Synergistic Interactions Among Fatigue, Sleep Disturbance, and Depression in Women With Breast Cancer A Cross-Sectional Study

OBJECTIVES: To assess the symptom cluster of fatigue, sleep disturbance, and depression among female patients with breast cancer receiving chemotherapy, and to evaluate its impact on quality of life (QOL) and symptom severity. SAMPLE & SETTING: 372 patients receiving adjuvant chemotherapy recruited from two tertiary hospitals in China. METHODS & VARIABLES: Symptom severity and QOL were evaluated using the Brief Fatigue Inventory, Pittsburgh Sleep Quality Index, Patient Health Questionnaire-9, and Functional Assessment of Cancer Therapy-Breast on the eighth day after receiving chemotherapy. RESULTS: All symptoms positively correlated with each other. Although the symptom cluster was significantly associated with decreased QOL, individualized symptom severity worsened as the number of symptoms increased. IMPLICATIONS FOR NURSING: The prevalence of and interactions among fatigue, sleep disturbance, and depression negatively affect symptom severity and patients' QOL. Conducting early assessment followed by effective cluster-based interventions is needed to manage this symptom cluster.