Early change in fatigue, insomnia, and cognitive impairment and symptom severity 3years post-treatment in breast cancer survivors.

Abstract

Breast cancer is the most common form of cancer among Canadian women. Survivorship challenges include fatigue, sleep disturbance, and cognitive impairment. This study examined (1) symptom trajectory from diagnosis to 3years; (2) whether symptom change in the first 4months was associated with prolonged difficulties after 3years; and (3) which factors were associated with deterioration in symptoms during the first 4months. This prospective observational cohort study examined 53 women (Mage = 58.6, 96.2% White, 67.9% stage I) with newly diagnosed breast cancer over 3years. Women completed assessments before starting treatment, 4months, and 3years after diagnosis. Three-way repeated-measures ANOVAs evaluated symptom trajectories. A repeated-measures mediation analysis was performed to determine if change from pre-treatment to 4 months accounted for change from pre-treatment to 3years. A series of between-subjects ANOVAs were used to determine what variables significantly differed by deterioration status. Perceived cognitive impairment and fatigue increased linearly from diagnosis to 3years. Change in fatigue in the first 4months fully accounted for its change over 3years. Insomnia severity and sleep quality deteriorated from diagnosis to 4months, but returned to pre-treatment levels at 3years. Those whose fatigue and cognitive ability deteriorated during the first 4months were younger. Efforts to identify those who are at risk of experiencing fatigue, sleep disturbance, and cognitive impairment; monitor patients early after receiving a diagnosis; and provide targeted interventions may prevent long-term deterioration and improve well-being.