Abstract
Fatigue is a common and distressing symptom following cancer treatment. Research examining “off-treatment” fatigue has been weakened by limited assessments of fatigue and lack of suitable comparison groups. The extent of off-treatment fatigue following treatment for breast cancer (BC) was examined. Women with BC (n = 88; mean, 28 months posttreatment) and age-matched women (n = 88) with benign breast problems (BBP), completed a set of fatigue questionnaires at an Initial assessment and a 4-month Follow-up assessment. The BC group reported more fatigue, more weakness, and less vitality relative to the BBP group at both assessments. No relationship was found in the BC group between fatigue and extent of treatment or time since treatment completion. While the results document the existence of off-treatment fatigue following BC, elucidation of the psychobiological processes underlying this symptom and development of clinical management strategies remain as challenges for future research.
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Adams, F., Quesada, J. R., and Gutterman, J. U. (1984). Neuropsychiatric manifestations of human leukocyte interferon therapy in patients with cancer. JAMA 252: 938–941.
Aistars, J. (1987). Fatigue in the cancer patient: A conceptual approach to a clinical problem. Oncol. Nurs. Forum 14: 25–29
Andrykowski, M. A., Brady, M. J., and Hunt, J. W. (1993). Positive psychosocial adjustment in potential bone marrow transplant recipients: Cancer as a psychosocial transition. Psycho-Oncology 2: 261–276.
Andrykowski, M. A., Greiner, C. B., Altmaier, E. M., Burish, T. G., Antin, J. H., Gingrich, R., McGarigle , C., and Henslee-Downey, P. J. (1995). Quality of life following bone marrow transplantation: Findings from a multicentre study. Br. J. Cancer 71: 1322–1329.
Bartley, S. H. (1976). What do we call fatigue? In Simonson, E., and Weiner, P. C. (eds.), Psychological Aspects and Physiological Correlates of Work and Fatigue, Charles C Thomas, Springfield , IL, pp. 409–416.
Berglund, G., Bolund, C., Fornander, T., Rutquist, L. E., and Sjödén, P.-0. (1991). Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients. Eur. J. Cancer 27: 1075–1081.
Blesch, K., Paice, J. A., Wickham, R., Harte, N., Schnoor, D. K., Purl, S., Rehwait, M., Kopp, P., Manson, S., Coveny, S., Mchale, M., and Cahill, M. (1991). Correlates of fatigue in people with breast or lung cancer. Oncol. Nurs. Forum 18: 81–87.
Bloom, J. R., Gorsky, R. D., Fobair, P., Hoppe, R., Cox, R. S., Varghese, A., and Spiegel, D. (1990). Physical performance at work and at leisure: Validation of a measure of biological energy in survivors of Hodgkin's disease. J. Psychosoc. Oncol. 8: 49–63.
Bradburn, N. M., Rips, L. J., and Shevell, S. K. (1987). Answering autobiographical questions: The impact of memory and inference. Science 236: 157–161.
Bruera, E., Brenneis, C., Michaud, M., Rafter, J., Magnan, A., Tennant, A., Hanson, J., and Macdonald, R. N. (1989). Association between asthenia and nutritional status, lean body mass, anemia, psychological status, and tumor mass in patients with advanced breast cancer. J. Pain Symptom Manage. 4: 59–63.
Bush, N. E., Haberman, M., Donaldson, G., and Sullivan, K. M. (1995). Quality of life of 125 adults surviving 6–18 years after bone marrow transplantation. Soc. Sci. Med. 40: 479–490.
Buysse, D. J., Reynolds, C. F., III, Monk, T. H., Berman, S. R., and Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatr. Res. 28: 193–213.
Chalder, T., Berelowitz, G., Pawlikowska, T., Watts, L., Wessely, S., Wright, D., and Wallace, E. P. (1993). Development of a fatigue scale. J. Psychosom. Res. 37: 147–153.
Cimprich, B. (1992). Attentional fatigue following breast cancer surgery. Res. Nurs. Health 15: 199–207.
de Haes, J. C. J. M., van Knippenberg, F. C. E., and Neijt, J. P. (1990). Measuring psychological and physical distress in cancer patients: Structure and application of the Rotterdam Symptom Checklist. Br. J. Cancer 62: 1034–1038.
Demark-Wahnefried, W., Winer, E. P., and Rimer, B. K. (1993). Why women gain weight with adjuvant chemotherapy for breast cancer. J. Clin. Oncol. 11: 1418–1429.
Devlen, J., Maguire, P., Philips, P., Crowther, D., and Chambers, H. (1987). Psychological problems associated with diagnosis and treatment of lymphomas. 1. Retrospective; 2. Prospective. Br. Med. J. 295: 953–957.
Eardley, A. (1986). Patients and radiotherapy: 3. Patients' experiences after discharge. Radiography 52: 17–19.
Fobair, P., Hoppe, R. T., Bloom, J., Cox, R., Varghese, A., and Spiegel, D. (1986). Psychosocial problems among survivors of Hodgkin's disease. J. Clin. Oncol. 4: 805–814.
Glaus, A. (1993). Assessment of fatigue in cancer and non-cancer patients and in healthy individuals. Support. Care Cancer 1: 305–315.
Graydon, J. E., Bubela, N., Irvine , D., and Vincent, L. (1995). Fatigue-reducing strate gies used by patients receiving treatment for cancer. Cancer Nurs. 18: 23–28.
Greenberg, D. B., Sawicka, J., Eisenthal, S., and Ross, D. (1992). Fatigue syndrome due to localized radiation. J. Pain Symptom Manage. 7: 38–45.
Greenberg, D. B., Gray, J. L., Mannix, C. M., Eisenthal , S., and Carey, M. (1993). Treatment-related fatigue and serum interluekin-1 levels in patients during external beam irradiation for prostate cancer. J. Pain Symptom Manage. 8: 196–200.
Irvine, D. M., Vincent, L., Bubela, N., Thompson, L., and Graydon, J. (1991). A critical appraisal of the research literature investigating fatigue in the individual with cancer. Cancer Nurs. 14: 188–199.
Irvine, D., Vincent, L., Graydon, J. E., Bubela, N., and Thompson, L. (1994). The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy: A comparison with the fatigue experienced by healthy individuals. Cancer Nurs. 17: 367–378.
King, K. B., Nail, L. M., Kreamer, K., Strohl R. A., and Johnson, J. E. (1985). Patients' description of the experience of receiving radiation therapy. Oncol. Nurs. Forum 12: 55–61.
Knobf, M. T. (1986). Physical and psychologic distress associated with adjuvant chemotherapy in women with breast cancer. J. Clin. Oncol. 4: 678–684.
Kobashi-Schoot, J. A. M., Hanewald, G. J. F. P., van Dam, F. S. A. M., and Bruning, P. F. (1985). Assessment of malaise in cancer treated with radiotherapy. Cancer Nurs. 8: 306–314.
Larson, P., Lindsey, A., Dodd, M., Brecht, M., and Packer, A. (1993). Influence of age on problems expe rienced by patients with lung cancer undergoing radiation therapy. Oncol. Nurs. Forum 20: 473–480.
Love, R., Leventhal, H., Easterling, M. and Nerenz, D. (1989). Side effects and emotional distress during cancer chemotherapy. Cancer 63: 604–612.
Mahler, D. A., and Franco, M. J. (1996). Clinical applications of cardiopulmonary exercise testing. J. Cardiopul. Rehab. 16: 357–365.
Malone, M., Harris, A. L., and Luscombe, D. K. (1994). Assessment of the impact of cancer on work, recreation, home management and sleep using a general health status measure. J. Royal Soc. Med. 87: 386–389.
McCorkle, R., and Quint-Benoliel, J. (1983). Symptom distress, current concerns and mood disturbance after diagnosis of life-threatening disease. Soc. Sci. Med. 17: 431–438.
McCorkle, R., and Young, K. (1978). Development of a symptom distress scale. Cancer Nurs. 1: 373–378.
McNair, P. M., Lorr, M., and Droppelman, L. (1981). POMS Manual, 2nd ed., Educational and Industrial Testing Service, San Diego.
Nail, L. M. (1993). Coping with intra cavitary radiation treatment for gynecologic cancer. Cancer Pract. 1: 218–224.
Oberst, M. T., Hughes, S. H., Chang, A. S., and McCubbin, M. A. (1991). Self-care burden, stress appraisal, and mood among persons receiving radiotherapy. Cancer Nurs. 14: 71–78.
Patterson, S. M., Krantz, D. S., Montgomery, L. C., Deuster, P. A., Hedges, S. M., and Nebel, L. E. (1993). Automated physical activity monitoring: Validation and comparison with physiological and self-report measures. Psychophysiology 30: 296–305.
Piper, B. F. (1989). Fatigue: Current bases of practice. In Funk, G., Tornquist, E. M., Champagne, M. T., Copp, L. A., and Wiese, R. A. (eds.) , Key Aspects of Comfort: Management of Pain, Fatigue, and Nausea, Springer, New York, pp. 187–198.
Piper, B., Lindsey, A., and Dodd, M. (1987). Fatigue me chanisms in cancer patients: Developing nursing theory. Oncol. Nurs. Forum 14(6): 17–23.
Piper, B. F., Lindsey, A. M., Dodd, M. J., Ferketich, S., Paul, S. M., and Weller, S. (1989). The development of an instrument to measure the subjective dimension of fatigue. In Funk, S. G., Tornquist, E. M., Champagne , M. T., Copp, L. A., and Wiese, R. A. (eds.), Key aspects of comfort: Management of pain, fatigue, and nausea, Springer, New York, pps. 199–208.
Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Appl. Psychol. Measure. 1: 385–401.
Rhodes, V. A., Watson, P. M., and Hanson, B. M. (1988). Patients' descriptions of the influence of tiredness and weakness on self-care activities. Cancer Nurs. 11: 186–194.
Ryden, M. (1977). Energy: A crucial consideration in the nursing process. Nurs. Forum 16: 71–82.
Siegel, S. (1956). Nonparametric Statistics for the Behavioral Sciences, McGraw Hill, New York.
Silberfarb, P. M., Hauri, P. J., Oxman, T. E., and Schnurr, P. (1993). Assessment of sleep in patients with lung cancer and breast cancer. J. Clin. Oncol. 11: 997–1004.
Sisto, S. A., LaManca, J., Cordero, D. L., Bergen, M. T., Ellis, S. P., Drastal, S., Boda, W. L., Tapp, W. N., and Natelson, B.H. (1996). Metabolic and cardiovascular effects of a progressive exe rcise test in patients with chronic fatigue syndrome. Am. J. Med. 100: 634–640.
Smets, E. M. A., Garssen, B., Schuster-Vitterhoeve, A. L. J., and de Haes, J. C. J. M. (1994). Fatigue in cancer patients. Br. J. Cancer 68: 220–224.
Stone, A. A., and Shiffman, S. (1994). Ecological mome ntary assessme nt in behavioral medicine. Ann. Behav. Med. 16: 199–202.
Stone, A. A., Brode rick, J. E., Porte r, L. S., Krupp, L., Gnys, M., Paty, J. A., and Shiffman, S. (1994). Fatigue and mood in chronic fatigue syndrome patients: Results of a momentary assessment protocol examining fatigue and mood levels and diurnal patterns. Ann. Behav. Med. 16: 228–234.
St. Pierre, B. A., Kaspar, G. E., and Lindsay, A. M. (1992). Fatigue mechanisms in patients with cancer: Effects of tumor necrosis factor and exercise on skele tal muscle. Oncol. Nurs. Forum 19: 419–425.
Vercoulen, J. H. M. M., Swanink, C. M. A., Fennis, J. F. M., Galama, J. M. D., and van der Meer, J. W. M. (1994). Dimensional assessmen t of chronic fatigue syndrome. J. Psychosom. Res. 35: 383–392.
Voorripps, L. E., Ravelli, A. C., Dongelmans, P. C., Duerenberg, P., and Van Staveren, W. A. (1991). A physical activity questionnaire for the elderly. Med. Sci. Sports Exer. 23: 974–979.
Ware, J. E., Jr., and Sherbourne, C. D. (1992). The MOS 36-item Short Form Health Survey (SF-36). I. Conceptual framework and item selection. Med. Care 30: 473–483.
Whaley, M. H., Woodall, T., Kaminsky, L. A., and Emmett, J. D. (1997). Reliability of perce ive d e xe rtion during grade d exe rcise te sting in appare ntly healthy adults. J. Cardiopul. Rehab. 17: 37–42.
Winningham, M. L., Nail, L. M., Burke , M. B., Brophy, L., Cimprich, B., Jones, L. S., Pickard-Holley, S., Rhodes, V., St. Pierre, B., Beck, S., Glass, E. C., Mock, U. L., Mooney, K. H., and Piper, B. (1994). Fatigue and the cancer expe rience: The state of the knowledge. Oncol. Nurs. Forum 21: 23–36.
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Andrykowski, M.A., Curran, S.L. & Lightner, R. Off-Treatment Fatigue in Breast Cancer Survivors: A Controlled Comparison. J Behav Med 21, 1–18 (1998). https://doi.org/10.1023/A:1018700303959
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DOI: https://doi.org/10.1023/A:1018700303959