Factors predicting clinically significant fatigue in women following treatment for primary breast cancer

• Published in: Supportive care in cancer Vol. 19; no. 10; pp. 1581 - 1591
• Main Authors: Gerber, Lynn H., Stout, Nicole, McGarvey, Charles, Soballe, Peter, Shieh, Ching-yi, Diao, Guoqing, Springer, Barbara A., Pfalzer, Lucinda A.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.10.2011; Springer; Springer Nature B.V
• Subjects: Adult; Age Factors; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Body Mass Index; Breast cancer; Breast Neoplasms - physiopathology; Breast Neoplasms - therapy; Cancer; Chemotherapy; Drug therapy; Fatigue; Fatigue - epidemiology; Fatigue - etiology; Female; Follow-Up Studies; Glucose metabolism; Hemoglobin; Humans; Leukocyte Count; Leukocytes; Medicine; Medicine & Public Health; Middle Aged; Motor Activity; Nuclear radiation; Nursing; Nursing Research; Oncology; Original; Original Article; Pain Medicine; Postmenopausal women; Prospective Studies; Rehabilitation Medicine; Sleep; Function; Fatigue; Breast cancer; Rehabilitation
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-010-0986-7

Cancer-related fatigue is common, complex, and distressing. It affects 70–100% of patients receiving chemotherapy and a significant number who have completed their treatments. We assessed a number of variables in women newly diagnosed with primary breast cancer (BrCa) to determine whether biological and/or functional measures are likely to be associated with the development of clinically significant fatigue (CSF). Two hundred twenty-three women participated in a study designed to document the impact of the diagnosis and treatment of primary breast cancer on function. Forty-four had complete data on all variables of interest at the time of confirmed diagnosis but prior to treatment (baseline) and ≥9 months post-diagnosis. Objective measures and descriptive variables included history, physical examination, limb volume, hemoglobin, white blood cell count, and glucose. Patient-reported outcomes included a verbal numerical rating of fatigue (0–10, a score of ≥4 was CSF), five subscales of the SF-36, Physical Activity Survey, and Sleep Questionnaire. At baseline, the entire cohort ( n  = 223) and the subset ( n  = 44) were not significantly different for demographic, biological, and self-reported data, except for younger age ( p  = 0.03) and ER+ ( p  = 0.01). Forty-five percent had body mass index (BMI) ≥ 25, 52% were post-menopause, and 52% received modified radical mastectomy, 39% lumpectomy, 52% chemotherapy, 68% radiation, and 86% hormonal therapy. Number of patients with CSF increased from 1 at baseline to 11 at ≥9 months of follow-up. CSF at ≥9 months significantly correlated with BMI ≥ 25, abnormal white blood cell count, and increase in limb volume and inversely correlated with vigorous activity and physical function ( p  < 0.05). Fatigue increases significantly following the treatment of BrCa. Predictors of CSF include high BMI and WBC count, increase in limb volume, and low level of physical activity. These are remediable.