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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy

Ran Young Kim1, Hyojung Park2
Korean Journal of Adult Nursing 2015;27(2):188-197.
Published online: April 30, 2015

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Corresponding author: Park, Hyojung Division of Nursing Science, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea. Tel: +82-2-3277-2824, Fax: +82-2-3277-2850, E-mail: hyojungp@ewha.ac.kr
• Received: September 30, 2014   • Accepted: April 13, 2015

Copyright © 2015 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this studywas to examine fatigue, sleepdisturbances, andqualityof life (QOL) among patientswithbreast cancerreceivingradiotherapy.
  • Methods
    Acrosssectional, descriptivedesignwas used. Data werecollected throughquestionnaires distributed to 201 breast cancerpatients ina hospital. Thedatawere analyzed using SPSS 21.0.
  • Results
    The fatigue scores showed significant differences depending on exercise and duration since diagnosis. The sleep disturbance scores showed significant differences depending on duration since diagnosis. QOL scores showed significant differences depending on exercise, duration since diagnosis, andtreatment site. Fatigueandsleepdisturbances (r=.40, p<.001) showedstatisticallysignificant positivecorre-lations, whilefatigueandQOL(r=-.55, p<.001),andsleepdisturbancesandQOL(r=-.45, p<.001)showed statistically significant negative correlations. Themultipleregressionanalysis, whichwas usedto determinethevariables influencing on QOL after radiotherapy, resulted in a significant regression model (F=23.88, p<.001), which accounted for approximately 45% of the explanatory power. Fatigue (β=-.39, p<.001) and sleep disturbances (β =-.27, p<.001) were revealedtoadverselyaffect qualityof life.
  • Conclusion
    Thenursinginterventionis necessary toreducefatigue and sleepdisturbanceand to promote exercisein order toenhanceQOLof patients withbreast neoplasm while receiving radiotherapy.
  • Key Words: Breast Neoplasms; Radiotherapy; Fatigue; Sleep; Quality of Life
Table 1.
Score for Fatigue, Sleep Disturbance and Quality of Life (N=201)
Variables M±SD Possible range Min Max
Fatigue 19.68±10.89 0~52 0 52
Sleep disturbance 7.55±4.24 0~21 1 21
Quality of life 92.16±20.95 0~148 21 142
  Physical well-being 19.57±6.33 0~28 0 28
  Social well-being 16.26±5.33 0~28 0 28
  Emotional well-being 17.00±4.87 0~24 1 24
  Functional well-being 16.14±6.22 0~28 0 28
  Breast cancer subscale 23.17±6.90 0~40 2 37
Table 2.
The Differences of Fatigue, Sleep Disturbance, Quality of Life to General Characteristics (N=201)
Characteristics Category n (%) Fatigue Sleep disturbance Quality of Life
M±SD t or F (p) Scheffé M±SD t t or F (p) Scheffé M±SD t or F (p) Scheffé
Age (year) 40 ≤ 45 (22.4) 19.49±10.34 1.14 7.49±4.52 0.29 95.76±19.12 1.40
41~50 94 (46.8) 20.05±11.52 (.334) 7.67±4.32 (.832) 91.12±22.46 (.245)
51~60 47 (23.4) 20.64±10.92   7.86±4.08   88.79±21.24  
61 ≥ 15 (7.4) 14.87±7.53   6.60±3.66   98.53±12.55  
Educational level Middle school ≤ a 15 (7.4) 16.73±9.80 1.31 7.80±3.65 3.19 96.53±19.09 8.09
High schoolb 85 (42.3) 20.95±13.03 (.273) 8.38±4.77 (.043) 85.46±24.09 (.001) ＜
c College ≥ 101 (50.2) 19.04±8.85   6.82±3.73 b c ＞ 97.16±16.52 b c ＜
Religion No 57 (28.4) 16.70±7.92 -2.90 7.02±4.22 -1.12 92.82±20.66 0.28
Yes 144 (71.6) 20.85±11.69 (.004) 7.76±4.25 (.262) 91.90±21.13 (.779)
Marital status Unmarrieda 17 (8.4) 21.00±11.08 2.84 9.18±4.41 2.63 102.00±15.24 3.83
Marriedb 166 (82.6) 18.95±10.45 (.061) 7.24±4.07 (.075) 92.19±20.83 (.023)
Widowed/divorcedc 18 (9.0) 25.17±13.47   8.89±5.25   82.67±23.27 a c ＞
Job No 41 (20.4) 18.27±10.02 -.93 7.07±4.20 -0.81 89.54±24.10 -0.90
Yes 160 (79.6) 20.04±11.11 (.355) 7.68±4.26 (.419) 92.84±20.10 (.369)
Monthly income (10,000 won) 200 ＜ 119 (59.2) 18.27±9.60 -2.13 7.39±3.78 -0.64 94.02±21.15 1.52
200 ≥ 82 (40.8) 21.72±12.31 (.035) 7.79±4.86 (.526) 89.48±20.49 (.131)
Weight Decrease 46 (22.9) 20.37±10.47 .32 7.70±4.82 1.19 93.85±21.33 1.27
Increase 64 (31.8) 20.14±11.05 (.723) 8.13±3.95 (.309) 88.72±20.86 (.282)
No change 91 (45.3) 19.00±11.07   7.08±4.12   93.74±20.76  
Drinking No 190 (94.5) 19.58±11.03 -.50 7.45±4.23 -1.46 92.34±21.15 0.49
Yes 11 (5.5) 21.27±8.53 (.618) 9.36±4.34 (.146) 89.18±17.70 (.628)
Exercise Noa 63 (31.3) 23.03±12.94 5.29 8.19±4.49 1.92 81.73±21.25 12.91
a week ≤ b 17 (8.5) 21.12±10.19 (.006) 8.53±4.98 (.149) 99.59±19.64 (.001) ＜
twice a week ≥ c 121 (60.2) 17.73±9.35 a c ＞ 7.08±3.97   96.55±19.04 a b, ＜ c
Emotional supporter Spouse 87 (43.3) 19.08±10.87 0.25 6.97±3.70 1.81 92.53±19.10 0.44
Family 85 (42.3) 20.01±10.98 (.781) 8.19±4.27 (.167) 90.84±22.41 (.644)
Others 29 (14.4) 20.48±11.02   7.45±5.45   94.97±22.24  
Table 3.
The Differences of Fatigue, Sleep Disturbance and Quality of Life to Clinical Characteristics (N=201)
Characteristics Category n (%) Fatigue Sleep disturbance Quality of life
M±SD t or F (p) Scheffé M±SD t or F (p) Scheffé M±SD t or F (p) Scheffé
Stage 0 16 (8.0) 22.19±12.72 2.06 8.75±3.57 1.39 92.94±20.05 1.09
  1 66 (32.8) 17.52±10.10 (.087) 6.76±3.78 (.241) 95.45±18.51 (.367)
  2 71 (35.3) 20.03±9.69   7.79±4.67   91.41±18.98  
  3 40 (19.9) 19.98±11.57   7.58±4.27   89.93±27.21  
  4 8 (4.0) 27.88±16.61   9.50±4.69   81.38±22.28  
Treatment OP+RT 73 (36.3) 19.49±10.10 -0.10 7.85±3.83 0.77 96.36±17.13 2.25
modality OP+CT+RT 128 (63.7) 19.64±11.28 (.923) 7.37±4.48 (.445) 89.97±22.56 (.025)
Duration since 6 ＜ a 77 (38.3) 18.87±10.28 3.74 7.73±3.67 9.14 96.79±17.97 3.11
diagnosis 6~12b 116 (57.7) 19.52±10.82 (.025) 7.03±3.40 (＜ .001) 89.29±21.80 (.047)
(month) ＞12c 8 (4.0) 29.75±13.96 a, b ＜ c 13.38±2.77 a, b ＜ c 89.25±29.13  
Menopause Yes 63 (31.3) 18.84±10.92 -0.73 7.41±4.10 -0.31 89.81±19.87 -1.08
  No 138 (68.7) 20.06±10.90 (.464) 7.62±4.32 (.754) 93.24±21.41 (.283)
Fraction size Hypofraction therapy 154 (76.6) 18.94±10.31 -1.76 7.32±4.13 -1.42 93.04±19.42 1.93
  Conventional therapy 47 (23.4) 22.11±12.45 (.081) 8.32±4.57 (.158) 86.36±24.69 (.058)
Treatment site Breast 141 (70.1) 18.73±10.13 1.82 7.30±4.17 2.85 94.04±18.47 3.31
  Breast+SCL 53 (26.4) 22.00±12.84 (.166) 7.74±4.25 (.061) 86.15±25.86 (.039)
  Breast++SCL+IMN 7 (3.5) 21.14±7.84   11.14±4.60   100.00±20.08  

OP=operation; CT=chemotherapy; RT=radiotherapy; SCL=subclavian lymphnode; IMN=internal mammary node.

Table 4.
Correlation among Fatigue, Sleep Disturbance and Quality of Life (N=201)
Variables Fatigue Sleep disturbance
r (p) r (p)
Sleep disturbance .40 (＜ .001)  
Quality of life -.55 (＜ .001) -.45 (＜ .001)
Table 5.
Influencing Factors on the Quality of Life (N=201
Selected variables B SE β t p VIF
(Constant) 123.76 6.55 　 18.89    
Marital status (Ref.=married) -12.34 4.07 -.22 -3.03 .003 1.96
Exercise (Ref.=no) 9.51 2.44 .21 3.90 .001 ＜ 1.06
Fatigue -0.74 0.11 -.39 -6.51 .001 ＜ 1.27
Sleep disturbance -1.32 0.29 -.27 -4.54 .001 ＜ 1.25
  Adj. R2=.45, F=23.88, p .001, ＜ Durbin-Watson=2.02

SE=standard error; VIF=variance inflation factor.

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    Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy
    Korean J Adult Nurs. 2015;27(2):188-197.   Published online April 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.2.188
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    Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy
    Korean J Adult Nurs. 2015;27(2):188-197.   Published online April 30, 2015
    DOI: https://doi.org/10.7475/kjan.2015.27.2.188
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    Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy
    Fatigue, Sleep Disturbance, and Quality of Life among Breast Cancer Patients Receiving Radiotherapy

    Score for Fatigue, Sleep Disturbance and Quality of Life (N=201)

    Variables M±SD Possible range Min Max
    Fatigue 19.68±10.89 0~52 0 52
    Sleep disturbance 7.55±4.24 0~21 1 21
    Quality of life 92.16±20.95 0~148 21 142
      Physical well-being 19.57±6.33 0~28 0 28
      Social well-being 16.26±5.33 0~28 0 28
      Emotional well-being 17.00±4.87 0~24 1 24
      Functional well-being 16.14±6.22 0~28 0 28
      Breast cancer subscale 23.17±6.90 0~40 2 37

    The Differences of Fatigue, Sleep Disturbance, Quality of Life to General Characteristics (N=201)

    Characteristics Category n (%) Fatigue Sleep disturbance Quality of Life
    M±SD t or F (p) Scheffé M±SD t t or F (p) Scheffé M±SD t or F (p) Scheffé
    Age (year) 40 ≤ 45 (22.4) 19.49±10.34 1.14 7.49±4.52 0.29 95.76±19.12 1.40
    41~50 94 (46.8) 20.05±11.52 (.334) 7.67±4.32 (.832) 91.12±22.46 (.245)
    51~60 47 (23.4) 20.64±10.92   7.86±4.08   88.79±21.24  
    61 ≥ 15 (7.4) 14.87±7.53   6.60±3.66   98.53±12.55  
    Educational level Middle school ≤ a 15 (7.4) 16.73±9.80 1.31 7.80±3.65 3.19 96.53±19.09 8.09
    High schoolb 85 (42.3) 20.95±13.03 (.273) 8.38±4.77 (.043) 85.46±24.09 (.001) ＜
    c College ≥ 101 (50.2) 19.04±8.85   6.82±3.73 b c ＞ 97.16±16.52 b c ＜
    Religion No 57 (28.4) 16.70±7.92 -2.90 7.02±4.22 -1.12 92.82±20.66 0.28
    Yes 144 (71.6) 20.85±11.69 (.004) 7.76±4.25 (.262) 91.90±21.13 (.779)
    Marital status Unmarrieda 17 (8.4) 21.00±11.08 2.84 9.18±4.41 2.63 102.00±15.24 3.83
    Marriedb 166 (82.6) 18.95±10.45 (.061) 7.24±4.07 (.075) 92.19±20.83 (.023)
    Widowed/divorcedc 18 (9.0) 25.17±13.47   8.89±5.25   82.67±23.27 a c ＞
    Job No 41 (20.4) 18.27±10.02 -.93 7.07±4.20 -0.81 89.54±24.10 -0.90
    Yes 160 (79.6) 20.04±11.11 (.355) 7.68±4.26 (.419) 92.84±20.10 (.369)
    Monthly income (10,000 won) 200 ＜ 119 (59.2) 18.27±9.60 -2.13 7.39±3.78 -0.64 94.02±21.15 1.52
    200 ≥ 82 (40.8) 21.72±12.31 (.035) 7.79±4.86 (.526) 89.48±20.49 (.131)
    Weight Decrease 46 (22.9) 20.37±10.47 .32 7.70±4.82 1.19 93.85±21.33 1.27
    Increase 64 (31.8) 20.14±11.05 (.723) 8.13±3.95 (.309) 88.72±20.86 (.282)
    No change 91 (45.3) 19.00±11.07   7.08±4.12   93.74±20.76  
    Drinking No 190 (94.5) 19.58±11.03 -.50 7.45±4.23 -1.46 92.34±21.15 0.49
    Yes 11 (5.5) 21.27±8.53 (.618) 9.36±4.34 (.146) 89.18±17.70 (.628)
    Exercise Noa 63 (31.3) 23.03±12.94 5.29 8.19±4.49 1.92 81.73±21.25 12.91
    a week ≤ b 17 (8.5) 21.12±10.19 (.006) 8.53±4.98 (.149) 99.59±19.64 (.001) ＜
    twice a week ≥ c 121 (60.2) 17.73±9.35 a c ＞ 7.08±3.97   96.55±19.04 a b, ＜ c
    Emotional supporter Spouse 87 (43.3) 19.08±10.87 0.25 6.97±3.70 1.81 92.53±19.10 0.44
    Family 85 (42.3) 20.01±10.98 (.781) 8.19±4.27 (.167) 90.84±22.41 (.644)
    Others 29 (14.4) 20.48±11.02   7.45±5.45   94.97±22.24  

    The Differences of Fatigue, Sleep Disturbance and Quality of Life to Clinical Characteristics (N=201)

    Characteristics Category n (%) Fatigue Sleep disturbance Quality of life
    M±SD t or F (p) Scheffé M±SD t or F (p) Scheffé M±SD t or F (p) Scheffé
    Stage 0 16 (8.0) 22.19±12.72 2.06 8.75±3.57 1.39 92.94±20.05 1.09
      1 66 (32.8) 17.52±10.10 (.087) 6.76±3.78 (.241) 95.45±18.51 (.367)
      2 71 (35.3) 20.03±9.69   7.79±4.67   91.41±18.98  
      3 40 (19.9) 19.98±11.57   7.58±4.27   89.93±27.21  
      4 8 (4.0) 27.88±16.61   9.50±4.69   81.38±22.28  
    Treatment OP+RT 73 (36.3) 19.49±10.10 -0.10 7.85±3.83 0.77 96.36±17.13 2.25
    modality OP+CT+RT 128 (63.7) 19.64±11.28 (.923) 7.37±4.48 (.445) 89.97±22.56 (.025)
    Duration since 6 ＜ a 77 (38.3) 18.87±10.28 3.74 7.73±3.67 9.14 96.79±17.97 3.11
    diagnosis 6~12b 116 (57.7) 19.52±10.82 (.025) 7.03±3.40 (＜ .001) 89.29±21.80 (.047)
    (month) ＞12c 8 (4.0) 29.75±13.96 a, b ＜ c 13.38±2.77 a, b ＜ c 89.25±29.13  
    Menopause Yes 63 (31.3) 18.84±10.92 -0.73 7.41±4.10 -0.31 89.81±19.87 -1.08
      No 138 (68.7) 20.06±10.90 (.464) 7.62±4.32 (.754) 93.24±21.41 (.283)
    Fraction size Hypofraction therapy 154 (76.6) 18.94±10.31 -1.76 7.32±4.13 -1.42 93.04±19.42 1.93
      Conventional therapy 47 (23.4) 22.11±12.45 (.081) 8.32±4.57 (.158) 86.36±24.69 (.058)
    Treatment site Breast 141 (70.1) 18.73±10.13 1.82 7.30±4.17 2.85 94.04±18.47 3.31
      Breast+SCL 53 (26.4) 22.00±12.84 (.166) 7.74±4.25 (.061) 86.15±25.86 (.039)
      Breast++SCL+IMN 7 (3.5) 21.14±7.84   11.14±4.60   100.00±20.08  

    OP=operation; CT=chemotherapy; RT=radiotherapy; SCL=subclavian lymphnode; IMN=internal mammary node.

    Correlation among Fatigue, Sleep Disturbance and Quality of Life (N=201)

    Variables Fatigue Sleep disturbance
    r (p) r (p)
    Sleep disturbance .40 (＜ .001)  
    Quality of life -.55 (＜ .001) -.45 (＜ .001)

    Influencing Factors on the Quality of Life (N=201

    Selected variables B SE β t p VIF
    (Constant) 123.76 6.55 　 18.89    
    Marital status (Ref.=married) -12.34 4.07 -.22 -3.03 .003 1.96
    Exercise (Ref.=no) 9.51 2.44 .21 3.90 .001 ＜ 1.06
    Fatigue -0.74 0.11 -.39 -6.51 .001 ＜ 1.27
    Sleep disturbance -1.32 0.29 -.27 -4.54 .001 ＜ 1.25
      Adj. R2=.45, F=23.88, p .001, ＜ Durbin-Watson=2.02

    SE=standard error; VIF=variance inflation factor.
    Table 1. Score for Fatigue, Sleep Disturbance and Quality of Life (N=201)

    Table 2. The Differences of Fatigue, Sleep Disturbance, Quality of Life to General Characteristics (N=201)

    Table 3. The Differences of Fatigue, Sleep Disturbance and Quality of Life to Clinical Characteristics (N=201)

    OP=operation; CT=chemotherapy; RT=radiotherapy; SCL=subclavian lymphnode; IMN=internal mammary node.

    Table 4. Correlation among Fatigue, Sleep Disturbance and Quality of Life (N=201)

    Table 5. Influencing Factors on the Quality of Life (N=201

    SE=standard error; VIF=variance inflation factor.

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

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