Post-Treatment Symptoms of Pain, Anxiety, Sleep Disturbance, and Fatigue in Breast Cancer Survivors

Pain Manag Nurs. 2019 Apr;20(2):146-151. doi: 10.1016/j.pmn.2018.09.005. Epub 2018 Dec 7.


Background: In part because of improvements in early detection and treatment, the number of breast cancer survivors is increasing. After treatment, however, breast cancer survivors often experience distressing symptoms, including pain, sleep disturbance, anxiety, and fatigue; at the same time, they have less frequent contact with health care providers. Pain commonly co-occurs with other symptoms and the combination of symptoms contribute to the amount of distress experienced by survivors. Previous studies of post-treatment symptoms include primarily urban and white women.

Aims: The purpose of this study was to describe the post-treatment cluster of symptoms, to examine the correlations among these symptoms, and to examine the role pain intensity may play in understanding the variation in sleep disturbance, fatigue, and anxiety in a racially diverse sample of rural breast cancer survivors.

Design: The theoretical framework for this descriptive correlational study was the theory of unpleasant symptoms.

Settings: Outpatient university-affiliated cancer clinic.

Participants/subjects: Forty women who were between 6 months and 5 years post breast cancer diagnosis.

Methods: Participants completed the following self-report instruments: Patient Reported Outcomes Measurement Information System of pain intensity, pain interference, anxiety, and sleep disturbance and the Piper Fatigue Short Form 12.

Results: The average age of participants was 58 years, and 57.5% were black. Most women reported sleep disturbance (78%), pain interference (68%), and pain intensity (63%) above the national average for an American adult. Black women reported higher pain intensity than whites. There were moderate to strong correlations among the symptoms (range r = 0.35-0.89).

Conclusions: Nurses and health care providers in primary care settings need to screen for symptoms, and nursing interventions are needed to assist breast cancer survivors to manage distressing symptoms.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anxiety / etiology*
  • Anxiety / psychology
  • Breast Neoplasms / complications*
  • Breast Neoplasms / psychology
  • Cancer Pain / etiology*
  • Cancer Pain / psychology
  • Fatigue / etiology*
  • Fatigue / psychology
  • Female
  • Humans
  • Middle Aged
  • Psychometrics / instrumentation
  • Psychometrics / methods
  • Quality of Life / psychology
  • Self Report
  • Sleep Disorders, Circadian Rhythm / etiology*
  • Sleep Disorders, Circadian Rhythm / psychology
  • Survivors / psychology
  • Survivors / statistics & numerical data