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Supportive Care in Cancer
Published in: Supportive Care in Cancer 9/2014

01-09-2014 | Original Article

Living with cancer-related uncertainty: associations with fatigue, insomnia, and affect in younger breast cancer survivors

Authors: Daniel L. Hall, Merle H. Mishel, Barbara B. Germino

Published in: Supportive Care in Cancer | Issue 9/2014

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Abstract

Purpose

Uncertainty in cancer patients and survivors about cancer-related symptoms, treatment, and disease course has been related to poorer mental and physical health. However, little is known about whether cancer-related uncertainty relates with specific disease and treatment-related outcomes such as fatigue, insomnia, and affect disruptions. In this paper, we report these associations in younger survivors aged 50 years or less, a population increasing in prevalence.

Methods

Participants included 313 breast cancer survivors (117 African-Americans and 196 Caucasians) who were aged 24 to 50 years and were 2 to 4 years posttreatment. Self-reported cancer-related uncertainty (Mishel Uncertainty in Illness Scale–Survivor Version), fatigue (Piper Fatigue Scale–Revised), insomnia (Insomnia Severity Index), and negative and positive affect (Positive and Negative Affect Schedule (PANAS)) measures were collected upon study entry.

Results

Hierarchical regression analyses controlled for relevant sociodemographic variables include the following: race, age, years of education, number of children, employment status, marital status, monthly income, smoking status, family history of cancer, endorsement of treatment-induced menopause, and religiosity. Over and above these factors, higher cancer-related uncertainty was significantly associated with more self-reported fatigue (β = .43), insomnia (β = .34), negative affect (β = .43), as well as less positive affect (β = −.33), all ps < .01.

Conclusions

Younger breast cancer survivors who are 2–4 years posttreatment experience cancer-related uncertainty, with higher levels associated with more self-reported psychophysiological disruptions. Cancer survivors who present in clinical settings with high uncertainty about recurrence or management of long-term effects of treatment may thus benefit from assessment of fatigue, insomnia, and affect.
Literature
1.
American Cancer Society (2012) Cancer facts and figures 2012. American Cancer Society, Atlanta
2.
Gil KM, Mishel MH, Germino B, Porter LS, Carlton-Laney I, Belyea M (2006) Uncertainty management intervention for older African American and Caucasian long-term breast cancer survivors. J Psychosoc Oncol 23(2–3):3–21CrossRef
3.
Bloom JR, Stewart SL, D’Onofrio CN, Luce J, Banks PJ (2008) Addressing the needs of young breast cancer survivors at the 5 year milestone: can a short-term, low intensity intervention produce change? J Cancer Survivorship 2(3):190–204CrossRef
4.
Kornblith AB, Powell M, Regan MM et al (2007) Long-term psychosocial adjustment of older vs younger survivors of breast and endometrial cancer. Psycho-Oncology 16(10):895–903PubMedCrossRef
5.
Sammarco A (2009) Quality of life of breast cancer survivors: a comparative study of age cohorts. Cancer Nurs 32(5):347–356PubMedCrossRef
6.
Gil KM, Mishel MH, Belyea M et al (2004) Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors. Oncol Nurs Forum 31(3):633–639CrossRef
7.
McKinley ED (2000) Under toad days: surviving the uncertainty of cancer recurrence. Ann Intern Med 133(6):479PubMedCrossRef
8.
Ganz PA, Greendale GA, Petersen L, Kahn B, Bower JE (2003) Breast cancer in younger women: reproductive and late health effects of treatment. J Clin Oncol 21(22):4184–4193PubMedCrossRef
9.
Sammarco A (2001) Perceived social support, uncertainty, and quality of life of younger breast cancer survivors. Cancer Nurs 24(3):212–219PubMedCrossRef
10.
Knobf MT (2006) The influence of endocrine effects of adjuvant therapy on quality of life outcomes in younger breast cancer survivors. Oncologist 11(2):96–110PubMedCrossRef
11.
12.
Mishel MH (1990) Reconceptualization of the uncertainty in illness theory. J Nurs Scholarsh 22(4):256–262CrossRef
13.
14.
Mishel MH, Germino BB, Belyea M et al (2003) Moderators of an uncertainty management intervention: for men with localized prostate cancer. Nurs Res 52(2):89–97PubMedCrossRef
15.
Song L, Northouse LL, Braun TM et al (2011) Assessing longitudinal quality of life in prostate cancer patients and their spouses: a multilevel modeling approach. Qual Life Res 20(3):371–381PubMedCentralPubMedCrossRef
16.
Germino BB, Mishel MH, Belyea M, Harris L, Ware A, Mohler J (2002) Uncertainty in prostate cancer. Ethnic and family patterns. Cancer Pract 6(2):107–113CrossRef
17.
Pelusi J (1997) The lived experience of surviving breast cancer. Oncol Nurs Forum 24(8):1343–1353PubMed
18.
19.
Dunn J, Steginga SK (2000) Young women’s experience of breast cancer: defining young and identifying concerns. Psycho-Oncology 9(2):137–146PubMedCrossRef
20.
Connell S, Patterson C, Newman B (2006) Issues and concerns of young Australian women with breast cancer. Support Care Cancer 14(5):419–426PubMedCrossRef
21.
Meeske K, Wilder Smith A, Alfano CM et al (2007) Fatigue in breast cancer survivors two to five years post diagnosis: a HEAL study report. Qual Life Res 16(6):947PubMedCrossRef
22.
Bower JE, Ganz PA, Desmond KA et al (2000) Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 18(4):743PubMed
23.
Bower JE (2005) Fatigue in cancer patients and survivors: mechanisms and treatment. Prim Psychiatry 12(5):53
24.
Von Ah DM, Kang D-H, Carpenter JS (2008) Predictors of cancer-related fatigue in women with breast cancer before, during, and after adjuvant therapy. Cancer Nurs 31(2):134CrossRef
25.
Stasi R, Abriani L, Beccaglia P, Terzoli E, Amadori S (2003) Cancer-related fatigue. Cancer 98(9):1786–1801PubMedCrossRef
26.
27.
Savard J, Morin CM (2001) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19(3):895–908PubMed
28.
Simard S, Blanchet J, Ivers H (2001) Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer. Sleep 24(5):583–590PubMed
29.
Porter LS, Clayton MF et al (2006) Predicting negative mood state and personal growth in African American and white long-term breast cancer survivors. Ann Behav Med 31(3):195–204PubMedCrossRef
30.
Germino BB, Mishel MH, Crandell J et al (2013) Outcomes of an uncertainty management intervention in younger African American and Caucasian breast cancer survivors. Oncol Nurs Forum 40(1):82–92PubMedCrossRef
31.
Germino BB, Mishel MH, Alexander GR et al (2011) Engaging African American breast cancer survivors in an intervention trial: culture, responsiveness and community. J Cancer Survivorship 5(1):82–91CrossRef
32.
Brown DR, Gary LE (1987) Stressful life events, social support networks, and the physical and mental health of urban black adults. J Hum Stress 13(4):165–174CrossRef
33.
Mishel MH, Germino BB, Gil KM et al (2005) Benefits from an uncertainty management intervention for African–American and Caucasian older long-term breast cancer survivors. Psycho-Oncology 14(11):962–978PubMedCrossRef
34.
Watson D, Clark LA, Tellegen A (1988) Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 54(6):1063–1070PubMedCrossRef
35.
Piper BF, Dribble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM (1998) The revised piper fatigue scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum 25:677–684PubMed
36.
Bastien CH, Vallières A, Morin CM (2001) Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med 2(4):297–307PubMedCrossRef
37.
Savard MH, Savard J, Simard S, Ivers H (2005) Empirical validation of the Insomnia Severity Index in cancer patients. Psycho-Oncology 14(6):429–441PubMedCrossRef
38.
Mishel MH (1997) Uncertainty in illness scales manual
39.
Bennett B, Goldstein D, Friedlander M, Hickie I, Lloyd A (2007) The experience of cancer-related fatigue and chronic fatigue syndrome: a qualitative and comparative study. J Pain Symptom Manag 34(2):126–135CrossRef
40.
Morin CM, Belleville G, Bélanger L, Ivers H (2011) The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 34(5):601–608PubMedCentralPubMed
41.
Pachman DR, Barton DL, Swetz KM, Loprinzi CL (2012) Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain. J Clin Oncol 30(30):3687–3696PubMedCrossRef
42.
Kim Y, Kashy DA, Wellisch DK, Spillers RL, Kaw CK, Smith TG (2008) Quality of life of couples dealing with cancer: dyadic and individual adjustment among breast and prostate cancer survivors and their spousal caregivers. Ann Behav Med 35(2):230–238PubMedCrossRef
43.
Carver CS, Smith RG, Antoni MH, Petronis VM, Weiss S, Derhagopian RP (2005) Optimistic personality and psychosocial well-being during treatment predict psychosocial well-being among long-term survivors of breast cancer. Health Psychol 24(5):508–516PubMedCrossRef
44.
Bower JE, Lamkin DM (2012) Inflammation and cancer-related fatigue: mechanisms, contributing factors, and treatment implications. Brain Behav Immun 30:S48–S57PubMedCentralPubMedCrossRef
45.
Gil KM, Mishel MH, Belyea M, Germino BB, Porter LS, Clayton M (2006) Benefits of the uncertainty management intervention for African American and white older breast cancer survivors: 20-month outcomes. Int J Behav Med 13(4):286–294PubMedCrossRef
Metadata
Title
Living with cancer-related uncertainty: associations with fatigue, insomnia, and affect in younger breast cancer survivors
Authors
Daniel L. Hall
Merle H. Mishel
Barbara B. Germino
Publication date
01-09-2014
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 9/2014
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-014-2243-y

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