Abstract
BackgroundAlthough fatigue is a common and distressing symptom in cancer survivors, the mechanism of fatigue is not fully understood. Therefore, this study aims to investigate the relation between the fatigue and mindfulness of breast cancer survivors using anxiety, depression, pain, loneliness, and sleep disturbance as mediators.MethodsPath analysis was performed to examine direct and indirect associations between mindfulness and fatigue. Participants were breast cancer survivors who visited a breast surgery department at a university hospital in Japan for hormonal therapy or regular check-ups after treatment. The questionnaire measured cancer-related-fatigue, mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance. Demographic and clinical characteristics were collected from medical records.ResultsTwo-hundred and seventy-nine breast cancer survivors were registered, of which 259 answered the questionnaire. Ten respondents with incomplete questionnaire data were excluded, resulting in 249 participants for the analyses. Our final model fit the data well (goodness of fit index = .993; adjusted goodness of fit index = .966; comparative fit index = .999; root mean square error of approximation = .016). Mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance were related to fatigue, and mindfulness had the most influence on fatigue (β = − .52). Mindfulness affected fatigue not only directly but also indirectly through anxiety, depression, pain, loneliness, and sleep disturbance.ConclusionsThe study model helps to explain the process by which mindfulness affects fatigue. Our results suggest that mindfulness has both direct and indirect effects on the fatigue of breast cancer survivors and that mindfulness can be used to more effectively reduce their fatigue. It also suggests that health care professionals should be aware of factors such as anxiety, depression, pain, loneliness, and sleep disturbance in their care for fatigue of breast cancer survivors.Trial registrationThis study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN number. 000027720) on June 12, 2017.
Highlights
Fatigue is a common and distressing symptom in cancer survivors, the mechanism of fatigue is not fully understood
This study investigated the mediating effects and relevance of mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance in the context of the relation between mindfulness and the fatigue of breast cancer survivors
We found that increasing mindfulness relieves fatigue directly and indirectly by relieving or preventing anxiety, depression, and sleep disturbance, as well as by acting on pain and loneliness that is rooted in anxiety
Summary
Fatigue is a common and distressing symptom in cancer survivors, the mechanism of fatigue is not fully understood. Breast cancer is among the most common cancers that affect women. In cancer survivors (patients who have completed cancer treatment as well as all patients who have been diagnosed with cancer), fatigue is a common symptom, and it reduces quality of life (QOL) [3,4,5]. Fatigue affects cancer survivors during treatment, and affects 23–55% of survivors after treatment completion and can persist for months or even years [4, 6,7,8,9,10]. It is important to treat fatigue to improve cancer survivors’ QOL
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