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Changes in Fatigue, Psychological Distress, and Quality of Life After Chemotherapy in Women with Breast Cancer

A Prospective Study

Oh, Pok-Ja, RN, PhD; Cho, Jung-Ran, RN

doi: 10.1097/NCC.0000000000000689
Article: PDF Only

Background Chemotherapy leads to various symptoms and psychological distress, which contribute to a significant decrease in the quality of life of the patients.

Objectives The aim of this study was to identify changes and interrelationships in the fatigue-depression-anxiety symptom cluster and quality of life during the cancer care trajectory in women with breast cancer.

Methods Fifty women participated in the study and completed questionnaires at 3 different times: prechemotherapy, postchemotherapy, and 6 months after the completion of chemotherapy. The assessment tools were the Functional Assessment of Cancer Therapy–Fatigue Scale, Hospital Anxiety and Depression Scale, and Functional Assessment of Cancer Therapy–Breast Cancer version 4 Scale. Data were analyzed using descriptive and repeated-measures analysis of variance statistics.

Results A significant increase in fatigue (F = 41.95, P < .001) and psychological distress (F = 26.55, P < .001) from prechemotherapy to postchemotherapy was noted. Improvement was observed 6 months after the completion of chemotherapy. A positive or negative change in fatigue was associated with the same in psychological distress. Quality of life (F = 65.22, P < .001) also showed similar change patterns as observed with fatigue and psychological distress. Fatigue had a greater impact on quality of life at postchemotherapy, but psychological distress had a greater impact at prechemotherapy and at the 6-month follow-up.

Conclusion These results suggest that chemotherapy is highly associated with the fatigue-depression-anxiety symptom cluster and quality of life in women with breast cancer.

Implications for Practice Nursing intervention is needed to relieve the intensity of the fatigue-depression-anxiety symptom cluster and thus improve the quality of life of patients undergoing chemotherapy from before treatment to follow-up.

Author Affiliations: Department of Nursing (Dr Oh); Department of Nursing, Graduate School (Ms Cho), Sahmyook University, Seoul, Korea.

This article was supported by the Fund of the Sahmyook University in 2017.

The authors have no conflicts of interest to disclose.

Correspondence: Pok-Ja Oh, RN, PhD, Department of Nursing, Sahmyook University, 815 Kongnung-dong, Hwarang-ro, Nowon-gu, Seoul 01795, Korea (;

Accepted for publication October 23, 2018.

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