Insomnia, mood and fatigue symptoms among newly diagnosed breast cancer patients

Sleep disturbance is a common symptom affecting women undergoing treatments for breast cancer. Often occurring around diagnosis, symptoms regularly persist beyond completion of active treatment, causing significant disruption and distress. Insomnia symptoms tend to exist within a symptom cluster affecting sleep, mood and fatigue. The aim of this study is to describe the natural history of insomnia in breast cancer patients; interplay between sleep and related symptoms; and potential critical periods where intervention may be most effectively implemented. Methods: This ongoing longitudinal study is measuring sleep and related symptoms among 250 newly diagnosed breast cancer patients. Participants provide a retrospective account of sleep quality using the Insomnia Severity Index (ISI); prior to diagnosis, and then monthly for the year following diagnosis. Using a modified version of the ISI (including frequency of symptoms and use of sleep medica- tion) allows participants to be classified as Good Sleepers; those with Insomnia Symptoms; and those with Insomnia Syndrome. The Hospital Anxiety and Depression Scale (HADS) and Fatigue Severity Scale (FSS) provide measures of mood and fatigue symptoms at 0, 3, 6, 9 and 12 month assessment points. Results: Currently, 110 females are participating in the study. This interim analysis reports data from 24 participants who have completed measures up to 3 months. Exploration of sleep data reveals a pre-diagnosis median ISI score of 3.5, increasing to 10.0 at month 0 (shortly after diagnosis). Scores remain in the range of subclinical sleep disturbance at months 1 (10.5) and 2 (9.0), peaking at month 3 (13.0), during active treatment. Pre-diagnosis, 61.5% of participants were ÔGood SleepersÕ, dropping to 26.9% by month 3. Conversely, only 7.7% of participants were experiencing Insomnia Syndrome pre-diagnosis, rising to 30.8% at month 3. Exploring mood and fatigue variables at month 3 reveals moderate positive associations between ISI and HADS scores (r = +0.43, P = 0.029) and ISI and FSS scores (r = +0.39, P = 0.056). Conclusion: These early findings provide information on the time course of disturbed sleep among breast cancer patients and associations between sleep, mood and fatigue symptoms during active cancer treatment. On completion, this study will provide important novel data on the natural history of sleep disturbance in this population, with implications for the implementation of evidence based treatments. This study is funded by Breast Cancer Campaign.