Are there efficacious treatments for treating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients? A Rapid Evidence Assessment of the Literature (REAL^©)

Abstract

Purpose

While fatigue, sleep disturbance, and depression often co-occur in breast cancer patients, treatment efficacy for this symptom cluster is unknown. A systematic review was conducted to determine whether there are specific interventions (ie, medical, pharmacological, behavioral, psychological, and complementary medicine approaches) that are effective in mitigating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients, using the Rapid Evidence Assessment of the Literature (REAL^©) process.

Methods

Peer-reviewed literature was searched across multiple databases; from database inception – October 2011, using keywords pre-identified to capture randomized controlled trials (RCT) relevant to the research question. Methodological bias was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) 50 checklist. Confidence in the estimate of effect and assessment of safety were also evaluated across the categories of included interventions via the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology.

Results

The initial search yielded 531 citations, of which 41 met the inclusion criteria. Of these, twelve RCTs reported on all three symptoms, and eight of these were able to be included in the GRADE analysis. The remaining 29 RCTs reported on two symptoms. Studies were of mixed quality and many were underpowered. Overall, results suggest that there is: 1) promising evidence for the effectiveness of various treatment types in mitigating sleep disturbance in breast cancer patients; 2) mixed evidence for fatigue; 3) little evidence for treating depression; and 4) no clear evidence that treatment of one symptom results in effective treatment for other symptoms.

Conclusion

More high-quality studies are needed to determine the impact of varied treatments in mitigating the fatigue–sleep disturbance–depression symptom cluster in breast cancer patients. Furthermore, we encourage future studies to examine the psychometric and clinical validity of the hypothesized relationship between the symptoms in the fatigue–sleep disturbance–depression symptom cluster.

Keywords:

• fatigue
• sleep disturbance
• depression
• symptom cluster
• breast cancer
• Rapid Evidence Assessment of the Literature

Acknowledgments

The authors have not presented this data and information before in any journal. This data was presented in a poster at the MASCC/ISOO International Symposium on Supportive Care in Cancer in June 2012⁷⁰ as well as at the American Psychosocial Oncology Society in February 2013.⁷¹ The authors have no professional relationships with companies or manufacturers who will benefit from the results of this present study. This material is based upon work supported by the US Army Medical Research and Materiel Command under Award No W81XWH-06-1-0279. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.

Disclosure

The authors report no conflicts of interest in this work.