Predictors of fatigue 30 days after completing anthracycline plus taxane adjuvant chemotherapy for breast cancer.

PURPOSES/OBJECTIVES: To identify the predictors of fatigue 30 days after completing adjuvant chemotherapy for breast cancer and whether differences are observed between a behavioral sleep intervention and a healthy-eating attention control group in predicting fatigue. DESIGN: Descriptive, exploratory, secondary analysis of a randomized clinical trial. SETTING: Outpatient oncology patients in a midwestern U. S. city. SAMPLE: 96 women, ages 29-83 years, 72% married, 95% white, diagnosed with stage I-IIIA breast cancer, receiving adjuvant anthracycline and taxane chemotherapy. METHODS: Participants were randomized to a behavioral sleep intervention group or an attention control group. Participants completed data collection prior to and during the peak and rebound days of the initial chemotherapy treatment cycle and after the last treatment. MAIN RESEARCH VARIABLES: Fatigue, circadian rhythms of activity, objective and subjective sleep-wake, and objective and subjective activity-rest. FINDINGS: Predictors of fatigue were less total sleep time prior to treatment, higher fatigue prior to treatment and at the peak, and less energy upon awakening on rebound days. In the control group, predictors of higher fatigue were higher fatigue prior to treatment, higher body mass index, higher number of positive lymph nodes, and less daytime dysfunction. For the intervention group, lower peak activity at the peak of initial treatment differentially predicted fatigue. CONCLUSIONS: Results suggest the sleep intervention group participants who maintained activity balanced with sleep at the peak of the initial treatment benefited most from the intervention. IMPLICATIONS FOR NURSING: Nurses should screen for fatigue prior to initial chemotherapy treatment and at regular intervals, further assess for poor sleep in patients who report fatigue of 4 or higher (on a 0-10 scale), and use evidence-based guidelines to select appropriate interventions.

Methodological challenges when using actigraphy in research.

Actigraphy has become a valuable clinical and research tool to objectively evaluate sleep, daytime activity, and circadian activity rhythms in healthy individuals as well as persons with primary and comorbid insomnia. However, procedures used for sampling, data processing, and analysis are not consistently reported in the literature. The wide variability in how actigraphy is reported makes it difficult to compare findings across studies. The procedures and reporting methods from 21 studies that used actigraphs to assess sleep and wake in adult patients with cancer are reviewed to highlight the differences in reporting strategies. Patients with cancer were chosen to illustrate the methodological challenges related to procedures and reporting in one population. The aim of this article was to advance standards of information presented in publications to enable comparisons across research studies that use actigraphy. Specific methodological challenges when using actigraphy in research include instrumentation, selection of pertinent variables, sampling, and data processing and analysis. Procedural decisions are outlined and discussed, and suggestions are made for standardized actigraphy information to include in research reports. More consistent procedures and reporting will advance the science of sleep, daytime activity, and circadian activity rhythms and their association with other health-related variables.