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Patterns of Objective Physical Functioning and Perception of Mood and Fatigue in Posttreatment Breast Cancer Patients and Healthy Controls: An Ambulatory Psychophysiological Investigation

From the Division of Internal Medicine (P.G.), Department of Psychosomatic Medicine, University of Basel Hospital, Basel, Switzerland; Freiburg Institute of Mindfulness Research (P.G., G.D.), Freiburg, Germany; Department of Oncology (L.E.C.), Faculty of Medicine, University of Calgary, Calgary, Canada; and the Department of Psychology (S.N.G., T.S.C., L.E.C.), University of Calgary, Calgary, Canada.

Address correspondence and reprint requests to Paul Grossman, Department of Psychosomatic Medicine, Division of Internal Medicine, Hebelstrasse 2, CH-4031 Basel, Switzerland.

Objective: To monitor objective physiological and self-report measures among apparently disease-free breast cancer patients (n = 33) in the first 2 years of posttreatment recovery, using a cross-sectional design, and compare findings with women without histories of cancer or other serious disorders (n =33). Time-since-treatment also served as an independent variable. Few studies have examined adjustment of breast cancer patients after primary treatment or objectively characterized posttreatment, everyday patterns of functioning.

Methods: A 24-hour ambulatory minute-by-minute cardiorespiratory functioning and accelerometry activity were measured during one day, together with multiple repeated assessments of mood and fatigue. Traditional retrospective measures of well-being were also evaluated. Our ambulatory methodology permitted estimation of physiological rhythms of cardiorespiratory and accelerometry activity.

Results: Patients reported lower ambulatory levels of energy and poorer mood during the daytime than controls. Time-since-treatment was related directly to both momentary mood and energy as well as to objective measures of activity and respiratory parameters. Retrospective self-reports of impaired mood and symptoms persisted in patients, independently of time-since-treatment and of ambulatory physical or physiological activity. Ambulatory self-report data were associated with concurrent respiratory measures. Chemotherapy-related elevation of heart rate was found but was unrelated to self-report measures.

Conclusions: Impaired sense of well being based on retrospective measures is not associated with pattern of physical or physiological functioning after treatment for breast cancer. However, ambulatory, momentary levels of mood and fatigue seem to be related to concurrent ventilatory activity and time-since-treatment. This is the first investigation that relates ambulatory and retrospective measures of affect and fatigue to concurrent, real-life physical functioning.

Key Words: breast cancer • heart rate • ecological momentary assessment • depression • fatigue • respiration

Abbreviations: ACCEL = accelerometer activity; F_b = breathing frequency; DC = duty cycle; IF = inspiratory flow rate; T_i = inspiratory time; V_m = minute ventilation volume; RMANOVA = repeated-measures analysis of variance; V_t = tidal volume.