Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy

Ran Young Kim; Hyojung Park

doi:10.7475/kjan.2015.27.2.188

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Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy

Ran Young Kim¹, Hyojung Park²

Korean Journal of Adult Nursing 2015;27(2):188-197.
Published online: April 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.2.188

¹Master's student, Graduate School, Ewha Womans University, Seoul

²Division of Nursing Science, Ewha Womans University, Seoul, Korea

Corresponding author: Park, Hyojung Division of Nursing Science, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea. Tel: +82-2-3277-2824, Fax: +82-2-3277-2850, E-mail: hyojungp@ewha.ac.kr

• Received: September 30, 2014 • Accepted: April 13, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
REFERENCES

Abstract

Purpose
The purpose of this studywas to examine fatigue, sleepdisturbances, andqualityof life (QOL) among patientswithbreast cancerreceivingradiotherapy.
Methods
Acrosssectional, descriptivedesignwas used. Data werecollected throughquestionnaires distributed to 201 breast cancerpatients ina hospital. Thedatawere analyzed using SPSS 21.0.
Results
The fatigue scores showed significant differences depending on exercise and duration since diagnosis. The sleep disturbance scores showed significant differences depending on duration since diagnosis. QOL scores showed significant differences depending on exercise, duration since diagnosis, andtreatment site. Fatigueandsleepdisturbances (r=.40, p<.001) showedstatisticallysignificant positivecorre-lations, whilefatigueandQOL(r=-.55, p<.001),andsleepdisturbancesandQOL(r=-.45, p<.001)showed statistically significant negative correlations. Themultipleregressionanalysis, whichwas usedto determinethevariables influencing on QOL after radiotherapy, resulted in a significant regression model (F=23.88, p<.001), which accounted for approximately 45% of the explanatory power. Fatigue (β=-.39, p<.001) and sleep disturbances (β =-.27, p<.001) were revealedtoadverselyaffect qualityof life.
Conclusion
Thenursinginterventionis necessary toreducefatigue and sleepdisturbanceand to promote exercisein order toenhanceQOLof patients withbreast neoplasm while receiving radiotherapy.
Key Words: Breast Neoplasms; Radiotherapy; Fatigue; Sleep; Quality of Life

Table 1.

Score for Fatigue, Sleep Disturbance and Quality of Life (N=201)

Variables	M±SD	Possible range	Min	Max
Fatigue	19.68±10.89	0~52	0	52
Sleep disturbance	7.55±4.24	0~21	1	21
Quality of life	92.16±20.95	0~148	21	142
Physical well-being	19.57±6.33	0~28	0	28
Social well-being	16.26±5.33	0~28	0	28
Emotional well-being	17.00±4.87	0~24	1	24
Functional well-being	16.14±6.22	0~28	0	28
Breast cancer subscale	23.17±6.90	0~40	2	37

Table 2.

The Differences of Fatigue, Sleep Disturbance, Quality of Life to General Characteristics (N=201)

Characteristics	Category	n (%)	Fatigue		Sleep disturbance		Quality of Life
Characteristics	Category	n (%)	M±SD	t or F (p) Scheffé	M±SD t	t or F (p) Scheffé	M±SD	t or F (p) Scheffé
Age (year)	40 ≤	45 (22.4)	19.49±10.34	1.14	7.49±4.52	0.29	95.76±19.12	1.40
	41~50	94 (46.8)	20.05±11.52	(.334)	7.67±4.32	(.832)	91.12±22.46	(.245)
	51~60	47 (23.4)	20.64±10.92		7.86±4.08		88.79±21.24
	61 ≥	15 (7.4)	14.87±7.53		6.60±3.66		98.53±12.55
Educational level	Middle school ≤ a	15 (7.4)	16.73±9.80	1.31	7.80±3.65	3.19	96.53±19.09	8.09
	High school^b	85 (42.3)	20.95±13.03	(.273)	8.38±4.77	(.043)	85.46±24.09	(.001) ＜
	c College ≥	101 (50.2)	19.04±8.85		6.82±3.73	b c ＞	97.16±16.52	b c ＜
Religion	No	57 (28.4)	16.70±7.92	-2.90	7.02±4.22	-1.12	92.82±20.66	0.28
Religion	Yes	144 (71.6)	20.85±11.69	(.004)	7.76±4.25	(.262)	91.90±21.13	(.779)
Marital status	Unmarried^a	17 (8.4)	21.00±11.08	2.84	9.18±4.41	2.63	102.00±15.24	3.83
	Married^b	166 (82.6)	18.95±10.45	(.061)	7.24±4.07	(.075)	92.19±20.83	(.023)
	Widowed/divorced^c	18 (9.0)	25.17±13.47		8.89±5.25		82.67±23.27	a c ＞
Job	No	41 (20.4)	18.27±10.02	-.93	7.07±4.20	-0.81	89.54±24.10	-0.90
Job	Yes	160 (79.6)	20.04±11.11	(.355)	7.68±4.26	(.419)	92.84±20.10	(.369)
Monthly income (10,000 won)	200 ＜	119 (59.2)	18.27±9.60	-2.13	7.39±3.78	-0.64	94.02±21.15	1.52
Monthly income (10,000 won)	200 ≥	82 (40.8)	21.72±12.31	(.035)	7.79±4.86	(.526)	89.48±20.49	(.131)
Weight	Decrease	46 (22.9)	20.37±10.47	.32	7.70±4.82	1.19	93.85±21.33	1.27
	Increase	64 (31.8)	20.14±11.05	(.723)	8.13±3.95	(.309)	88.72±20.86	(.282)
	No change	91 (45.3)	19.00±11.07		7.08±4.12		93.74±20.76
Drinking	No	190 (94.5)	19.58±11.03	-.50	7.45±4.23	-1.46	92.34±21.15	0.49
Drinking	Yes	11 (5.5)	21.27±8.53	(.618)	9.36±4.34	(.146)	89.18±17.70	(.628)
Exercise	No^a	63 (31.3)	23.03±12.94	5.29	8.19±4.49	1.92	81.73±21.25	12.91
	a week ≤ b	17 (8.5)	21.12±10.19	(.006)	8.53±4.98	(.149)	99.59±19.64	(.001) ＜
	twice a week ≥ c	121 (60.2)	17.73±9.35	a c ＞	7.08±3.97		96.55±19.04	a b, ＜ c
Emotional supporter	Spouse	87 (43.3)	19.08±10.87	0.25	6.97±3.70	1.81	92.53±19.10	0.44
	Family	85 (42.3)	20.01±10.98	(.781)	8.19±4.27	(.167)	90.84±22.41	(.644)
	Others	29 (14.4)	20.48±11.02		7.45±5.45		94.97±22.24

Table 3.

The Differences of Fatigue, Sleep Disturbance and Quality of Life to Clinical Characteristics (N=201)

Characteristics	Category	n (%)	Fatigue		Sleep disturbance		Quality of life
Characteristics	Category	n (%)	M±SD	t or F (p) Scheffé	M±SD	t or F (p) Scheffé	M±SD	t or F (p) Scheffé
Stage	0	16 (8.0)	22.19±12.72	2.06	8.75±3.57	1.39	92.94±20.05	1.09
	1	66 (32.8)	17.52±10.10	(.087)	6.76±3.78	(.241)	95.45±18.51	(.367)
	2	71 (35.3)	20.03±9.69		7.79±4.67		91.41±18.98
	3	40 (19.9)	19.98±11.57		7.58±4.27		89.93±27.21
	4	8 (4.0)	27.88±16.61		9.50±4.69		81.38±22.28
Treatment	OP+RT	73 (36.3)	19.49±10.10	-0.10	7.85±3.83	0.77	96.36±17.13	2.25
modality	OP+CT+RT	128 (63.7)	19.64±11.28	(.923)	7.37±4.48	(.445)	89.97±22.56	(.025)
Duration since	6 ＜ a	77 (38.3)	18.87±10.28	3.74	7.73±3.67	9.14	96.79±17.97	3.11
diagnosis	6~12^b	116 (57.7)	19.52±10.82	(.025)	7.03±3.40	(＜ .001)	89.29±21.80	(.047)
(month)	＞12^c	8 (4.0)	29.75±13.96	a, b ＜ c	13.38±2.77	a, b ＜ c	89.25±29.13
Menopause	Yes	63 (31.3)	18.84±10.92	-0.73	7.41±4.10	-0.31	89.81±19.87	-1.08
	No	138 (68.7)	20.06±10.90	(.464)	7.62±4.32	(.754)	93.24±21.41	(.283)
Fraction size	Hypofraction therapy	154 (76.6)	18.94±10.31	-1.76	7.32±4.13	-1.42	93.04±19.42	1.93
	Conventional therapy	47 (23.4)	22.11±12.45	(.081)	8.32±4.57	(.158)	86.36±24.69	(.058)
Treatment site	Breast	141 (70.1)	18.73±10.13	1.82	7.30±4.17	2.85	94.04±18.47	3.31
	Breast+SCL	53 (26.4)	22.00±12.84	(.166)	7.74±4.25	(.061)	86.15±25.86	(.039)
	Breast++SCL+IMN	7 (3.5)	21.14±7.84		11.14±4.60		100.00±20.08

OP=operation; CT=chemotherapy; RT=radiotherapy; SCL=subclavian lymphnode; IMN=internal mammary node.

Table 4.

Correlation among Fatigue, Sleep Disturbance and Quality of Life (N=201)

Variables	Fatigue	Sleep disturbance
Variables	r (p)	r (p)
Sleep disturbance	.40 (＜ .001)
Quality of life	-.55 (＜ .001)	-.45 (＜ .001)

Table 5.

Influencing Factors on the Quality of Life (N=201

Selected variables	B	SE	_β	t	p	VIF
(Constant)	123.76	6.55		18.89
Marital status (Ref.=married)	-12.34	4.07	-.22	-3.03	.003	1.96
Exercise (Ref.=no)	9.51	2.44	.21	3.90	.001 ＜	1.06
Fatigue	-0.74	0.11	-.39	-6.51	.001 ＜	1.27
Sleep disturbance	-1.32	0.29	-.27	-4.54	.001 ＜	1.25
	Adj. R²=.45, F=23.88, p .001, ＜ Durbin-Watson=2.02

SE=standard error; VIF=variance inflation factor.

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Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy

Korean J Adult Nurs. 2015;27(2):188-197. Published online April 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.2.188

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Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy

Korean J Adult Nurs. 2015;27(2):188-197. Published online April 30, 2015

DOI: https://doi.org/10.7475/kjan.2015.27.2.188

Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy

Table 1.

Score for Fatigue, Sleep Disturbance and Quality of Life (N=201)

Variables	M±SD	Possible range	Min	Max
Fatigue	19.68±10.89	0~52	0	52
Sleep disturbance	7.55±4.24	0~21	1	21
Quality of life	92.16±20.95	0~148	21	142
Physical well-being	19.57±6.33	0~28	0	28
Social well-being	16.26±5.33	0~28	0	28
Emotional well-being	17.00±4.87	0~24	1	24
Functional well-being	16.14±6.22	0~28	0	28
Breast cancer subscale	23.17±6.90	0~40	2	37

Table 2.

The Differences of Fatigue, Sleep Disturbance, Quality of Life to General Characteristics (N=201)

Characteristics	Category	n (%)	Fatigue		Sleep disturbance		Quality of Life
Characteristics	Category	n (%)	M±SD	t or F (p) Scheffé	M±SD t	t or F (p) Scheffé	M±SD	t or F (p) Scheffé
Age (year)	40 ≤	45 (22.4)	19.49±10.34	1.14	7.49±4.52	0.29	95.76±19.12	1.40
	41~50	94 (46.8)	20.05±11.52	(.334)	7.67±4.32	(.832)	91.12±22.46	(.245)
	51~60	47 (23.4)	20.64±10.92		7.86±4.08		88.79±21.24
	61 ≥	15 (7.4)	14.87±7.53		6.60±3.66		98.53±12.55
Educational level	Middle school ≤ a	15 (7.4)	16.73±9.80	1.31	7.80±3.65	3.19	96.53±19.09	8.09
	High school^b	85 (42.3)	20.95±13.03	(.273)	8.38±4.77	(.043)	85.46±24.09	(.001) ＜
	c College ≥	101 (50.2)	19.04±8.85		6.82±3.73	b c ＞	97.16±16.52	b c ＜
Religion	No	57 (28.4)	16.70±7.92	-2.90	7.02±4.22	-1.12	92.82±20.66	0.28
Religion	Yes	144 (71.6)	20.85±11.69	(.004)	7.76±4.25	(.262)	91.90±21.13	(.779)
Marital status	Unmarried^a	17 (8.4)	21.00±11.08	2.84	9.18±4.41	2.63	102.00±15.24	3.83
	Married^b	166 (82.6)	18.95±10.45	(.061)	7.24±4.07	(.075)	92.19±20.83	(.023)
	Widowed/divorced^c	18 (9.0)	25.17±13.47		8.89±5.25		82.67±23.27	a c ＞
Job	No	41 (20.4)	18.27±10.02	-.93	7.07±4.20	-0.81	89.54±24.10	-0.90
Job	Yes	160 (79.6)	20.04±11.11	(.355)	7.68±4.26	(.419)	92.84±20.10	(.369)
Monthly income (10,000 won)	200 ＜	119 (59.2)	18.27±9.60	-2.13	7.39±3.78	-0.64	94.02±21.15	1.52
Monthly income (10,000 won)	200 ≥	82 (40.8)	21.72±12.31	(.035)	7.79±4.86	(.526)	89.48±20.49	(.131)
Weight	Decrease	46 (22.9)	20.37±10.47	.32	7.70±4.82	1.19	93.85±21.33	1.27
	Increase	64 (31.8)	20.14±11.05	(.723)	8.13±3.95	(.309)	88.72±20.86	(.282)
	No change	91 (45.3)	19.00±11.07		7.08±4.12		93.74±20.76
Drinking	No	190 (94.5)	19.58±11.03	-.50	7.45±4.23	-1.46	92.34±21.15	0.49
Drinking	Yes	11 (5.5)	21.27±8.53	(.618)	9.36±4.34	(.146)	89.18±17.70	(.628)
Exercise	No^a	63 (31.3)	23.03±12.94	5.29	8.19±4.49	1.92	81.73±21.25	12.91
	a week ≤ b	17 (8.5)	21.12±10.19	(.006)	8.53±4.98	(.149)	99.59±19.64	(.001) ＜
	twice a week ≥ c	121 (60.2)	17.73±9.35	a c ＞	7.08±3.97		96.55±19.04	a b, ＜ c
Emotional supporter	Spouse	87 (43.3)	19.08±10.87	0.25	6.97±3.70	1.81	92.53±19.10	0.44
	Family	85 (42.3)	20.01±10.98	(.781)	8.19±4.27	(.167)	90.84±22.41	(.644)
	Others	29 (14.4)	20.48±11.02		7.45±5.45		94.97±22.24

Table 3.

The Differences of Fatigue, Sleep Disturbance and Quality of Life to Clinical Characteristics (N=201)

Characteristics	Category	n (%)	Fatigue		Sleep disturbance		Quality of life
Characteristics	Category	n (%)	M±SD	t or F (p) Scheffé	M±SD	t or F (p) Scheffé	M±SD	t or F (p) Scheffé
Stage	0	16 (8.0)	22.19±12.72	2.06	8.75±3.57	1.39	92.94±20.05	1.09
	1	66 (32.8)	17.52±10.10	(.087)	6.76±3.78	(.241)	95.45±18.51	(.367)
	2	71 (35.3)	20.03±9.69		7.79±4.67		91.41±18.98
	3	40 (19.9)	19.98±11.57		7.58±4.27		89.93±27.21
	4	8 (4.0)	27.88±16.61		9.50±4.69		81.38±22.28
Treatment	OP+RT	73 (36.3)	19.49±10.10	-0.10	7.85±3.83	0.77	96.36±17.13	2.25
modality	OP+CT+RT	128 (63.7)	19.64±11.28	(.923)	7.37±4.48	(.445)	89.97±22.56	(.025)
Duration since	6 ＜ a	77 (38.3)	18.87±10.28	3.74	7.73±3.67	9.14	96.79±17.97	3.11
diagnosis	6~12^b	116 (57.7)	19.52±10.82	(.025)	7.03±3.40	(＜ .001)	89.29±21.80	(.047)
(month)	＞12^c	8 (4.0)	29.75±13.96	a, b ＜ c	13.38±2.77	a, b ＜ c	89.25±29.13
Menopause	Yes	63 (31.3)	18.84±10.92	-0.73	7.41±4.10	-0.31	89.81±19.87	-1.08
	No	138 (68.7)	20.06±10.90	(.464)	7.62±4.32	(.754)	93.24±21.41	(.283)
Fraction size	Hypofraction therapy	154 (76.6)	18.94±10.31	-1.76	7.32±4.13	-1.42	93.04±19.42	1.93
	Conventional therapy	47 (23.4)	22.11±12.45	(.081)	8.32±4.57	(.158)	86.36±24.69	(.058)
Treatment site	Breast	141 (70.1)	18.73±10.13	1.82	7.30±4.17	2.85	94.04±18.47	3.31
	Breast+SCL	53 (26.4)	22.00±12.84	(.166)	7.74±4.25	(.061)	86.15±25.86	(.039)
	Breast++SCL+IMN	7 (3.5)	21.14±7.84		11.14±4.60		100.00±20.08

OP=operation; CT=chemotherapy; RT=radiotherapy; SCL=subclavian lymphnode; IMN=internal mammary node.

Table 4.

Correlation among Fatigue, Sleep Disturbance and Quality of Life (N=201)

Variables	Fatigue	Sleep disturbance
Variables	r (p)	r (p)
Sleep disturbance	.40 (＜ .001)
Quality of life	-.55 (＜ .001)	-.45 (＜ .001)

Table 5.

Influencing Factors on the Quality of Life (N=201

Selected variables	B	SE	_β	t	p	VIF
(Constant)	123.76	6.55		18.89
Marital status (Ref.=married)	-12.34	4.07	-.22	-3.03	.003	1.96
Exercise (Ref.=no)	9.51	2.44	.21	3.90	.001 ＜	1.06
Fatigue	-0.74	0.11	-.39	-6.51	.001 ＜	1.27
Sleep disturbance	-1.32	0.29	-.27	-4.54	.001 ＜	1.25
	Adj. R²=.45, F=23.88, p .001, ＜ Durbin-Watson=2.02

SE=standard error; VIF=variance inflation factor.

Table 1. Score for Fatigue, Sleep Disturbance and Quality of Life (N=201)

Table 2. The Differences of Fatigue, Sleep Disturbance, Quality of Life to General Characteristics (N=201)

Table 3. The Differences of Fatigue, Sleep Disturbance and Quality of Life to Clinical Characteristics (N=201)

OP=operation; CT=chemotherapy; RT=radiotherapy; SCL=subclavian lymphnode; IMN=internal mammary node.

Table 4. Correlation among Fatigue, Sleep Disturbance and Quality of Life (N=201)

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Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy

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