Fatigue and sleep quality are associated with changes in inflammatory markers in breast cancer patients undergoing chemotherapy

Abstract

Fatigue and sleep disturbances are two of the most common and distressing symptoms reported by cancer patients. Fatigue and sleep are also correlated with each other. While fatigue has been reported to be associated with some inflammatory markers, data about the relationship between cancer-related sleep disturbances and inflammatory markers are limited. This study examined the relationship between fatigue and sleep, measured both subjectively and objectively, and inflammatory markers in a sample of breast cancer patients before and during chemotherapy. Fifty-three women with newly diagnosed stage I–III breast cancer scheduled to receive at least four 3-week cycles of chemotherapy participated in this longitudinal study. Fatigue was assessed with the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF), sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and objective sleep was measured with actigraphy. Three inflammatory markers were examined: Interleukin-6 (IL-6), Interleukin-1 receptor antagonist (IL-1RA) and C-reactive protein (CRP). Data were collected before (baseline) and during cycle 1 and cycle 4 of chemotherapy. Compared to baseline, more fatigue was reported, levels of IL-6 increased and IL-1RA decreased during chemotherapy. Reports of sleep quality remained poor. Mixed model analyses examining changes from baseline to each treatment time point revealed overall positive relationships between changes in total MFSI-SF scores and IL-6, between changes in total PSQI scores and IL-6 and IL-1RA, and between total wake time at night and CRP (all p’s<0.05). These relationships suggest that cancer-related fatigue and sleep disturbances may share common underlying biochemical mechanisms.

Sleep Quality in Women with Breast Cancer: An Integrative Review

“…tance of longitudinal studies because analyzing the patient in 2 or more stages of treatment and documenting the difference in quality of sleep, may be helpful to nurses in managing their patients care. Nine articles reported randomized clinical trials [8,10,[16][17][18][19][20][21]] and 3 were a secondary analysis [4,[22][23].…”

“…Furthermore, Liu et al [8] reports a longitudinal relationship between fatigue, sleep parameters, and inflammation in breast cancer patients. These authors found that changes in reports of sleep quality were significantly associated with a decrease in circulating levels of IL-1RA.…”

Kualitas Tidur Pasien Kanker Payudara Berdasarkan Terapi yang Diberikan di RSUP DR. Hasan Sadikin Bandung

“…Hasil ini sependapat dengan Liu et al (2012), bahwa pasien kanker payudara menghabiskan waktu 2 jam untuk tertidur kembali saat terbangun di malam hari, dan rata-rata total waktu tidur < 7 jam. Terlalu banyak waktu yang dihabiskan untuk bangun dan tidak cukup waktu untuk tidur adalah tanda tidur yang tidak mencukupi.…”

A Nested Case-Controlled Comparison of Telomere Length and Psychological Functioning in Breast Cancer Survivors with and without Insomnia Symptoms

“…12 Furthermore, in breast cancer patients undergoing chemotherapy, poor sleep quality has been associated with increases in inflammatory cytokines (interleukin-6 and interleukin-1 receptor agonist) and C-reactive protein. 13 In samples of healthy individuals, disrupted sleep quality/quantity have been demonstrated to have cascading neuroendocrine effects, including increased inflammatory cytokine production 14 and reduced immune function 15 ; however, the relationship of poor sleep to cancer processes and outcomes is only beginning to be understood. Additionally, a high level of subjective stress has been associated with both insomnia and shorter TLs.…”