Advances Interview - Berger

  reducing breast cancer
  chemotherapy fatigue
Ann Berger, PhD   What Dr. Ann Berger remembers most was her mother's fatigue. Battling leukemia, she fought valiantly to keep daily life normal for her five children but was exhausted by chemotherapy. She died at age 53.

That memory has framed and inspired the long and distinguished research career of Ann Berger, PhD, RN, AOCN, FAAN. Dr. Berger is currently testing interventions that may reduce fatigue in women undergoing chemotherapy for breast cancer.

Dr. Berger is Niedfelt Professor and director of the College of Nursing's doctoral program. She and her team are in the fifth and final year of a $1.5 million grant from the National Institute of Nursing Research, a division of the National Institutes of Health.

"Without a doubt," said Dr. Berger, "the number one most prevalent and distressing symptom for breast cancer chemotherapy is fatigue." The problem is long-term, and she hopes her findings will help improve quality of life during and after treatment.

It's the first study of its kind in the nation, and patients call it life changing. Dr. Berger's team recruited 220 women with breast cancer and divided them into two groups. One group changed sleeping habits; the other, eating habits.


"Fatigue in Breast Cancer – A Behavioral Sleep Intervention" compares immediate and consequent fatigue between the two groups. The study examines stage I, II or IIIA breast cancer patients, age 19 and older, postoperative, during four or eight cycles of adjuvant chemotherapy. The women were randomly assigned to the interventional (sleeping) or attentional (eating) group.

Cancer-related fatigue (CRF) has a rippling effect on a patient's life — with significant physical, emotional, social and economic consequences that may persist for months or years after completing treatment, Dr. Berger said. Unsatisfactory sleep is a companion to fatigue and further debilitates waking hours.

"When you add fatigue into the model, you also get more pain, anxiety, depression, lower activity rates, poor appetite and sleep interruption," Dr. Berger said. Little is known about the relationship between fatigue and insomnia in breast cancer patients, and the study hopes to shine light on the association.

Women in the attentional control group are instructed in healthy eating habits. The interventional group meets with a nurse educator to learn the four components of behavioral sleep intervention. First is sleep restriction. Group members are told to limit nighttime sleep to the amount they normally get. They can add one additional hour if they feel ill. If they need a 30 to 40-minute nap during the day, the nap is to be completed at least four hours before bedtime. There should be no long naps.

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advances spring 2007