Biobehavioral predictors of mood, pain, fatigue, and insomnia in endometrial cancer survivors

Objective

Endometrial cancer survivors experience persistent health-related quality of life concerns, including pain, fatigue, and disrupted emotional and social functioning. The purpose of this longitudinal study was to evaluate associations between biobehavioral factors, including daytime physical activity, nighttime sleep, and 24-h circadian rest-activity rhythms, with psychological and physical symptoms following endometrial cancer surgery.

Methods

This study included 69 adult female patients undergoing surgery for endometrial cancer. At each of three assessment points (1, 4, and 16 weeks post-surgery), participants wore a wrist actigraph for 3 days and completed a sleep log and self-report measures of depression and anxiety (Inventory of Depression and Anxiety Symptoms), pain (Brief Pain Inventory), fatigue (Fatigue Symptom Inventory), and insomnia (Insomnia Severity Index). Physical activity, sleep, and 24-h rest-activity indices were derived from actigraphy. Mixed- and fixed-effects linear regression models were utilized to evaluate relationships between actigraphy indices and patient-reported outcomes.

Results

Clinically elevated fatigue persisted for a majority of participants (64 %), while a sizeable minority continued to report clinically elevated insomnia (41 %) and pain (19 %) at 16-weeks post-surgery. Participants who recorded less daytime activity, more disrupted sleep, and less consistent 24-h rest-activity rhythms by actigraphy reported more depression and anxiety symptoms and greater pain and fatigue. Within individual participants, at time points when activity was lowest, sleep most disrupted, and 24-h rest-activity rhythms least consistent, participants experienced more psychological and physical symptoms.

Conclusions

Findings suggest that disruptions in daytime physical activity, nighttime sleep, and 24-h rest-activity patterns contribute to patient-reported outcomes in the weeks and months after endometrial cancer treatment. Findings support modifiable intervention targets to address co-occurring physical and psychological symptoms and optimize health and recovery after endometrial cancer surgery.