Background Although fatigue is a common and distressing symptom in cancer survivors, the mechanism of fatigue is not fully understood. Therefore, this study aims to investigate the relation between the fatigue and mindfulness of breast cancer survivors using anxiety, depression, pain, loneliness, and sleep disturbance as mediators. Methods Path analysis was performed to examine direct and indirect associations between mindfulness and fatigue. Participants were breast cancer survivors who visited a breast surgery department at a university hospital in Japan for hormonal therapy or regular check-ups after treatment. The questionnaire measured cancer-related-fatigue, mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance. Demographic and clinical characteristics were collected from medical records. Results Two-hundred and seventy-nine breast cancer survivors were registered, of which 259 answered the questionnaire. Ten respondents with incomplete questionnaire data were excluded, resulting in 249 participants for the analyses. Our final model fit the data well (goodness of fit index = .993; adjusted goodness of fit index = .966; comparative fit index = .999; root mean square error of approximation = .016). Mindfulness, anxiety, depression, pain, loneliness, and sleep disturbance were related to fatigue, and mindfulness had the most influence on fatigue (β = - .52). Mindfulness affected fatigue not only directly but also indirectly through anxiety, depression, pain, loneliness, and sleep disturbance. Conclusions The study model helps to explain the process by which mindfulness affects fatigue. Our results suggest that mindfulness has both direct and indirect effects on the fatigue of breast cancer survivors and that mindfulness can be used to more effectively reduce their fatigue. It also suggests that health care professionals should be aware of factors such as anxiety, depression, pain, loneliness, and sleep disturbance in their care for fatigue of breast cancer survivors. Trial registration This study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN number. 000027720) on June 12, 2017.

中文翻译：

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正念与乳腺癌女性疲劳之间的关系：路径分析。

背景 虽然疲劳是癌症幸存者常见且令人痛苦的症状，但疲劳的机制尚不完全清楚。因此，本研究旨在以焦虑、抑郁、疼痛、孤独和睡眠障碍为中介，调查乳腺癌幸存者的疲劳和正念之间的关系。方法进行路径分析以检查正念和疲劳之间的直接和间接关联。参与者是乳腺癌幸存者，他们前往日本大学医院的乳腺外科进行激素治疗或治疗后的定期检查。该问卷测量了与癌症相关的疲劳、正念、焦虑、抑郁、疼痛、孤独和睡眠障碍。从医疗记录中收集人口统计学和临床​​特征。结果登记乳腺癌幸存者279人，其中259人回答了问卷。问卷数据不完整的 10 名受访者被排除在外，共有 249 名参与者进行分析。我们的最终模型很好地拟合了数据（拟合优度指数 = .993；调整后的拟合优度指数 = .966；比较拟合指数 = .999；近似的均方根误差 = .016）。正念、焦虑、抑郁、疼痛、孤独和睡眠障碍与疲劳有关，而正念对疲劳的影响最大（β = - .52）。正念不仅直接影响疲劳，还通过焦虑、抑郁、疼痛、孤独和睡眠障碍间接影响疲劳。结论 该研究模型有助于解释正念影响疲劳的过程。我们的研究结果表明，正念对乳腺癌幸存者的疲劳有直接和间接的影响，并且正念可以用来更有效地减轻他们的疲劳。它还建议医疗保健专业人员在护理乳腺癌幸存者的疲劳时应注意焦虑、抑郁、疼痛、孤独和睡眠障碍等因素。试验注册 本研究于 2017 年 6 月 12 日在大学医院医学信息网络临床试验注册中心（UMIN 编号：000027720）注册。和睡眠障碍在他们照顾乳腺癌幸存者的疲劳。试验注册 本研究于 2017 年 6 月 12 日在大学医院医学信息网络临床试验注册中心（UMIN 编号：000027720）注册。和睡眠障碍在他们照顾乳腺癌幸存者的疲劳。试验注册 本研究于 2017 年 6 月 12 日在大学医院医学信息网络临床试验注册中心（UMIN 编号：000027720）注册。