Sleep quality and fatigue after a stress management intervention for women with early-stage breast cancer in southern Florida

Abstract

Background: Sleep disruption and fatigue are ubiquitous among cancer patients and are sources of stress that may compromise treatment outcomes. Previously, we showed that a cognitive behavioral stress management (CBSM) intervention reduced anxiety and other stress-related processes in women undergoing primary treatment for breast cancer.

Purpose: This study examined secondary outcomes from a CBSM intervention trial for women with early-stage breast cancer to test if CBSM would improve sleep quality and fatigue among these patients at a single site in southern Florida. CBSM-related effects have already been demonstrated for indicators of psychosocial adaptation (e.g., general and cancer-related anxiety).

Methods: Patients were randomized to CBSM (n= 120) or a 1-day psychoeducation control group (n= 120). The Pittsburgh Sleep Quality Index (PSQI) and Fatigue Symptom Inventory were completed prior to randomization and 6 and 12 months after the baseline assignment.

Results: In latent growth analyses, women in CBSM reported greater improvements in PSQI sleep quality scores than controls, although there were no significant differences between conditions on PSQI total scores. Women in CBSM also reported greater reductions in fatigue-related daytime interference than controls, though there were no significant differences in changes in fatigue intensity. Changes in sleep quality were associated with changes in fatigue.

Conclusions: Future work may consider integrating sleep and fatigue content into stress management interventions for women with early-stage breast cancer.

Trial registration: ClinicalTrials.gov NCT01422551.

Conflict of interest statement

Conflict of Interest Statement: Dr. Antoni reports that he received royalties from books and related training materials that he has authored on cognitive behavioral stress management intervention in health psychology. All other authors reported no financial interests or potential conflicts of interest.

Figures

Figure 1. Experimental design and flow diagram of participants

Figure 2

Changes in sleep quality among post-surgical patients with early breast cancer randomly assigned to either a 10-week cognitive behavioral stress management (CBSM) intervention or a psycho-education (PE) control including means by time point and standard error bars (condition effect on slope z= -2.26, p<.03)

Figure 3

Changes in fatigue-related daytime interference among post-surgical patients with early breast cancer randomly assigned to either a 10-week CBSM intervention or a 1-day psycho-education control including means by time point and standard error bars (condition effect on slope z= -1.99, p<.05)