Paper
Friday, 21 July 2006
This presentation is part of : Health Concerns for Adult Women
Psychophysical and Immune Predictors of Fatigue in Breast Cancer Over Time
Duck-Hee Kang, RN, PhD, FAAN1, Michael Weaver, RN, PhD, FAAN1, and Traci McArdle, RN, BS2. (1) School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA, (2) School of Nursing, The Universtiy of Alabama at Birmingham, Birmingham, AL, USA
Learning Objective #1: explain significant psychophysical and immune predictors of fatigue.
Learning Objective #2: describe how fatigue changes over the course of cancer treatment.
Purpose: Fatigue is the most distressing symptom in women with breast cancer and significantly decreases functional performances and quality of life. Causes of fatigue remain elusive, although psychophysical and immune parameters may contribute to fatigue. Because different dimensions of fatigue can be affected by different predictors and differentially change over time, we examined the best set of predictors for each dimension of fatigue and changes in fatigue over cancer treatment. Methods: Eighty-two women newly diagnosed with breast cancer (mean age= 48.5), stage 1-3, completed standardized psychological and physical questionnaires and gave blood samples four times: before, during, 2-4 months after and 8-10 months after cancer treatment. Cancer-specific stress, depression, anxiety, physical symptoms (i.e., nausea, vomiting, sleep difficulty, etc.), income, hemoglobin, and cytokines (interleukin [IL]-1 alpha, IL-4, -10, and -12) were assessed for their contributions to fatigue (total, behavioral, affective, sensory, and cognitive). Cytokines were assessed with ELISA, and data were analyzed using MR and GLMM. Results: Before treatment, psychophysical and immune predictors explained 35-58% (adjusted R2) of all dimensions of fatigue, p < .001. Physical symptoms and depression were significant, independent predictors for nearly all dimensions of fatigue. For immune parameters, IL-10 was a significant independent predictor for total and sensory fatigue and marginally predicted cognitive fatigue. In addition, income predicted affective fatigue. Across 4 time points, physical symptoms and depression remained to be significant independent predictors for all dimensions of fatigue, p < .001, and hemoglobin predicted affective fatigue across time. Behavioral, sensory and cognitive fatigue decreased significantly over time, whereas total and affective fatigue remained similar across timepoints. Conclusion: Selective psychophysical and immune factors explain significant portions of fatigue variance before treatment and across time. Although psychophysical predictors are known to contribute to fatigue, IL-10 is a novel indicator warranting further investigation for its role.

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