Poor Sleep Quality, Depression and Hope before Breast Cancer Surgery

Poor Sleep Quality, Depression and Hope before Breast Cancer Surgery


Breast cancer causes high cancer-related mortalities among women and the risk of contracting the condition among women increases with age although men and young women are also at risk. The treatment of breast cancer and care of affected patients remains a major challenge facing the public health sector. According to Schattner (2016), statistics indicate that the prevalence of breast cancer incidences among women of all races in the United States increased by 25% during the period from 1975 to 2012. The statistics also suggest that the number of deaths from breast cancer cases has reduced significantly due to advances in screening and treatment methods. Nonetheless, depression and poor sleep quality remain some of the

primary concerns raised by cancer patients due to the fear of lymphedema, breast mutilation, pain, prejudice, and death. Additionally, breast cancer patients express hopelessness due to worries about social devaluation because of their conditions, yet many members of the society continue to ignore the breast cancer patients’ fears.  Thus, this paper critiques a scholarly paper on issues related to depression, poor sleep quality, hope, and breast cancer to discern the quality of the paper and the veracity of the authors’ arguments.

Critique of the Paper

The paper selected for critique is titled “Fatigued Breast Cancer Survivors: The Role of Sleep Quality, Depressed Mood, Stage, and Age” that was published in the “Psychology & Health” Journal in 2009. The article’s authors included Rajni Banthia, George Sandler, Celine Ko, James Varni, and Vanessa Malcarne. Banthia, Malcarne, Ko, Varni, & Sandler (2009) pointed out that controversy exists in conceptualizing cancer-related fatigue as a disorder, syndrome, side-effect, or symptom and this may affect the quality of breast cancer treatment. Additionally, the authors noted that several approaches for assessing fatigue exist. Thus, Banthia et al., (2009) advocate the introduction of a general assessment of cancer-related fatigue in addition to measuring energy and vigor as opposite constructs. To achieve this, the authors designed a research study that focused on the relationship between cancer stage, age, depression, and sleep quality with cancer-related fatigue. Moreover, the authors identified physical, emotional, mental, and general fatigue subtypes in their study and sought to present differential interactions with different subtypes. Although, the research questions are not presented in the article implicitly, the study design suggests that the authors sought to answer the question, “What is the relationship between cancer stage, age, depression, and quality of sleep with fatigue among cancer patients?” Furthermore, the authors also sought to illustrate physical, emotional, mental, and general fatigue as subtypes of cancer-related fatigue among breast cancer patients.

The main points presented by Banthia et al., (2009 in their study include the fact that literature on the causes of cancer-related fatigue among breast cancer patients is inadequate. The authors acknowledge that there is a need to measure closely related potential predictors of cancer-related fatigue. Additionally, the authors suggest de-conditioning resulting from reduced activity, lasting side effects, and co-morbid medical conditions as some of the factors that could cause breast cancer patients to experience cancer-related fatigue. Banthia et al., (2009), provide a literature review and the authors support their views using findings from previous studies that focused on breast cancer patients. The literature review incorporates studies that analyzed the relationships between cancer stage, age, sleep quality, and depression with fatigue among cancer patients. However, one of the limitations of the article’s literature review is that it is too brief because it covers less than two pages of the paper. Another shortcoming is that some of the scholarly papers used by the authors in are date and may be inappropriate to use in a study that involves intensive and continued research. For example, the authors incorporate studies by Radloff (1977), Levine et al. (1988), and Buysse et al. (1989) as academic sources in their research although the papers were published more than thirty years ago. Ideally, sources used in medical, technological, and scientific research studies should be recently published or updated due to the rapid changes that occur in the disciplines. Nonetheless, the paper by Banthia et al. (2009) is appropriate and important in addressing the issue of fatigue related to breast cancer because the condition affects an increasing number of people.

The authors’ initial hypothesis was that depression, poor sleep quality, and younger age had a close relationship with reduced vigor and increased fatigue among the breast cancer patients. To test their hypothesis, Banthia et al., (2009), prepared a cross-sectional study that involved seventy women who were breast cancer survivors from different ethnic and socio-economic as well as varying ages. The study concentrated on duration of treatment, type of treatment, stage of the breast cancer, and time since the end of the treatment. The authors designed a Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) that included thirty items for use in assessing the cancer survivors and patients at different stages of cancer. The authors used a rating scale for the response from the participants and tallied the ratings of specific domains but did not determine the total scores. The authors also used the Pittsburgh Sleep Quality Index (PSQI) that included nineteen measures to determine the breast cancer patients’ quality of sleep during the preceding month. Banthia et al. (2009) argue that Pittsburgh Sleep Quality Index is appropriate for conducting studies on cancer victims because researchers have used it extensively and it has proven reliability as well as validity. Finally, the authors assessed depression among the participants use the Center for Epidemiological Studies-Depression Scale (CES-D). The authors considered CES-D as an appropriate tool for the study because it focuses on the affective, motivational, and cognitive symptoms of depression.

The authors used an experimental research design because all the participants engaged in the research were women who were randomly selected from San Diego County. Additionally, the authors randomly selected patients with different ages and at different stages of cancer. As Schattner (2016) points out, invasive breast cancer affects about 130 for every 100,000 women in the United States. Thus, the sample size of seventy participants used in the study was appropriate for the study because Banthia et al. (2009) restricted it to San Diego County. Although, the inclusion of women participants from all ethnic and socio-economic backgrounds is recommended, the sample composition is inappropriate because breast cancer also affects men. Thus, the sample selected for the study on fatigue, depression, and poor sleep quality among breast cancer patients was biased. The authors used descriptive statistics such as standard deviations, coefficient of alpha, range, and kurtosis among others in analyzing the results from the study.

One of the significant findings from the study includes the close relationship between psychological distress and number of children in households where the mothers are breast cancer patients. Additionally, the authors affirmed the relationship sleep quality and fatigue although they noted that mental fatigue was not a significant factor. Thus, the study indicates that mothers suffering from breast cancer need support services to help them in overcoming depression. Moreover, the authors point out the under-appreciation and under-recognition of fatigue among breast cancer patients by healthcare providers. Nonetheless, the authors could have improved their study by conducting the study in other counties and states in addition to increasing the sample size. Additionally, further research on the issue of depression, sleep quality, and age among male breast cancer patients is essential because the condition also affects men. Many researchers often ignore studies on the impacts of breast cancer among male patients. Moreover, the authors point out inadequate information on fatigue before and after treatment in addition to lack of information on the patients’ sleep disorders or depression as some of the limitations of the study. Baqutayan (2012) notes that breast cancer patients also experience anxiety that increases their depression burden and this may affect their fatigue levels.


Breast cancer is a serious health problem that affects many women across the world and it remains one of the leading causes of mortality among women. Baqutayan (2012) indicates that worldwide mortality rate of breast cancer is about 500,000 women while Schattner (2016) notes that breast cancer affects approximately 130 women out of every 100,000. The article by Banthia et al., (2009), is straightforward and informative because it addresses some of the issues that are frequently overlooked in breast cancer studies. I concur with the authors’ view that depression and poor sleep quality increases fatigue among the breast cancer patients. Several researchers also point out the impact of depression and sleep quality on breast cancer patients. Fafouti, Paparrigopoulos, Zervas, Rabavilas, Malamos, Liappas, & Tzavara (2010) note that more than 30% of breast cancer patients endure psychological morbidity that can increase in severity unless healthcare providers adopt intervention measures. Additionally, I agree that healthcare providers should increase their focus on the impacts of depression and poor sleep quality among breast cancer patients because this will help in improving their quality of life and enhancing the treatment outcomes.





Banthia, R., Malcarne, V. L., Ko, C. M., Varni, J. W., & Sadler, G. R. (2009). Fatigued breast cancer survivors: the role of sleep quality, depressed mood, stage and age. Psychology and Health, 24(8), 965-980.

Baqutayan, S. M. S. (2012). The effect of anxiety on breast cancer patients. Indian Journal of Psychological Medicine, 34(2), 119-123.

Fafouti, M., Paparrigopoulos, T., Zervas, Y., Rabavilas, A., Malamos, N., Liappas, I., & Tzavara, C. (2010). Depression, anxiety and general psychopathology in breast cancer patients: a cross-sectional control study. In Vivo, 24(5), 803-810.

Schattner, E. (2016). The unfortunate reality of rising rate of breast cancer. Retrieved from http://www.forbes.com/sites/elaineschattner/2016/10/21/the-unfortunate-reality-of-a-rising-rate-of-breast-cancer/#471629992de2