F., Rabinowitz, I., & Zimmerman, M.B. (2006). Biomarkers, fatigue, sleep, and depressive symptoms in women with breast cancer: A pilot study. Oncology Nursing Forum, 33, 775-783.
    Piper, B.F., Dibble, S.L., Dodd, M.J., Weiss, M.C., Slaughter, R.E., & Paul, S.M. (1998). The revised Piper Fatigue Scale: Psychometric evaluation in women with breast cancer. Oncology Nursing Forum, 25, 677-684.
    Ramfelt, E., Severinsson, E., & Lutzen, K. (2002). Attempting to find meaning in illness to achieve emotional coherence. Cancer Nursing, 25, 141-149.
    Reker, G.T. (1992). Manual: Life Attitude Profile-Revised. Peterborough, Canada: Student Psychologists Press.
    Richer, M., & Ezer, H. (2002). Living in it, living with it, and moving on: Dimensions of meaning during chemotherapy. Oncology Nursing Forum, 29, 113-119.
    Schnoll, R.A., Knowles, J.C., & Harlow, L. (2002). Correlates of adjustment among cancer survivors. Journal of Psychosocial Oncology, 20, 37-59.
    Schwartz, A.L. (1998). Patterns of exercise and fatigue in physically active cancer survivors. Oncology Nursing Forum, 25, 485-491.
    Smets, E.M.A., Visser, M.R.M., Willems-Groot, A.F.M.N., Garssen, B., Oldenburger, F., van Tienhoven, G., et al. (1998). Fatigue and radiotherapy: (A) experience in patients undergoing treatment. British Journal of Cancer, 78, 899-906.
    Spelten, E.R., Verbeek, J.H.A.M., Uitterhoeve, A.L.J., Ansink, A.C., van der Lelie, J., de Reijke, R.M., et al. (2003). Cancer, fatigue and the return of patients to work—A prospective cohort study. European Journal of Cancer, 39, 1562-1567.
    Steeves, R.H. (1992). Patients who have undergone bone marrow transplantation: Their quest for meaning. Oncology Nursing Forum, 19, 899-905.
    Taylor, E.J. (1993). Factors associated with meaning in life among people with recurrent cancer. Oncology Nursing Forum, 20, 1399-1405.
    Taylor, E.J. (2000). Transformation of tragedy among women surviving breast cancer. Oncology Nursing Forum, 27, 781-788.
    Taylor, E.J. (2003). Spiritual needs of patients with cancer and family caregivers. Cancer Nursing, 26, 260-266.
    Utley, R. (1999). The evolving meaning of cancer for long-term survivors of breast cancer. Oncology Nursing Forum, 26, 1519-1523.
    Ware, J.E., & Sherbourne, C.D. (1992). The MOS 36-item short-form health survey (SF36). Medical Care, 30, 473-485.
    Woo, B., Dibble, S.L., Piper, B., Keating, S.B., & Weiss, M.C. (1998). Differences in fatigue by treatment methods in women with breast cancer. Oncology Nursing Forum, 25, 915-919.