Living with cancer-related uncertainty: associations with fatigue, insomnia, and affect in younger breast cancer survivors
Open accessAbstract
Purpose Uncertainty in cancer patients and survivors about cancer-related symptoms, treatment, and disease course has been related to poorer mental and physical health. However, little is known about whether cancer-related uncertainty relates with specific disease and treatment-related outcomes such as fatigue, insomnia, and affect disruptions. In this paper, we report these associations in younger survivors aged 50 years or less, a population increasing in prevalence.Methods Participants included 313 breast cancer survivors (117 African-Americans and 196 Caucasians) who were aged 24 to 50 years and were 2 to 4 years posttreatment. Self-reported cancer-related uncertainty (Mishel Uncertainty in Illness Scale-Survivor Version), fatigue (Piper Fatigue Scale-Revised), insomnia (Insomnia Severity Index), and negative and positive affect (Positive and Negative Affect Schedule (PANAS)) measures were collected upon study entry.Results Hierarchical regression analyses controlled for relevant sociodemographic variables include the following: race, age, years of education, number of children, employment status, marital status, monthly income, smoking status, family history of cancer, endorsement of treatment-induced menopause, and religiosity. Over and above these factors, higher cancer-related uncertainty was significantly associated with more self-reported fatigue (β = .43), insomnia (β = .34), negative affect (β = .43), as well as less positive affect (β = -.33), all ps < .01.Conclusions Younger breast cancer survivors who are 2-4 years posttreatment experience cancer-related uncertainty, with higher levels associated with more self-reported psychophysiological disruptions. Cancer survivors who present in clinical settings with high uncertainty about recurrence or management of long-term effects of treatment may thus benefit from assessment of fatigue, insomnia, and affect.
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Fear of cancer recurrence severity is independent of cancer type, treatment history, and time since treatment.
“Like insomnia, the FCR severity is independent of cancer type, treatment history, or time since treatment.25–33”
From An exploration into the relationship between insomnia and repetitive negative thinking among cancer survivors. (2025) · cites this paper as [27]
The Methods describe only younger breast cancer survivors 2–4 years posttreatment, and the Discussion addresses associations between cancer-related uncertainty, insomnia, fatigue, and mood. Searches for recurrence severity, cancer type, treatment history, and time since treatment found no analysis establishing that fear-of-recurrence severity is independent of those factors. (LLM, conf=0.76)
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- Authors
- Hall, D. L., Mishel, M. H., & Germino, B. B.
- Affiliations
- University of Miami (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Hall, Daniel L.
- ORCID
- Hall, Daniel L.
- Venue
- Supportive Care in Cancer
- Published
- 2014-04-12
- Volume
- 22
- Issue
- 9
- Pages
- 2489-2495
- ISSN
- 0941-4355 (ISSN-L)
- 1433-7339
- PMC
- PMC6375671
- OpenAlex
- W2135223644
- Cited by
- 110
- References
- 48
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 12 · 2023: 12 · 2022: 12 · 2021: 8 · 2020: 14 · 2019: 12 · 2018: 10 · 2017: 9 · 2016: 8 · 2015: 3 · 2014: 2
- FWCI
- 3.54
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Supportive Care in Cancer (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Nursing Research (R01NR010190)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- breast cancer survivors, young adults, fatigue, insomnia, affect, negative affect, positive affect, psychosocial outcomes, racial differences, African American women, long-term treatment outcomes
- MeSH terms
- Adult, Affect, Age Factors, Black or African American, Breast Neoplasms, Fatigue, Female, Humans, Sleep Initiation and Maintenance Disorders, Middle Aged, Neoplasm Recurrence, Local, Quality of Life, Prevalence, Survivors, Uncertainty, White People, Young Adult
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