Fatigue, Depression, and Insomnia: Evidence for a Symptom Cluster in Cancer
Section snippets
What are the Similarities and Differences Among Fatigue, Depression, and Insomnia?
To understand the conceptual similarities and differences among fatigue, depression, and insomnia in cancer, it is necessary to consider how these symptoms have been operationally defined. Our approach focuses on the ways in which they have been assessed in cancer patients. Three distinct assessment approaches may be identified: the single-symptom approach, the multi-symptom approach, and the clinical syndrome approach.
The single-symptom approach refers to assessment methods that focus
To What Extent Do These Symptoms Occur, Alone and in Combination, Among Cancer Patients, and How Might They Be Distinguished?
Prevalence rates of fatigue, depression, and insomnia among cancer patients vary widely across studies. Factors accounting for this variability include the use of different assessment methods and whether studies distinguish between depression, for example, as a symptom and as a disorder. Similarly, differences may be attributable to cancer types, treatment modalities, stage of disease, and where patients are in the treatment process. Nevertheless, there is general agreement that fatigue is the
What are the Implications of This Symptom Cluster for Patient Assessment and Management?
The research findings provide considerable evidence that fatigue, depression, and insomnia cluster together in cancer. The next logical step is to consider the evidence for treatment of this symptom cluster. Considered individually, each symptom has generally accepted pharmacologic and non-pharmacologic management approaches in patients.
Conclusion
As noted previously, fatigue, depression, and insomnia can each be assessed using a single-symptom, a multi-symptom, or a clinical syndrome approach. A review of measurement approaches indicates that there is overlap among all three approaches, although research has been limited primarily to the use of either single- or multi-symptom approaches. Existing research also indicates that fatigue, depression, and insomnia commonly co-occur in cancer. However, there is evidence that this clustering is
Kristine A. Donovan, PhD: Member, Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center & Research Institute; Assistant Professor, College of Medicine, University of South Florida, Tampa, FL.
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2023, Seminars in Oncology NursingCitation Excerpt :Then fatigue-reducing effect derived from CBT is more likely to occur through a mutual dynamic process encompassing improvements in cognitions and sleep disturbance.93 In this sense, we have to acknowledge that CRF, depressive symptoms, and sleep disturbances are some of the most common symptom clusters among patients with cancer.94,95 Our analysis restricted to patients with breast cancer who received MBSR interventions showed similar significant results compared to mixed cancer populations.
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2021, Sleep Medicine ReviewsCitation Excerpt :Similarly, the frequency of comorbid insomnia and anxiety disorders in the general population has been found to be 32.5%, while that of insomnia and major depressive disorder and dysthymia is 17.3% [5]. The co-occurrence of sleep and psychiatric problems is also common in patients with medical conditions such as chronic pain, cancer, and diabetes [6,7]. The neurobiological mechanisms of insomnia, such as the dysregulation of circadian genes and of the serotonin and dopamine systems, are also relevant to psychiatric disorders, as they are suspected to play an important role in these disorders’ onset and maintenance [8].
Kristine A. Donovan, PhD: Member, Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center & Research Institute; Assistant Professor, College of Medicine, University of South Florida, Tampa, FL.
Paul B. Jacobsen, PhD: Program Leader, Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center & Research Institute; Professor, Department of Psychology, University of South Florida, Tampa, FL.