Fatigue, Depression, and Insomnia: Evidence for a Symptom Cluster in Cancer

https://doi.org/10.1016/j.soncn.2007.01.004Get rights and content

Objectives

To review the evidence for considering fatigue, depression, and insomnia as a symptom cluster in cancer.

Data Sources

Empirical studies, clinical articles, and review articles.

Conclusion

The single- and multi-symptom measurement approaches are of limited usefulness in distinguishing fatigue, depression, and insomnia. Studies in which these symptoms have been measured concurrently in patients with cancer yield consistent evidence of high positive correlations. Results do not appear to be solely a function of overlap in measurement approaches.

Implications for Nursing Practice

Successful management of fatigue, depression, and insomnia in cancer patients are likely to combine pharmacologic and nonpharmacologic therapies.

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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    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.

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