The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study

Oncol Nurs Forum. 2009 Jul;36(4):E205-14. doi: 10.1188/09.ONF.E205-E214.


Purpose/objectives: To examine the symptom cluster of fatigue, pain, anxiety, and depression and its effect on the quality of life (QOL) of women receiving chemotherapy or radiotherapy for breast cancer.

Design: Descriptive.

Setting: Oncology outpatient sections of four public hospitals in Hong Kong.

Sample: 215 ethnic Chinese women who were midway through treatment for breast cancer.

Methods: Chinese versions of the Brief Fatigue Inventory, Hospital Anxiety and Depression Scale, Brief Pain Inventory, Functional Assessment of Chronic Illness Therapy for Breast Cancer, and Medical Outcomes Study Social Support Survey were used. Spearman rho correlation and structural equation modeling were used to examine the relationships among the study variables.

Main research variables: Breast cancer, fatigue, pain, anxiety, depression, and QOL.

Findings: Most participants reported mild-to-moderate levels of fatigue and pain. Twenty-one percent and 36% of patients might have had an anxiety or depression disorder, respectively. Significant correlations among the four symptoms supported the existence of the symptom cluster. The participants receiving chemotherapy had inadequate social support, experienced higher levels of symptoms, and were more likely to have a poorer QOL.

Conclusions: The findings supported the existence of the symptom cluster that had detrimental effects on QOL.

Implications for nursing: This study shed light on a contemporary approach of grouping several related symptoms together. The findings enhance nurses' clinical sensitivity when identifying patients in high-risk groups and provide useful information for designing and prioritizing symptom-management strategies to meet patients' needs.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / epidemiology*
  • Breast Neoplasms / nursing*
  • Breast Neoplasms / therapy
  • Cross-Sectional Studies
  • Depression / epidemiology*
  • Depression / nursing
  • Fatigue / epidemiology*
  • Fatigue / nursing
  • Female
  • Health Status
  • Hong Kong / epidemiology
  • Humans
  • Middle Aged
  • Oncology Nursing
  • Outpatients / psychology
  • Pain / epidemiology*
  • Pain / nursing
  • Prevalence
  • Quality of Life*
  • Surveys and Questionnaires