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Model 1: depression, fatigue, and sleep disturbances in the postmenopausal sample. Only statistically significant pathways are displayed in the model. **P # 0.01, ***P # 0.001. Refer to Table 3 for model statistics.
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Depression, fatigue, and sleep disturbances have been identified as a symptom cluster among breast cancer patients. However, few longitudinal studies have examined the temporal relations between these symptoms surrounding diagnosis and treatment.Objectives
The current study investigated the co-occurrence of and interrelations between non-somatic de...
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Context 1
... parameters between T 1 and T 3 ; therefore, these paths were dropped to create a more parsimonious model. The final model demon- strated excellent fit (c 2 (9, n ¼ 67) ¼ 7.69, P > 0.05, CFI ¼ 1.00, RMSEA ¼ 0.00, 90% CI 0.00e0.12, SRMR ¼ 0.02). Table 3 presents the statistically significant standard- ized path coefficients in the final model (Fig. 2 repre- sents the corresponding model). All within-time symptom correlations were significant, with the excep- tion of fatigue and sleep disturbances at T 3 . As ex- pected, continuity paths for all three symptoms emerged as significant. Contrary to hypotheses, we did not observe significant cross-symptom paths. The indirect effect from ...
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Background: Prospective inter-relationships among biomarkers were unexplored, which may provide mechanistic insights into diseases. We investigated the longitudinal associations of BMI change with trajectories of biomarkers related to cardiometabolic or breast cancer risk.
Methods: A longitudinal study was conducted among 400 healthy women between...
Citations
... 24 It is further suggested that cancer-related fatigue is a composite of interacting responses to stress related to diagnosis and treatment, with the relationship of sleep disorders, depression, anemia, and inflammation featuring centrally for those under treatment as well as into the survivorship phase. 25 CRF and a number of these factors and symptoms, including sleep disruption and emotional distress often cooccur as a symptom cluster, [26][27][28] with some of these associations potentially linked to the underlying inflammatory biomarker changes such as cortisol level 29 most associated with fatigue. 3,24,30 Exploring symptom clusters is an important gap in symptom research to shed light on the common biological mechanisms 31 and is gaining increased attention in the field of oncology in an attempt to improve the quality of life of patients diagnosed with cancer. ...
... 32 Hence, there is a need to pay attention to the co-occurrences of fatigue, sleep disorder and depression as a symptom cluster in the evaluation and treatment of cancer survivors experiencing CRF. 3,[26][27][28] In spite of fatigue being the most common symptom reported by patients, they were least likely to report getting wanted help for it, perhaps due to the complexity of treating this common condition. 5 Given the multifactorial nature of CRF which is still poorly understood, there is currently no "gold standard" treatment for CRF despite some approaches such as exercise, psychosocial interventions, and mindbody interventions being reported to yield beneficial effects in improving CRF. ...
Background
Cancer-related fatigue and its associated symptoms of sleep disorder and depression are prevalent in cancer survivors especially among breast, lung, and colorectal cancer survivors. While there is no gold standard for treating cancer-related fatigue currently, studies of mind-body exercises such as Qigong have reported promise in reducing symptoms. This study was designed to evaluate the feasibility and effect of Guolin Qigong on cancer-related fatigue and other symptoms in breast, lung and colorectal cancer survivors while exploring their perceptions and experiences of Guolin Qigong intervention.
Methods
This is an open-label randomized controlled trial with 60 participants divided into 2 study groups in a 1:1 ratio. The intervention group will receive 12 weeks of Guolin Qigong intervention with a 4-week follow-up while control will receive usual care under waitlist. The primary outcome will be feasibility measured based on recruitment and retention rates, class attendance, home practice adherence, nature, and quantum of missing data as well as safety. The secondary subjective outcomes of fatigue, sleep quality and depression will be measured at Week-1 (baseline), Week-6 (mid-intervention), Week-12 (post-intervention), and Week-16 (4 weeks post-intervention) while an objective 24-hour urine cortisol will be measured at Week-1 (baseline) and Week-12 (post-intervention). We will conduct a semi-structured interview individually with participants within 3 months after Week-16 (4 weeks post-intervention) to obtain a more comprehensive view of practice adherence.
Discussion
This is the first mixed-method study to investigate the feasibility and effect of Guolin Qigong on breast, lung, and colorectal cancer survivors to provide a comprehensive understanding of Guolin Qigong’s intervention impact and participants’ perspectives. The interdisciplinary collaboration between Western Medicine and Chinese Medicine expertise of this study ensures robust study design, enhanced participant care, rigorous data analysis, and meaningful interpretation of results. This innovative research contributes to the field of oncology and may guide future evidence-based mind-body interventions to improve cancer survivorship.
Trial registration
This study has been registered with ANZCTR (ACTRN12622000688785p), was approved by Medical Research Ethic Committee of University Malaya Medical Centre (MREC ID NO: 2022323-11092) and recognized by Western Sydney University Human Research Ethics Committee (RH15124).
... There has been interest by the healthcare science community in recent years in looking closely at how symptoms cluster together within and across clinical conditions as a way to understand the potential shared etiologies, possible preventive strategies, and treatment interventions that may be useful (Miaskowski et al., 2007;. This has been driven particularly strongly within oncology and nursing research, where so-called "symptom clustering" approaches have been used to understand the patient experience of their outcomes holistically when numerous co-occurring symptoms-such as pain, fatigue, insomnia, and depression-go undetected and unaddressed if the primary clinical focus is elsewhere, as in the case of cancer treatment (Dodd et al., 2001;Ho et al., 2015;Huang & Lin, 2009;Illi et al., 2012;Kim et al., 2005). The clinical challenges posed by complex, comorbid, and chronic conditions are familiar to clinical and health psychologists and neuropsychologists (Ashworth et al., 2015;Ford, 2018;Miles et al., 2021), although the concept of a "symptom cluster" as defined by these allied health research traditions (see Table 1) may be a novel framing (Barsevick, 2016;2007;Dodd et al., 2001;Harris et al., 2022;Miaskowski et al., 2017). ...
Objective
Symptom clustering research provides a unique opportunity for understanding complex medical conditions. The objective of this study was to apply a variable-centered analytic approach to understand how symptoms may cluster together, within and across domains of functioning in mild cognitive impairment (MCI) and dementia, to better understand these conditions and potential etiological, prevention, and intervention considerations.
Method
Cognitive, motor, sensory, emotional, and social measures from the NIH Toolbox were analyzed using exploratory factor analysis (EFA) from a dataset of 165 individuals with a research diagnosis of either amnestic MCI or dementia of the Alzheimer’s type.
Results
The six-factor EFA solution described here primarily replicated the intended structure of the NIH Toolbox with a few deviations, notably sensory and motor scores loading onto factors with measures of cognition, emotional, and social health. These findings suggest the presence of cross-domain symptom clusters in these populations. In particular, negative affect, stress, loneliness, and pain formed one unique symptom cluster that bridged the NIH Toolbox domains of physical, social, and emotional health. Olfaction and dexterity formed a second unique cluster with measures of executive functioning, working memory, episodic memory, and processing speed. A third novel cluster was detected for mobility, strength, and vision, which was considered to reflect a physical functioning factor. Somewhat unexpectedly, the hearing test included did not load strongly onto any factor.
Conclusion
This research presents a preliminary effort to detect symptom clusters in amnestic MCI and dementia using an existing dataset of outcome measures from the NIH Toolbox.
... These patterns are consistent with other studies, all of which have revealed that fatigue is a predictor of depression in patients with breast cancer. With fatigue symptoms patients were more likely to take a nap during the day resulting in insomnia at night (19,20) . ...
Background: Cluster symptoms are a common occurrence in breast cancer patients undergoing chemotherapy. The telephone is a well-recognized, convenient device for reaching out to patients for monitoring and managing their symptoms in an efficient, prompt, and appropriate manner. Objective: To investigate the efficacy of telephone-based intervention to achieve energy conservation among breast cancer patients with the aim of alleviating fatigue, pain, sleep disturbance, and depression. Materials and Methods: The present study was a two-armed, randomized control trial conducted in the university hospital between March and September 2019. Seventy-four breast cancer patients, receiving four courses of adjuvant chemotherapy, were randomly recruited and assigned into the experimental group and the control group. One face-to-face intervention interview for energy conservation was conducted, followed by 20-minutes telephone brief counselling and assessment sessions, scheduled on day 1, 2, 7, and 14. Results: The scores for symptoms of median fatigue and pain in the experimental group were shown to be significantly reduced at the end of the study as compared to those scores within the control group (p<0.05). Similarly, scores for median sleep time and depression were greater at the end of cycle 1 and highest in cycle 2 (p<0.05, 0.001, respectively). Physical activity levels were also higher in the experimental group than in the control group in every cycle, with a statistical significance (p<0.001). Conclusion: The present study intervention demonstrated an effectiveness for the reduction of cluster symptoms. Further studies would be needed in a larger population scale in the customary, randomized controlled trial manner. Keywords: Cancer; Energy conservation; Fatigue; Pain; Sleep; Telephone
... However, investigating the direct and indirect linkages of CRF with these co-occurring PNP symptoms has just gained a new interest in survivorship research with the long-term goal of using these proven relationships as interventional targets to reduce or eliminate the distressing impact of these symptoms on the lives of BCS. Prior longitudinal study observed that depression, fatigue, and sleep disturbance reported by BCS were highly correlated both within and between treatment time points, where baseline fatigue (time 1) predicted post-chemotherapy depression (time 2), and post-chemotherapy fatigue (time 2) predicted depression at follow-up (time 3) (Ho et al., 2015). Even while CRF has been found to be a significant risk factor for other behaviors, there is currently less research on how CRF and these co-occurring PNP symptoms interact and influence one another, particularly over time (Trudel-Fitzgerald et al., 2013a, 2013b. ...
... Second, we further investigated the potential connections between these important variables in a path model using path analysis. Based on several recent studies and our personal knowledge of CRF, three distinct models were investigated: 1) The first model was a simple mediation model using CRF as the mediator, based on a previous observation that bodily pain predicts CRF, and CRF predicts depression (Ho et al., 2015); ...
... were present for each of the suggested paths. Model 1 had the fewest relevant variables, just CRF, bodily pain, and depression, according to a previous report (Ho et al., 2015). The goodness of fit indices consistently demonstrated that this model provided a good fit to the data (CFI = 0.997, RMSEA = 0.041, 90% CI 0-0.15, ...
... The studies conducted on cancer patients have reported that the type of cancer, its treatment, and the duration of treatment adversely affect the coping strategies of patients with the disease and cause them to suffer from anxiety and depression disorders (Bag, 2014). Furthermore, depression in patients causes individuals to feel more tired and experience sleep disorders (Ho, 2015). Studies have indicated that nearly half of cancer patients experience sleep disturbances due to factors related to their current diseases, pain, treatment side effects, stress, anxiety, depression, and fatigue (Pazarcikci, 2017). ...
Background and Aim: Cancer is a health problem that ranks second among the causes of death in the world and has a high mortality and morbidity rate. The most preferred systemic treatment method in cancer is chemotherapy. Chemotherapy has many side effects, depending on the treatment regimen used. Fatigue is one of the most common symptoms that cause many cognitive and physiological conditions in cancer patients. Therefore, aim of this study is to examine how fatigue affects anxiety, depression, and sleep quality of patients undergoing chemotherapy. Method: The data of this descriptive-cross-sectional study were obtained from 72 cancer patients over the age of 18 who agreed to participate in the study in a research hospital in Izmir between May 2020 and October 2020. 'Patient Information Form', 'Hospital Anxiety and Depression Scale (HADS), 'FACIT Fatigue Scale', and 'Pittsburgh Sleep Quality Index (PSQI)' were used to collect data. Results: As a result of the analysis, a statistically significant and positive correlation was found with a correlation coefficient of 0.468 for PSQI and FACIT and Depression subscale. A statistically significant, positive and moderate correlation was found with a correlation coefficient of 0.342 calculated between PSQI and Depression subscale. A statistically significant difference was found with a correlation coefficient of 0.616 calculated between the FACIT scale and the HADS. In the scales applied to the patients, it was determined that there were statistically significant differences only between the chemotherapy type, disease stage, and age from the descriptive characteristics of the patients. Conclusion and Recommendations: A high level of fatigue affects adversely patients' anxiety, depression and sleep quality. Planning interventions to control the factors that cause fatigue in patients undergoing chemotherapy will prevent them from experiencing other negative symptoms.
... The studies conducted on cancer patients have reported that the type of cancer, its treatment, and the duration of treatment adversely affect the coping strategies of patients with the disease and cause them to suffer from anxiety and depression disorders (Bag, 2014). Furthermore, depression in patients causes individuals to feel more tired and experience sleep disorders (Ho, 2015). Studies have indicated that nearly half of cancer patients experience sleep disturbances due to factors related to their current diseases, pain, treatment side effects, stress, anxiety, depression, and fatigue (Pazarcikci, 2017). ...
Background and Aim: Cancer is a health problem that ranks second among the causes of death in the world and has a high mortality and morbidity rate. The most preferred systemic treatment method in cancer is chemotherapy. Chemotherapy has many side effects, depending on the treatment regimen used. Fatigue is one of the most common symptoms that cause many cognitive and physiological conditions in cancer patients. Therefore, aim of this study is to examine how fatigue affects anxiety, depression, and sleep quality of patients undergoing chemotherapy. Method: The data of this descriptive-cross-sectional study were obtained from 72 cancer patients over the age of 18 who agreed to participate in the study in a research hospital in Izmir between May 2020 and October 2020. 'Patient Information Form', 'Hospital Anxiety and Depression Scale (HADS), 'FACIT Fatigue Scale', and 'Pittsburgh Sleep Quality Index (PSQI)' were used to collect data. Results: As a result of the analysis, a statistically significant and positive correlation was found with a correlation coefficient of 0.468 for PSQI and FACIT and Depression subscale. A statistically significant, positive and moderate correlation was found with a correlation coefficient of 0.342 calculated between PSQI and Depression subscale. A statistically significant difference was found with a correlation coefficient of 0.616 calculated between the FACIT scale and the HADS. In the scales applied to the patients, it was determined that there were statistically significant differences only between the chemotherapy type, disease stage, and age from the descriptive characteristics of the patients. Conclusion and Recommendations: A high level of fatigue affects adversely patients' anxiety, depression and sleep quality. Planning interventions to control the factors that cause fatigue in patients undergoing chemotherapy will prevent them from experiencing other negative symptoms.
... Xu et al. [27] found that the lack of energy symptom can last until 1 year after chemotherapy; the sleep quality and fatigue have an impact on cognitive ability. Ho et al. [28] have shown that the symptom cluster of depression, fatigue, sleep disorder in breast cancer patients is stable, which is inconsistent with the classification of symptom cluster in this study, which may be related to different characteristics of the included population, different research tools, and analysis methods. Buck et al. [29] believed that lack of energy was positively correlated with caregivers' depression. ...
Purpose
The aim of this study was to identify symptom clusters in breast cancer patients undergoing adjuvant chemotherapy.
Methods
A prospective longitudinal study was conducted. And a sample of 620 breast cancer patients receiving adjuvant chemotherapy was recruited using convenience sampling from May 20, 2020, to March 31, 2021. Data were collected eight times: the first chemotherapy cycle (T1) to the eighth cycle of chemotherapy (T8). Exploratory factor analysis was used to explore the composition of symptom clusters.
Results
Symptoms with an incidence of less than 20% were deleted and the remaining symptoms were included in the factor analysis. Three common factors were extracted in T1, including gastrointestinal symptom cluster, emotional and psychological symptom cluster, and menopausal symptom cluster. Five common factors were extracted from T2 to T7, including gastrointestinal symptom cluster, emotional and psychological symptom cluster, neurological symptom cluster, menopausal symptom cluster, and self-image disorder symptom cluster. Four common factors were extracted at T8, including gastrointestinal symptom cluster, emotional and psychological symptom cluster, neurological symptom cluster, and menopausal symptom cluster.
Conclusion
Breast cancer patients undergoing adjuvant chemotherapy experience multiple symptoms and different symptom clusters in different chemotherapy cycles. It is a benefit for health care providers to better understand and care for breast cancer patients. It will also help such women to manage concurrent symptoms ahead to promote their quality of life.
... 36 In addition, there is evidence that depressive symptoms and the presence of inflammatory markers in breast cancer survivors are independent risk factors for CRF, while depression may act as a mediator between insomnia and fatigue. 37 Although longitudinal studies suggest fatigue as a better predictor of depression than vice versa, 38 as well as of other symptoms such as insomnia and pain, 39 the association between fatigue and depression still seems to be bidirectional, albeit with different predictive power. 34 Beside chemotherapy, also RT techniques/regimens might play a role as determining treatment factors for fatigue. ...
Fatigue is common in breast‐cancer survivors. Our study assessed fatigue longitudinally in breast cancer patients receiving adjuvant radiotherapy (RT) and aimed to identify risk factors associated with long‐term fatigue and underlying fatigue trajectories. Fatigue was measured in a prospective multicenter cohort (REQUITE) using the Multidimensional Fatigue Inventory (MFI‐20) and analyzed using mixed models. Multivariable logistic models identified factors associated with fatigue dimensions at 2 years post‐RT and latent class growth analysis identified individual fatigue trajectories. A total of 1443, 1302, 1203 and 1098 patients completed the MFI‐20 at baseline, end of RT, after 1 and 2 years. Overall, levels of fatigue significantly increased from baseline to end of RT for all fatigue dimensions (P < .05) and returned to baseline levels after 2 years. A quarter of patients were assigned to latent trajectory high (23.7%) and moderate (24.8%) fatigue classes, while 46.3% and 5.2% to the low and decreasing fatigue classes, respectively. Factors associated with multiple fatigue dimensions at 2 years include age, BMI, global health status, insomnia, pain, dyspnea and depression. Fatigue present at baseline was consistently associated with all five MFI‐20 fatigue dimensions (ORGeneralFatigue = 3.81, P < .001). From latent trajectory analysis, patients with a combination of factors such as pain, insomnia, depression, younger age and endocrine therapy had a particularly high risk of developing early and persistent high fatigue years after treatment. Our results confirmed the multidimensional nature of fatigue and will help clinicians identify breast cancer patients at higher risk of having persistent/late fatigue so that tailored interventions can be delivered.
... However, BC survivors often experienced a range of physical and emotional symptoms due to the lengthy cancer experience and adjuvant therapy-related side effects. Depression, fatigue, and sleep disturbance are three commonly reported symptoms and frequently coexist as a cluster among BC survivors, with an incidence of the fatigue-sleep disturbance-depression symptom cluster (FSDSC) being reported of up to 84% Ho et al., 2015). The high prevalence of the FSDSC across the cancer trajectory synergistically impacts the cancer survivors' physical and mental health well-being, deteriorating their QoL, increasing financial burden and utilization of healthcare resources, as well as impeding their adherence to treatment and follow-up (Bower, 2014;Fiorentino et al., 2011;He et al., 2022;Ho et al., 2015;So et al., 2021). ...
... Depression, fatigue, and sleep disturbance are three commonly reported symptoms and frequently coexist as a cluster among BC survivors, with an incidence of the fatigue-sleep disturbance-depression symptom cluster (FSDSC) being reported of up to 84% Ho et al., 2015). The high prevalence of the FSDSC across the cancer trajectory synergistically impacts the cancer survivors' physical and mental health well-being, deteriorating their QoL, increasing financial burden and utilization of healthcare resources, as well as impeding their adherence to treatment and follow-up (Bower, 2014;Fiorentino et al., 2011;He et al., 2022;Ho et al., 2015;So et al., 2021). ...
Objective:
To evaluate the feasibility of the somatic acupressure (SA) for managing the fatigue-sleep disturbance-depression symptom cluster (FSDSC) among breast cancer (BC) survivors and its preliminary effects.
Methods:
In this Phase II randomized controlled trial (RCT), 51 participants were randomised evenly into the true SA group, sham SA group, and usual care group. All the participants received usual care. The two SA groups performed additional true or sham self-acupressure daily for seven weeks. The primary outcomes related to the assessment of participants' recruitment and compliance with study questionnaires and interventions. Clinical outcomes assessed the preliminary effects of SA on fatigue, sleep disturbance, depression, and quality of life. Semi-structured interviews were undertaken to capture participants' experiences of participating in this study. The statistical effects of the intervention on the outcomes were modelled in repeated measures ANOVA and adjusted generalized estimating equations.
Results:
Forty-five participants completed the SA intervention. No adverse events were reported. Over 85% of the participants could sustain for 25 days or more and 15 min or more per session, but the adherence to the intervention requirement was yet to improve. The group by time effect of the FSDSC and depression were significant (p < 0.05). Qualitative findings showed that participants positively viewed SA as a beneficial strategy for symptom management.
Conclusions:
The SA intervention protocol and the trial procedures were feasible. The results demonstrated signs of improvements in targeted outcomes, and a full-scale RCT is warranted to validate the effects of SA on the FSDSC.
... By using the app, the patients may have been able to overcome the negative effects of anxiety, such as stress, fear, worry, and panic, caused by the disease and radiotherapy or chemotherapy. Some studies have shown that depression levels in breast cancer patients increase significantly with the duration of radiotherapy or chemotherapy, and, according to the data herein, the patients were able to suppress depression by using the app (Ho et al., 2015;Tsaras et al., 2018;He et al., 2019). However, in terms of the depression factor, the second test showed a higher dispersion than the first test, with some patients experiencing an increase or decrease in depression, but no significant increase overall, suggesting that the use of the app during the radiotherapy or chemotherapy period was able to suppress depression. ...
Purpose
Breast cancer is one of the most common malignant cancers in women, seriously endangering the physical and mental health of patients. In this study, we developed an app for breast cancer patients undergoing radiotherapy or chemotherapy with a focus on exercise interventions, supplemented by nutritional and psychological interventions, to verify the applicability of the app for these patients and its impact on their quality of life, sleep, and psychological state. We also investigated the patients’ experience and perceptions of the app.
Methods
A total of 17 participants, aged 42–58 years, were recruited for this study using a mixed-methods design, including quantitative group pre-and post-test scores and qualitative interview results. The participants used the app for 8–18 weeks depending on their radiotherapy or chemotherapy cycle. During the radiotherapy or chemotherapy period, the participants used the “Yun Dong Ru Kang” exercise rehabilitation app to perform aerobic exercises twice a week, as well as rehabilitation exercises appropriate to their radiotherapy or chemotherapy stage, and used the app on their own the rest of the time. The primary results included their scores on the PSSUQ overall assessment usability questionnaire, the users’ use of the app, and the results of the interviews; the secondary indicators were quality of life, sleep status, and anxiety and depression status.
Results
An overall score of 6.2 (out of 7 points) on the PSSUQ questionnaire indicates the high usability; the average use time per subject per week was 97.69 ± 11.82 min, which exceeds the minimum use time, but the average use time tended to decrease as the use time was postponed. Promoted articles on nutritional diets received the most hits. The results of the interviews were consistent with the questionnaire scores, with the majority of participants believing that the means of exercise should be enriched and the interface optimized, while the reduction in the length of use was related to the participants’ own state of learning about calisthenics. In the results of the Breast Cancer-Specific Scale FACT-B, there was a significant increase (p < 0.05) in the Emotional Status dimension score and a significant decrease (p < 0.05) on the Additional Concerns dimension score. In the results of the Pittsburgh Sleep Quality Inventory PSQI, there was a non-significant improvement in all items except for a significant increase (p < 0.05) for the Hypnotic Medication item. In the Hospital Anxiety and Depression Scale (HADS), there was no significant improvement in any of the anxiety and depression factors.
Conclusions
The “Yun Dong Ru Kang “app has certain applicability, and the use of the exercise rehabilitation app may effectively reduce the negative impact of chemotherapy side effects on the quality of life, sleep and depression of breast cancer patients in the chemotherapy or radiotherapy phase. Before it is put into use in the future, the app should be enriched with exercise tools, the interface should be optimized, and articles on nutrition and diet should be promoted.
