Are there efficacious treatments for treating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients? A Rapid Evidence Assessment of the Literature (REAL©)

Abstract

PurposeWhile fatigue, sleep disturbance, and depression often co-occur in breast cancer patients, treatment efficacy for this symptom cluster is unknown. A systematic review was conducted to determine whether there are specific interventions (ie, medical, pharmacological, behavioral, psychological, and complementary medicine approaches) that are effective in mitigating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients, using the Rapid Evidence Assessment of the Literature (REAL©) process.MethodsPeer-reviewed literature was searched across multiple databases; from database inception – October 2011, using keywords pre-identified to capture randomized controlled trials (RCT) relevant to the research question. Methodological bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) 50 checklist. Confidence in the estimate of effect and assessment of safety were also evaluated across the categories of included interventions via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology.ResultsThe initial search yielded 531 citations, of which 41 met the inclusion criteria. Of these, twelve RCTs reported on all three symptoms, and eight of these were able to be included in the GRADE analysis. The remaining 29 RCTs reported on two symptoms. Studies were of mixed quality and many were underpowered. Overall, results suggest that there is: 1) promising evidence for the effectiveness of various treatment types in mitigating sleep disturbance in breast cancer patients; 2) mixed evidence for fatigue; 3) little evidence for treating depression; and 4) no clear evidence that treatment of one symptom results in effective treatment for other symptoms.ConclusionMore high-quality studies are needed to determine the impact of varied treatments in mitigating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients. Furthermore, we encourage future studies to examine the psychometric and clinical validity of the hypothesized relationship between the symptoms in the fatigue–sleep disturbance–depression symptom cluster.

Depressive symptoms and inflammation are independent risk factors of fatigue in breast cancer survivors

“…These findings indicate that depressive symptoms not only have a direct impact on fatigue, but also indirectly influence fatigue through sleep problems and perceived stress. This mediating effect helps explain the complex relationship among fatigue, depressive symptoms and sleep problems, which represents a frequently identified symptom cluster in various cancer populations (Illi et al 2012; Doong et al 2015; Jain et al 2015; Ho et al 2015). Moreover, the mediating effects suggest that interventions for fatigue may be more efficient when considering other symptoms such as stress and sleep problems in addition to depressive symptoms.…”

“…However, both depression and fatigue can be distinct symptoms in cancer populations, because they have different trajectories during cancer diagnosis, its treatment and survival phases (Visser & Smets, 1998; Torres et al 2013; Schmidt et al 2016). In addition, the fact that certain treatment strategies may only be effective for one of these two symptoms (Jain et al 2015; Schmidt et al 2016) further supports that they are distinct. For instance, the antidepressant, paroxetine, was shown to be effective for depressive symptoms but not fatigue in cancer patients (Morrow et al 2003).…”

Factors associated with sleep disturbances in women undergoing treatment for early-stage breast cancer

“…Additionally, the associations between sleep disturbance and other symptoms including pain, nausea, depression, anxiety, decreased physical function, and difficulty participating in social roles and activities, especially in the radiation group, suggest the need for investigation regarding how symptom burden may be treated in a holistic manner. While some research indicates that there is no clear evidence that treatment of one facet in the fatigue-depression-sleep disturbance symptom cluster is effective in mitigating other symptoms [ 36 ], other research suggests that therapy intended to relieve a single symptom, such as anxiety or depression, may be useful in relieving sleep disturbance [ 37 ]. However, recent clinical practice guidelines on the use of integrative relief for symptom burden in cancer using review of recent literature list yoga as the only integrative therapy recommended for sleep disturbance [ 38 ].…”

Factors Associated with Sleep Disturbances in Women Undergoing Treatment for Early-Stage Breast Cancer

“…These associations between sleep disturbance and other symptoms including pain, nausea, depression, anxiety, decreased physical function and di culty participating in social roles and activities, especially in the radiation group, suggest the need for investigation regarding how symptom burden may be treated in a holistic manner. While some research indicates that there is no clear evidence that treatment of one facet in the fatigue-depression-sleep disturbance symptom cluster is effective in mitigating other symptoms [30], other research suggests that therapy intended to relieve a single symptom, such as anxiety or depression, may be useful in relieving sleep disturbance [31]. However, recent clinical practice guidelines on the use of integrative relief for symptom burden in cancer using review of recent literature lists yoga as the only integrative therapy recommended for sleep disturbance [32].…”