title: Fatigue and relating factors in high-risk breast cancer patients treated with adjuvant standard or high-dose chemotherapy: a longitudinal study.
abstract: OBJECTIVE
  Determine whether standard or high-dose chemotherapy leads to changes in fatigue, hemoglobin (Hb), mental health, muscle and joint pain, and menopausal status from pre- to post-treatment and to evaluate whether fatigue is associated with these factors in disease-free breast cancer patients.
  
  
  METHODS
  Eight hundred eighty-five patients were randomly assigned between two chemotherapy regimens both followed by radiotherapy and tamoxifen. Fatigue was assessed using vitality scale (score < or = 46 defined as fatigue), poor mental health using mental health scale (score < or = 56 defined as poor mental health) both of Short-Form 36, muscle and joint pain with Rotterdam Symptom Checklist, and Hb levels were assessed before and 1, 2, and 3 years after chemotherapy.
  
  
  RESULTS
  Fatigue was reported in 20% of 430 assessable patients (202 standard-dose, 228 high-dose) with at least a 3-year follow-up, without change over time or difference between treatment arms. Mean Hb levels were lower following high-dose chemotherapy. Only 5% of patients experienced fatigue and anemia. Mental health score was the strongest fatigue predictor at all assessment moments. Menopausal status had no effect on fatigue. Linear mixed effect models showed that the higher the Hb level (P = .0006) and mental health score (P < .0001), the less fatigue was experienced. Joint (P < .0001) and muscle pain (P = .0283) were associated with more fatigue.
  
  
  CONCLUSIONS
  In 3 years after treatment, no significant differences in fatigue were found between standard and high-dose chemotherapy. Fatigue did not change over time. The strongest fatigue predictor was poor mental health.
authors.affiliation: University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Nieboer
authors.forename: Ciska
authors.initials: C
authors.lastname: Buijs
authors.forename: Sjoerd
authors.initials: S
authors.lastname: Rodenhuis
authors.forename: Caroline
authors.initials: C
authors.lastname: Seynaeve
authors.forename: Louk V A M
authors.initials: LV
authors.lastname: Beex
authors.forename: Elsken
authors.initials: E
authors.lastname: van der Wall
authors.forename: Dick J
authors.initials: DJ
authors.lastname: Richel
authors.forename: Marianne A
authors.initials: MA
authors.lastname: Nooij
authors.forename: Emile E
authors.initials: EE
authors.lastname: Voest
authors.forename: Pierre
authors.initials: P
authors.lastname: Hupperets
authors.forename: Nanno H
authors.initials: NH
authors.lastname: Mulder
authors.forename: Winette T A
authors.initials: WT
authors.lastname: van der Graaf
authors.forename: Els M
authors.initials: EM
authors.lastname: TenVergert
authors.forename: Harm
authors.initials: H
authors.lastname: van Tinteren
authors.forename: Elisabeth G E
authors.initials: EG
authors.lastname: de Vries
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008593:Menopause; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D010146:Pain; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D012307:Risk Factors; D018709:Statistics, Nonparametric; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents; D006454:Hemoglobins