Fatigue in Breast Cancer: A Behavioral Sleep Intervention
Fjalë kyçe
Abstrakt
Përshkrim
Higher fatigue levels are found in women with stage I, II or IIIA breast cancer receiving adjuvant chemotherapy (CT) who adopt patterns of daytime inactivity and nighttime restlessness and have more symptom and psychological distress. Interventions that improve sleep quality and reduce daytime fatigue in persons with insomnia may also benefit women receiving adjuvant CT. Using selected factors from Piper's Integrated Fatigue Model (IFM), a randomized, controlled clinical trial will compare women with breast cancer who receive a four component behavioral sleep intervention to women in the attentional control group during and after adjuvant CT. The intervention is designed to reduce fatigue in these women by promoting daytime activity, improving sleep quality and decreasing symptom and psychological distress. The aims of this study are to: 1) Compare the immediate (sleep/wake, activity/exercise, symptoms, psychological distress) and consequent (fatigue) outcomes of women who receive a four component behavioral sleep intervention (sleep hygiene counseling, relaxation therapy, sleep restriction and stimulus control) (n=110) with the outcomes in the healthy eating group (n=110) in women with stage I, II or IIIA breast cancer during 4 or 8 cycles of adjuvant chemotherapy, at 30, 60 and 90 days after their last treatment, and 1 year after their first treatment; 2) Determine the extent to which factors selected from the IFM influence fatigue intensity levels a) in the total sample at baseline and b) differentially influence fatigue intensity levels between groups 30 days after the last chemotherapy treatment and 1 year after the first treatment and 3) Evaluate the adherence to the refined behavioral sleep intervention and preferences for sleep hygiene and relaxation therapy techniques in the experimental group over time. Women will be randomized on the basis of good or poor sleeping history and intent to treat (4 versus 8 cycles of CT) to the intervention or attentional control group. Using the co-scientist model, the sleep intervention group will follow an Individual Sleep Promotion Plan negotiated with the investigator with regularly scheduled reinforcements and revisions. The healthy eating group will receive equal time and attention regarding general topics and nutrition. Established instruments include the Piper Fatigue Scale, Hospital Anxiety and Depression Scale, SF-36 Health Survey, Symptom Experience Scale, Daily Diary and Pittsburgh Sleep Quality Index. Objective measures include wrist actigraph, hemoglobin/ hematocrit, white blood count, T4 & TSH, and body mass index and a C - reactive protein at 1 year. Statistical analyses include RM-ANOVA, generalized estimation equation methodology and multiple regression analysis. Results may inform development of clinical guidelines for fatigue management during adjuvant CT.
Datat
| Verifikuar së fundmi: | 11/30/2007 |
| Paraqitur së pari: | 12/10/2007 |
| Regjistrimi i vlerësuar u dorëzua: | 12/11/2007 |
| Postuar së pari: | 12/12/2007 |
| Përditësimi i fundit i paraqitur: | 12/11/2007 |
| Përditësimi i fundit i postuar: | 12/12/2007 |
| Data e fillimit të studimit aktual: | 03/31/2003 |
| Data e vlerësimit të përfundimit të studimit: | 05/31/2006 |
Gjendja ose sëmundja
Ndërhyrja / trajtimi
Behavioral: 1
Behavioral: 2
Faza
Grupet e krahëve
| Krah | Ndërhyrja / trajtimi |
|---|---|
| Experimental: 1 Four component behavioral sleep intervention comprised of activity-rest, sleep-wake, phychological distress and symptom management. Four components of the Individual Sleep Promotion Plan are: stimulus control, sleep restruction, relaxation, and sleep hygiene. | Behavioral: 1 Four components, including activity-rest, sleep-wake, psychological distress, and symptom management. Sleep-wake component has four strategies: stimulus control, sleep restriction, relaxation, and sleep hygiene |
| Placebo Comparator: 2 Equal time and attention, information about healthy eating and general conversation | Behavioral: 2 Equal time and attention and information about healthy eating |
Kriteret e pranimit
| Moshat e pranueshme për studim | 19 Years Për të 19 Years |
| Gjinitë e pranueshme për studim | All |
| Pranon Vullnetarë të Shëndetshëm | po |
| Kriteret | Inclusion Criteria: - Ages 19 and older - Diagnosed for the first time with stage I-IIIA breast cancer - Post-operative for breast cancer - Scheduled to receive anthracycline-based adjuvant chemotherapy with our without taxane chemotherapy - English speaking - Karnofsky performance Scale score equal to or greater than 60 Exclusion Criteria: - Comorbid diagnosis of chronic insomnia - Sleep apnea or chronic fatigue syndrome - Unstable congestive heart failure - Chronic obstructive pulmonary disease - Insulin-depenent diabetes - Neruomuscular disease - Abnormal thryoid function - Depression, or - Treatment with steriods - Erratic sleep schedule due to working rotating shifts |
Rezultati
Masat Kryesore të Rezultateve
1. fatigue as measured by Piper Fatigue Scale [1 year]
Masat dytësore të rezultateve
1. activity-rest as measured by SF-36v2 and actigraphy [1 year]
2. sleep-wake as measured by Pittsburgh Sleep Quality Index and actigraphy [1 year]
3. pyschological mood as measured by Hospital Anxiety and Depression Scale [1 year]
4. symptom experience as measured by Symptom Experience Scale [1 year]
