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

Abstract

Purpose 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 three years; 2) whether symptom change in the first four months was associated with prolonged difficulties after three years; and 3) which factors were associated with deterioration in symptoms during the first four months. Methods This prospective observational cohort study examined 53 women (Mage = 58.6, 96.2% White, 67.9% Stage I) with newly diagnosed breast cancer over three years. Women completed assessments before starting treatment, four months, and three years 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 four months accounted for change from pre-treatment to three years. A series of between-subjects ANOVAs were used to determine what variables significantly differed by deterioration status. Results Perceived cognitive impairment and fatigue increased linearly from diagnosis to three years. Change in fatigue in the first four months fully accounted for its change over three years. Insomnia severity and sleep quality deteriorated from diagnosis to four months, but returned to pre-treatment levels at three years. Those whose fatigue and cognitive ability deteriorated during the first four months were younger. Conclusion 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.