No votes yet

Impact of Adjuvant Breast Cancer Chemotherapy on Fatigue, Other Symptoms, and Quality of Life

Katherine L. Byar
Ann M. Berger
Suzanne L. Bakken
Melissa A. Cetak
ONF 2006, 33(1), E18-E26 DOI: 10.1188/06.ONF.E18-E26

Purpose/Objectives: To identify differences in fatigue, other physical symptoms, and psychological symptoms and their relationship to quality of life (QOL) during chemotherapy and as long as one year after.

Design: Longitudinal, descriptive design embedded in a pilot intervention study.

Setting: Midwestern urban oncology clinics and patient homes.

Sample: 25 Caucasian women, aged 40-65 years (X = 54.3), with stage I or II breast cancer receiving doxorubicin-based chemotherapy.

Methods: The Piper Fatigue Scale, Hospital Anxiety and Depression Scale, Symptom Experience Scale, and Medical Outcomes Study Short-Form General Health Survey were completed before and after each treatment; 30, 60, and 90 days after the last treatment; and one year after the first treatment.

Main Research Variables: Fatigue, physical and psychological symptoms, and QOL.

Findings: Fatigue levels were moderately intense during treatments and decreased significantly overtime. Sleep disturbances and pain were the most frequent, intense, and distressing other physical symptoms. Anxiety was highest at baseline, and depression was highest during the fourth chemotherapy treatment. Fatigue was correlated with other physical and psychological symptoms at some times during treatments and consistently following treatments. Higher fatigue was associated with lower QOL in several domains.

Conclusions: Fatigue is associated with other physical and psychological symptoms that fluctuate during and after treatment. Higher fatigue compromises QOL.

Implications for Nursing: Interventions targeting primary or cluster symptoms can reduce the impact of adjuvant chemotherapy on fatigue, other symptoms, and QOL.


American Cancer Society. (2005). <i>Breast cancer facts and figures 2003-2004</i>. Atlanta, GA: Author.

Badger, T., Segrin, C., Meek, P., Lopez, A.M., Bonham, E., & Sieger, A. (2005). Telephone interpersonal counseling with women with breast cancer: Symptom management and quality of life. <i>Oncology Nursing Forum, 32</i>, 273-279.

Badger, T.A., Braden, C.J., & Mishel, M.H. (2001). Depression burden, self-help interventions, and side effect experience in women receiving treatment for breast cancer. <i>Oncology Nursing Forum, 28</i>, 567-574.

Beck, S.L., Dudley, W.N., & Barsevick, A. (2005). Pain, sleep disturbance, and fatigue in patients with cancer: Using a mediation model to test a symptom cluster [Online exclusive]. <i>Oncology Nursing Forum, 32, E48-E55. Retrieved November 2, 2005</i>, from http://www.ons.org/publications/journals/ONF/Volume32/Issue3/3203542.asp

Berger, A.M. (1998). Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. <i>Oncology Nursing Forum, 25</i>, 51-62.

Berger, A.M., & Farr, L. (1999). The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue. <i>Oncology Nursing Forum, 26</i>, 1663-1671.

Berger, A.M., & Higginbotham, P. (2000). Correlates of fatigue during and following adjuvant breast cancer chemotherapy: A pilot study. <i>Oncology Nursing Forum, 27</i>, 1443-1448.

Berger, A.M., VonEssen, S., Kuhn, B.R., Piper, B.F., Agrawal, S., Lynch, J.C., et al. (2003). Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: Results of a feasibility intervention study. <i>Oncology Nursing Forum, 30</i>, 513-522.

Berger, A.M., VonEssen, S., Kuhn, B.R., Piper, B.F., Farr, L., Agrawal, S., et al. (2002). Feasibility of a sleep intervention during adjuvant breast cancer chemotherapy. <i>Oncology Nursing Forum, 29</i>, 1431-1441.

Berger, A.M., & Walker, S.N. (2001). An explanatory model of fatigue in women receiving adjuvant breast cancer chemotherapy [published erratum appears in <i>Nursing Research, 50</i>(3), 164]. <i>Nursing Research, 50</i>(1), 42-52.

Boehmke, M.M. (2004). Measurement of symptom distress in women with early-stage breast cancer. <i>Cancer Nursing, 27</i>, 144-152.

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. <i>Journal of Clinical Oncology, 18</i>, 743-753.

Broeckel, J.A., Jacobsen, P.B., Balducci, L., Horton, J., & Lyman, G.H. (2000). Quality of life after adjuvant chemotherapy for breast cancer. <i>Breast Cancer Research and Treatment, 62</i>, 141-150.

Broeckel, J.A., Jacobsen, P.B., Horton, J., Balducci, L., & Lyman, G.H. (1998). Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. <i>Journal of Clinical Oncology, 16</i>, 1689-1696.

Cella, D., Davis, K., Breitbart, W., & Curt, G. (2001). Cancer-related fatigue: Prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. <i>Journal of Clinical Oncology, 19</i>, 3385-3391.

de Jong, N., Courtens, A.M., Abu-Saad, H.H., & Schouten, H.C. (2002). Fatigue in patients with breast cancer receiving adjuvant chemotherapy: A review of the literature. <i>Cancer Nursing, 25</i>, 283-297.

Division of Cancer Control and Population Sciences. (2005). <i>Facts about Office of Cancer Survivorship National Cancer Institute</i>. Retrieved May 3, 2005, from <a target="_blank" href='http://dccps.nci.nih.gov/ocs/ocs_factsheet.pdf'>http://dccps.nci.nih.gov...

Dodd, M.J., Miaskowski, C., & Paul, S.M. (2001). Symptom clusters and their effect on the functional status of patients with cancer. <i>Oncology Nursing Forum, 28</i>, 465-470.

Donovan, K.A., Jacobsen, P.B., Andrykowski, M.A., Winters, E.M., Balducci, L., Malik, U., et al. (2004). Course of fatigue in women receiving chemotherapy and/or radiotherapy for early stage breast cancer. <i>Journal of Pain and Symptom Management, 28</i>, 373-380.

Eversley, R., Estrin, D., Dibble, S., Wardlaw, L., Pedrosa, M., & Favila-Penney, W. (2005). Post-treatment symptoms among ethnic minority breast cancer survivors. <i>Oncology Nursing Forum, 32</i>, 250-256.

Ganz, P.A., Desmond, K.A., Leedham, B., Rowland, J.H., Meyerowitz, B.E., & Belin, T.R. (2002). Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. <i>Journal of the National Cancer Institute, 94</i>, 39-49.

Given, C.W., Given, B., Azzouz, F., Kozachik, S., & Stommel, M. (2001). Predictors of pain and fatigue in the year following diagnosis among elderly cancer patients. <i>Journal of Pain and Symptom Management, 21</i>, 456-466.

Goodell, T.T., & Nail, L.M. (2005). Operationalizing symptom distress in adults with cancer: A literature synthesis [Online exclusive]. <i>Oncology Nursing Forum, 32, E42-E47. Retrieved November 2, 2005</i>, from http://www.ons.org/publications/journals/ONF/Volume32/Issue2/320242.asp

Haghighat, S., Akbari, M.E., Holakouei, K., Rahimi, A., & Montazeri, A. (2003). Factors predicting fatigue in breast cancer patients. <i>Supportive Care in Cancer, 11</i>, 533-538.

Herrmann, C. (1997). International experiences with the Hospital Anxiety and Depression Scale—A review of validation data and clinical results. <i>Journal of Psychosomatic Research, 42</i>, 17-41.

Jacobsen, P.B., Hann, D.M., Azzarello, L.M., Horton, J., Balducci, L., & Lyman, G.H. (1999). Fatigue in women receiving adjuvant chemotherapy for breast cancer: Characteristics, course, and correlates. <i>Journal of Pain and Symptom Management, 18</i>, 233-242.

Knobf, M. (2000). Symptom distress before, during, and after adjuvant breast cancer therapy. <i>Developments in Supportive Cancer Care, 4</i>(1), 13-17.

Longman, A.J., Braden, C.J., & Mishel, M.H. (1999). Side-effects burden, psychological adjustment, and life quality in women with breast cancer: Pattern of association over time. <i>Oncology Nursing Forum, 26</i>, 909-915.

Pasacreta, J.V. (1997). Depressive phenomena, physical symptom distress, and functional status among women with breast cancer. <i>Nursing Research, 46</i>, 214-221.

Patrick, D.L., Ferketich, S.L., Frame, P.S., Harris, J.J., Hendricks, C.B., Levin, B., et al. (2004). National Institutes of Health State-of-the-Science Conference statement: Symptom management in cancer: Pain, depression, and fatigue, July 15-17, 2002. <i>Journal of the National Cancer Institute Monographs, 32</i>, 9-16.

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. <i>Oncology Nursing Forum, 25</i>, 677-684.

Piper, B.F., Lindsey, A.M., & Dodd, M.J. (1987). Fatigue mechanisms in cancer patients: Developing nursing theory. <i>Oncology Nursing Forum, 14</i>(6), 17-23.

Samarel, N., Leddy, S.K., Greco, K., Cooley, M.E., Torres, S.C., Tulman, L., et al. (1996). Development and testing of the symptom experience scale. <i>Journal of Pain and Symptom Management, 12</i>, 221-228.

Shapiro, C.L., & Recht, A. (2001). Side effects of adjuvant treatment of breast cancer. <i>New England Journal of Medicine, 344</i>, 1997-2008.

Tchen, N., Juffs, H.G., Downie, F.P., Yi, Q.L., Hu, H., Chemerynsky, I., et al. (2003). Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer. <i>Journal of Clinical Oncology, 21</i>, 4175-4183.

Ware, J.E. (1993). <i>SF-36 health survey manual and interpretation guide</i>. Boston: The Health Institute.

Ware, J.E., Jr., & Sherbourne, C.D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. <i>Medical Care, 30</i>, 473-483.

Williams, S.A., & Schreier, A.M. (2004). The effect of education in managing side effects in women receiving chemotherapy for treatment of breast cancer [Online exclusive]. <i>Oncology Nursing Forum, 31, E16-E23. Retrieved November 2, 2005</i>, from http://www.ons.org/publications/journals/ONF/Volume31/Issuel/310143.asp

Zigmond, A.S., & Snaith, R.P. (1983). The hospital anxiety and depression scale. <i>Acta Psychiatrica Scandinavica, 67</i>, 361-370.