Inflammation and Behavioral Symptoms After Breast Cancer Treatment: Do Fatigue, Depression, and Sleep Disturbance Share a Common Underlying Mechanism?

Bower, Julienne E.; Ganz, Patricia A.; Irwin, Michael R.; Kwan, Lorna; Breen, Elizabeth C.; Cole, Steve W.

doi:10.1200/jco.2011.36.1154

Cited by 425 publications

(384 citation statements)

References 58 publications

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“…Although not statistically significant, we found a tendency for higher levels of poor sleep quality among women submitted to CTX, which is in accordance with previous results [13,36,37]; the daily life disruption related with the psychological (e.g., worries, anxiety, and depression related with anticipation of side effects) and physical (e.g., hot flashes, fatigue, nausea, and vomiting) side effects of treatment could, at least in part, explain these results [29,38].…”

Section: Discussionsupporting

confidence: 82%

The impact of breast cancer treatments on sleep quality 1 year after cancer diagnosis

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Pereira

Costa

et al. 2017

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Purpose The increasing number of women living longer with potential side effects of breast cancer treatment highlights the need of a comprehensive assessment of its burden. Therefore, we aimed to quantify the relation between different breast cancer treatments and sleep quality 1 year after diagnosis. Methods A cohort of 502 newly diagnosed breast cancer patients was prospectively followed. Sleep quality was evaluated with the Pittsburgh Sleep Quality Index (PSQI), at baseline and at the 1-year follow-up. Odds ratios (OR) were computed to quantify the association between patient characteristics and poor sleep quality (PSQI score >5) at baseline, and relative risks (RR) were computed for the association between treatments and the occurrence of poor sleep quality at 1 year. Results A total of 60.2% of the patients had poor sleep quality before breast cancer treatments, especially those with anxiety [OR = 2.86, 95% confidence interval (95%CI) 1.92 to 4.27] or depression (OR = 5.25, 95%CI 2.01 to 13.67). Radiotherapy increased the risk of poor sleep quality at 1 year (RR = 3.71, 95%CI 1.15 to 11.96, for a cumulative dose >50 Gy) and there was a tendency for a higher risk in those submitted to chemotherapy, although not statistically significant.Conclusions Our study shows that sleep disturbances are frequent before cancer treatment and confirms their cooccurrence with other medical conditions, such as anxiety and depression. Different breast cancer treatments increase the risk of impaired sleep quality, therefore contributing to the global disability associated with cancer treatments.

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Section: Discussionsupporting

confidence: 82%

The impact of breast cancer treatments on sleep quality 1 year after cancer diagnosis

Fontes

Pereira

Costa

et al. 2017

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“…Increased levels of inflammation have been shown to be associated with fatigue, insomnia, and depression in breast cancer survivors [39], and fatigue and disturbed sleep among metastatic CRC patients [40]. Genetic associations between the IL-6 gene with fatigue and sleep disturbance were found among breast cancer patients [41].…”

Section: Discussionmentioning

confidence: 91%

Identifying the subtypes of cancer-related fatigue: results from the population-based PROFILES registry

et al. 2017

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Purpose Little research has been done to identify possible cancer-related fatigue (CRF) subtypes and to classify cancer survivors accordingly. We aimed to identify CRF subtypes in a large population-based sample of (long term) stage I-III colorectal cancer survivors. We also identified factors associated with the CRF subtypes. Methods Respondents completed the Multidimensional Fatigue Inventory and other validated questionnaires on anxiety and reduced positive affect (anhedonia), sleep quality, and lifestyle factors (body mass index and physical activity). Latent class analysis was used to derive the CRF subtypes.Factors associated with the derived CRF subtypes were determined with multinomial logistic regression. Results Three CRF classes were identified: class 1 (no fatigue and distress, n = 644, 56%), class 2 (low fatigue, moderate distress, n = 256, 22%), and class 3 (high fatigue, moderate distress, n = 256, 22%). Multinomial logistic regression results show that survivors in class 3 were more likely to be female, were treated with radiotherapy, have comorbid diabetes mellitus, and be overweight/obese than survivors in class 1 (reference). Survivors in classes 2 and 3 were also more likely to have comorbid heart condition, report poorer sleep quality, experience anhedonia, and report more anxiety symptoms when compared with survivors in class 1. Conclusions Three distinct classes of CRF were identified which could be differentiated with sleep quality, anxiety, anhedonia, and lifestyle factors. Implications for cancer survivors The identification of CRF subtypes with distinct characteristics suggests that interventions should be targeted to the CRF subtype.

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“…Recent studies suggest the dysregulation of inflammatory cytokines cause and intensify CRF and its related symptoms. 11,12,[57][58][59] In our study, 63% of the patients perceived moderate to vast improvement of improvement in CRF with PG treatment.…”

Section: Discussionmentioning

confidence: 92%

High-Dose Asian Ginseng (Panax Ginseng) for Cancer-Related Fatigue

et al. 2015

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Introduction and Objective. Cancer-related fatigue (CRF) is the most common and severe symptom in patients with cancer. The number and efficacy of available treatments for CRF are limited. The objective of this preliminary study was to assess the safety of high-dose Panax ginseng (PG) for CRF. Methods. In this prospective, open-label study, 30 patients with CRF (≥4/10) received high-dose PG at 800 mg orally daily for 29 days. Frequency and type of side effects were determined by the National Cancer Institute’s Common Terminology Criteria for Adverse Events, version 4.0. Scores on the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) scale, Edmonton Symptom Assessment System (ESAS), and Hospital Anxiety and Depression Scale (HADS) were assessed at baseline, day 15, and day 29. Global Symptom Evaluation (GSE) was assessed at day 29. Results. Of the 30 patients enrolled, 24 (80%) were evaluable. The median age was 58 years; 50% were females, and 84% were white. No severe (≥grade 3) adverse events related to the study drug were reported. Of the 24 evaluable patients, 21 (87%) had an improved (by ≥3 points) FACIT-F score by day 15. The mean ESAS score (standard deviation) for well-being improved from 4.67 (2.04) to 3.50 (2.34) ( P = .01374), and mean score for appetite improved from 4.29 (2.79) to 2.96 (2.46) ( P = .0097). GSE score of PG for fatigue was ≥3 in 15/24 patients (63%) with median improvement of 5. Conclusion. PG is safe and improves CRF fatigue as well as overall quality of life, appetite, and sleep at night. Randomized controlled trials of PG for CRF are justified.

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Inflammation and Behavioral Symptoms After Breast Cancer Treatment: Do Fatigue, Depression, and Sleep Disturbance Share a Common Underlying Mechanism?

Cited by 425 publications

References 58 publications

The impact of breast cancer treatments on sleep quality 1 year after cancer diagnosis

The impact of breast cancer treatments on sleep quality 1 year after cancer diagnosis

Identifying the subtypes of cancer-related fatigue: results from the population-based PROFILES registry

High-Dose Asian Ginseng (Panax Ginseng) for Cancer-Related Fatigue

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