The symptom cluster of sleep, fatigue and depressive symptoms in breast cancer patients: severity of the problem and treatment options

Breast cancer is the most commonly diagnosed cancer in women. Insomnia is a significant problem in breast cancer patients, affecting between 20% and 70% of newly diagnosed or recently treated breast cancer patients. Pain, fatigue, anxiety and depression are also common conditions in breast cancer and often co-occur with insomnia in symptom clusters, exacerbating one another and decreasing quality of life (QOL). There have been no clinical trials of drugs for sleep in cancer. Cognitive behavioral psychotherapies on the contrary have shown some of the most positive results in alleviating the distressing symptoms that often accompany the breast cancer experience, but even these studies have not targeted the symptom cluster. Pharmacological as well as non-pharmacological treatments need to be explored. It might be that a combined pharmacological and behavioral treatment is most efficacious. In short, substantially more research is needed to fully understand and treat the symptom cluster of insomnia, fatigue, pain, depression and anxiety in breast cancer.