Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy.

PURPOSE/OBJECTIVES: To describe the patterns of fatigue and activity and rest and their relationship during adjuvant breast cancer chemotherapy.

DESIGN: Prospective, descriptive, repeated measures.

SETTING: Midwestern oncology clinics and subjects' homes.

SAMPLE: 72 women, ages 30-69, who were receiving chemotherapy after surgery for stage I or II breast cancer.

METHODS: The Piper Fatigue Scale was used to measure fatigue 48 hours after each treatment and at treatment cycle midpoints for three cycles. Wrist actigraphs were used to measure activity and rest cycles for 96 hours at each treatment and for 72 hours at each cycle midpoint.

MAIN RESEARCH VARIABLES: Fatigue, activity and rest cycles, chemotherapy protocols (doxorubicin- or non-doxorubicin-based protocols).

FINDINGS: Total and subscale fatigue scores were significantly different over time, with scores higher at treatments and lower at cycle midpoints. Activity levels were significantly different over time in a mirror-image pattern of fatigue. Fatigue was negatively correlated with activity levels at all times except the cycle 2 midpoint and positively correlated with awakenings at night only at the cycle 2 midpoint. Activity levels were significantly lower in women receiving doxorubicin-based protocols.

CONCLUSIONS: Roller-coaster patterns of fatigue and activity have not been previously reported in this patient population. Examination of the inverse relationship between fatigue and activity will assist nurses in the development and testing of interventions to modify fatigue.

IMPLICATIONS FOR NURSING PRACTICE: Women should be instructed to monitor the intensity of fatigue and encouraged to maintain activity levels balanced with efficient rest periods. Nurses can inform women that these patterns may be expected to be similar during the first three chemotherapy cycles.