Supportive Care in Cancer

, Volume 25, Issue 4, pp 1271–1278 | Cite as

Nausea and disturbed sleep as predictors of cancer-related fatigue in breast cancer patients: a multicenter NCORP study

  • Anita R. PeoplesEmail author
  • Joseph A. Roscoe
  • Robert C. Block
  • Charles E. Heckler
  • Julie L. Ryan
  • Karen M. Mustian
  • Michelle C. Janelsins
  • Luke J. Peppone
  • Dennis F. MooreJr
  • Charlotte Coles
  • Karen L. Hoelzer
  • Gary R. Morrow
  • Ann M. Dozier
Original Article



Cancer-related fatigue (CRF) is a prevalent and distressing side effect of cancer and its treatment that remains inadequately understood and poorly managed. A better understanding of the factors contributing to CRF could result in more effective strategies for the prevention and treatment of CRF. The objectives of this study were to examine the prevalence, severity, and potential predictors for the early onset of CRF after chemotherapy cycle 1 in breast cancer patients.


We report on a secondary data analysis of 548 female breast cancer patients from a phase III multi-center randomized controlled trial examining antiemetic efficacy. CRF was assessed by the Brief Fatigue Inventory at pre- and post-chemotherapy cycle 1 as well as by the four-day diary.


The prevalence of clinically relevant post-CRF was 75%. Linear regression showed that pre-treatment CRF, greater nausea, disturbed sleep, and younger age were significant risk factors for post-CRF (adjusted R2 = 0.39; P < 0.0001). Path modeling showed that nausea severity influenced post-CRF both directly and indirectly by influencing disturbed sleep. Similarly, pre-treatment CRF influenced post-CRF directly as well as indirectly through both nausea severity and disturbed sleep. Pearson correlations showed that changes in CRF over time were significantly correlated with concurrent changes in nausea severity (r = 0.41; P < 0.0001) and in disturbed sleep (r = 0.20; P < 0.0001).


This study showed a high prevalence (75%) of clinically relevant CRF in breast cancer patients following their initial chemotherapy, and that nausea severity, disturbed sleep, pre-treatment CRF, and age were significant predictors of symptom.


Breast cancer Cancer-related fatigue Nausea Disturbed sleep 



This study is supported by NCI grants U10 CA37420, R25 CA102618, and UG1 CA189961. Study medication was provided by MGI Pharma, Bloomington, MN.

Compliance of ethical standards

Conflict of interest

The authors declare that they have no conflict of interest. Dr. Roscoe has full control of the primary data and agrees to allow the journal to review the data if requested.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Anita R. Peoples
    • 1
    Email author
  • Joseph A. Roscoe
    • 1
  • Robert C. Block
    • 2
  • Charles E. Heckler
    • 1
  • Julie L. Ryan
    • 3
  • Karen M. Mustian
    • 1
  • Michelle C. Janelsins
    • 1
  • Luke J. Peppone
    • 1
  • Dennis F. MooreJr
    • 4
  • Charlotte Coles
    • 5
  • Karen L. Hoelzer
    • 6
  • Gary R. Morrow
    • 1
  • Ann M. Dozier
    • 2
  1. 1.Department of SurgeryUniversity of Rochester Medical CenterRochesterUSA
  2. 2.Department of Public Health SciencesUniversity of Rochester Medical CenterRochesterUSA
  3. 3.Department of DermatologyUniversity of Rochester Medical CenterRochesterUSA
  4. 4.Wichita NCORPWichitaUSA
  5. 5.Metro Minnesota Community Oncology Research ConsortiumSaint Louis ParkUSA
  6. 6.Heartland Cancer Research NCORPDecaturUSA

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