Fatigue in breast cancer patients on adjuvant treatment: course and prevalence

Kazi S Manir, Kallol Bhadra, Gaurav Kumar, Amitabha Manna, Niladri B Patra, Shyamal K Sarkar, Kazi S Manir, Kallol Bhadra, Gaurav Kumar, Amitabha Manna, Niladri B Patra, Shyamal K Sarkar

Abstract

Introduction: Fatigue is a major complain in breast cancer patients and survivors. Patterns and degree varies with schedule and type of the treatment. Different co-factors may aggravate fatigue. Multimodal approach is helpful in managing fatigue.

Aim: To quantify prevalence, course and degree of fatigue in breast cancer patients on adjuvant treatment and effectiveness of different management approach.

Materials and methods: One Hundred and ten post-mastectomy breast cancer patients (Stage I to Stage III) were assessed. Patients on chemotherapy were assessed one week before, day after chemotherapy and two weeks later in every cycle. Patients on External Beam Radiation Therapy (EBRT) were assessed one week before and every week during radiation. Assessment was continued on second and fourth week of follow up. Functional Assessment of Chronic Illness Therapy - Fatigue subscale (FACIT-F) was used for assessment. Significant cofactors were also searched for.

Results: Eighty four percent patients experienced fatigue. Fatigue was more prevalent during chemotherapy (91%) than EBRT (77%). Patients on Chemotherapy exhibit peak fatigue day after Chemotherapy and decreased level until the next cycle. Significant increase of fatigue was seen only in first cycle. Patient on EBRT had gradually increased fatigue during the course of treatment. Lower degree of fatigue was present in post treatment period. Anemia was a significant cofactor causing fatigue (P < 0.05). Blood Transfusion improved fatigue scores.

Conclusion: Fatigue increases during chemotherapy and or EBRT. Different intervention strategies are needed to address the issue.

Keywords: Breast cancer; Chemotherapy; External beam radiation therapy; Fatigue.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Changes in FACIT-F, FACT-G, FACIT Total score in different assessments during first cycle of chemotherapy, showing the mean value of these three parameters in different assessments
Figure 2
Figure 2
Changes in FACIT-F, FACT-G, FACIT Total score in different assessments during chemotherapy, showing the mean value of these three parameters on the day after chemotherapy
Figure 3
Figure 3
Changes in FACIT-F, FACT-G, FACIT Total score in different assessments during radiation therapy, showing the mean value of these three parameters in different assessments
Figure 4
Figure 4
Changes in FACIT-F, FACT-G, FACIT Total score in different assessments during radiation therapy, showing the mean value of these three parameters in different assessments
Figure 5
Figure 5
Changes in FACIT-F, FACT-G,PWB, SWB, EWB, and FWB in pretreatment assessment, showing the mean value of these three parameters
Figure 6
Figure 6
Changes in FACIT-F, FACT-G,PWB, SWB, EWB, and FWB during post-treatment week 2 assessment, showing the mean value of these three parameters
Figure 7
Figure 7
Changes in FACIT-F, FACT-G,PWB, SWB, EWB, and FWB during post-treatment week 4 assessments, showing the mean value of these three parameters

References

    1. Prue G, Rankin J, Allen J, Gracy J, Cramp F. Cancer-related fatigue: A critical appraisal. Eur J Cancer. 2006;42:846–63.
    1. Fosså SD, Dahl AA, Loge JH. Fatigue, anxiety, and depression in long-term survivors of testicular cancer. J ClinOncol. 2003;21:1249–54.
    1. Clinical practice guidelines forcancer-related fatigue. NCCN guideline version 1.2012 updates. National Comprehensive Cancer Network. [Last accessed on 12/4/2012]. Available from: .
    1. Barsevick AM, Whitmer K, Walker L. In their own words: Using the common sense model toanalyze patient descriptions of cancer-related fatigue. OncolNurs Forum. 2001;28:1363–9.
    1. Greene D, Nail LM, Fieler VK, Dudgeon D, Jones LS. A comparison of patient-reported side effects among three chemotherapy regimens for breast cancer. Cancer Pract. 1994;2:57–62.
    1. Sitzia J, Huggins L. Side effects of cyclophosphamide, methotrexate, and5-fluorouracil (CMF) chemotherapy for breast cancer. Cancer Pract. 1998;6:13–21.
    1. Jacobsen PB, Hann DM, Azzarello LM, Horton J, Balducci L, Lyman GH. Fatigue in women receiving adjuvant chemotherapy for breast cancer: Characteristics, course, and correlate. J Pain Symptom Manage. 1999;18:233–42.
    1. Berger AM, Higginbotham P. Correlates of fatigue during and following adjuvant breastcancer chemotherapy: A pilot study. OncolNurs Forum. 2000;27:1443–8.
    1. Rucinska M, Langkjer ST. Radiotherapy-related fatigue in breast cancer patients. 2005 ASCO Annual Meeting Proceedings. J ClinOncol. 2005;23(16S, Part I of II (June 1 Supplement)):8267.
    1. Blair S, Bardwell WA, Podbelewicz-Schuller Y. Hemoglobin and fatigue in women undergoing adjuvant chemotherapy: Discussion. Clin Breast Cancer. 2008;8:522–6.
    1. Cella DF. Manual of the functional assessment of chronic illness therapy (FACIT) scales.Version 4.Evanston, Ill: Evanston Northwestern Healthcare. 1997
    1. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E. Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage. 1997;13:63–74.
    1. Cella DF, Bonomi AE, Leslie WT, Von Roenn J, Tchekmeydian NS. Quality of life and nutritional wellbeing, Measurements and relationship. Oncology. 1993;79(suppl):105–11.
    1. Minton O, Stone P. A systematic review of the scales used for the measurement ofcancer-relatedfatigue(CRF) Ann Oncol. 2009;20:17–25.
    1. Cella DF, Webster K, Yost K. MID:Minimally Important Difference value. Health Qual Life Outcomes. 2003;1:79.
    1. Guyatt GH, Osoba D, Wu AW, Wyrwich KW, Norman GR. Methods to explain the clinical significance of health status measures. Mayo ClinProc. 2002;77:371–83.
    1. Webster K, Cella DF, Yost K. The functional assessment of chronicillnesstherapy (FACIT) measurement system: Properties, applications, and interpretation. Health Qual Life Outcomes. 2003;1:79.
    1. Yost K, Eton DT. Combining distribution- and anchor-based approaches to determine minimally important differences: The FACIT experience. Eval Health Prof. 2005;28:172–91.
    1. de Jong N, Candel MJ, Schouten HC, Abu-Saad HH, Courtens AM. Prevalence and course of fatigue in breast cancer patients receiving adjuvant chemotherapy. Ann Oncol. 2004;15:896–905.
    1. Janaki MG, Kadam AR, Mukhesh S, Nirmala S, Ponni A, Ramesh BS, et al. Magnitude of fatigue in cancer patients receiving radiotherapy and its short term effect on quality of life. J Can Res Ther. 2010;6:22–6.
    1. Irvine DM, Vincent L, Graydon JE, Diane M, Bubela N. Fatigue in women with breast cancer receiving radiation therapy. Cancer Nurs. 1998;21:127–35.
    1. Robert L, Askew BA, Xing Y, Cella DF, Lemuel AM, Janice NC, et al. Evaluating minimal important differences for the FACT-Melanoma quality of life questionnaire. Value Health. 2009;12:1144–50.
    1. So-Osman C, Nelissen R, Brand R, Brand A, Stiggelbout AM. Postoperative anemia after joint replacement surgery is not related to quality of life during the first two weeks postoperatively. Transfusion. 2011;51:71–81.
    1. Prick BW, Gerard Jansen AJ, EricSteegers AP, Wim CJ, Essink-Bot ML, Uyl-de Groot CA. Dallas, Texas: Am J Obstet Gynecol; 2012. RBC transfusion leads to an improvement of physicalfatigue in women with acute postpartum anemia:The WOMB study: Abstract No 64.Annual Meeting, Society for Maternal and Fetal Medicine (Feb 06-11, 2012) (January supplement)

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren