Even before women with breast cancer undergo chemotherapy, they experience fatigue and disruptions in sleep and activity levels, according to a new study from the University of Nebraska Medical Center (UNMC) in Omaha, Nebraska.

Researchers say their findings suggest that health professionals should address fatigue following breast cancer surgery and before any further medical procedures begin. Between 70 to 95 percent of breast cancer patients experience fatigue while undergoing chemotherapy, researchers point out, which makes controlling fatigue after surgery even more important.

The report involved 130 women with early stage breast cancer (stage I, II, IIIA), which makes it the largest study to document the prevalence of fatigue associated with altered sleep and activity patterns before chemotherapy treatment. The study - published in the current issue of the Journal of Pain and Symptom Management - confirms what was reported in a previous smaller study funded by the National Institutes of Health.

“We found women are not going into chemotherapy in the best possible shape,” said Ann Berger, Ph.D., Niedfelt Professor of Nursing, UNMC College of Nursing, who has conducted several studies over the past 15 years related to fatigue in cancer patients. “It makes it that much more difficult to reduce the fatigue during treatment. If you start out with some fatigue, it will probably increase.”

Dr. Berger said this report means health professionals need to address potential fatigue and sleep issues earlier in the medical process. “If women are having sleep problems after surgery, we need to address this symptom before women begin chemotherapy. What we’ve learned might explain why we’re having problems reducing fatigue in breast cancer patients during chemotherapy.”

The published study comes from initial results of a five-year, $1.5 million grant Dr. Berger and her team received in 2003. The purpose of the study, which was funded by the National Institute of Nursing Research, a division of the National Institutes of Health, was to determine the best ways to reduce fatigue during chemotherapy and to prevent chronic fatigue after treatment.

Researchers measured sleep and activity patterns during the 48 hours prior to the first chemotherapy treatment using wristwatch-sized activity monitors called actigraphs.

Fatigue, the most prevalent and distressing symptom for breast cancer patients receiving chemotherapy, has long been accepted by health professionals and patients alike as a side effect of treatment. Researchers say there are ways to intervene, and now they have found it may be important to intervene during the recovery period after breast cancer surgery.

Researchers say disrupted sleep, low daytime activity and reduced activity are all likely to contribute to mild fatigue before chemotherapy - and moderate to severe fatigue after chemo. That means fatigue needs to be addressed before and after surgery. Women typically begin chemotherapy three to four weeks after surgery.

Dr. Berger said because inactivity contributes to fatigue, she and colleagues believe women need to rest for several days after surgery, but also regain activity when they’re able. “We’ve been telling patients for years to rest and take it easy, but in some cases, we’re finding the patients who remain inactive are the ones who report higher fatigue.”

Cancer-related fatigue can have a profound impact on an individual’s life with significant physical, emotional, social and economic consequences that may persist for months or years after completing treatment. Even after treatment ends, between 30 and 50 percent of patients say their fatigue remains at least six months. Sometimes they say it never goes away.

Fatigue related to cancer treatment is described as a distressing, persistent, sense of tiredness or exhaustion that is not proportional to activity. The factors associated with fatigue are the presence and severity of anxiety, pain, lower sleep quality, physical inactivity and poor performance status, leaving little desire to work or socialize.

Dr. Berger said the new findings provide an important benchmark to begin looking for interventions to reduce cancer-related fatigue.

The study was undertaken to further establish values for sleep, wake, activity, rest, circadian rhythms and fatigue and how they interrelate in women before and during the first year after chemotherapy.

Source: University of Nebraska