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Adherence, Sleep, and Fatigue Outcomes After Adjuvant Breast Cancer Chemotherapy: Results of a Feasibility Intervention Study

Ann M. Berger
Susanna VonEssen
Brett R. Kuhn
Barbara F. Piper
Lynne Farr
Sangeeta Agrawal
James C. Lynch
Patti Higginbotham
ONF 2003, 30(3), 513-522 DOI: 10.1188/03.ONF.513-522

Purpose/Objectives: To evaluate outcomes of an intervention designed to promote sleep and modify fatigue after adjuvant breast cancer chemotherapy.

Design: Prospective, repeated measures, quasi-experimental, feasibility study.

Setting: Midwestern urban oncology clinics.

Sample: 21 female participants, ages 43-66 years (X = 55.3) with stage I or II breast cancer status post four cycles of doxorubicin chemotherapy. Eight had four additional cycles of paclitaxel, 10 also had radiation, and 18 took tamoxifen.

Methods: Each woman continued to revise her Individualized Sleep Promotion Plan (ISPP), developed during her first cycle of chemotherapy, that included sleep hygiene, relaxation therapy, stimulus control, and sleep restriction components. The daily diary, Pittsburgh Sleep Quality Index, wrist actigraph, and Piper Fatigue Scale were used for seven days 30, 60, and 90 days after the last chemotherapy treatment and one year after the first chemotherapy treatment.

Main Research Variables: Adherence and sleep and wake, fatigue, and ISPP components.

Findings: Adherence to the ISPP components remained high at all times (77%-88%) except for stimulus control (36%-56%). Sleep outcome means and the actigraph revealed that (a) sleep latency remained less than 30 minutes per night, (b) the time awake after sleep onset exceeded the desired less than 30 minutes per night, (c) sleep efficiency scores ranged from 82%-92%, (d) total rest time ranged from seven to eight hours per night, (e) feelings on arising ranged from 3.7-3.8 (on a 0-5 scale), (f) nighttime awakenings ranged from 10-11 per night, and (g) daytime naps ranged from 10-15 minutes in length. Fatigue remained low, from 2.9-3.5 on a 0-10 scale.

Conclusions: Adherence rates remained high for most components. Sleep and wake patterns were within normal limits except for the number and duration of night awakenings. Fatigue remained low.

Implications for Nursing: Future testing using an experimental design will focus on increasing ISPP adherence and decreasing nighttime awakenings. Adopting behavioral techniques to promote sleep may result in improved sleep and lower fatigue after chemotherapy.

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