Fatigue and relating factors in high-risk breast cancer patients treated with adjuvant standard or high-dose chemotherapy: a longitudinal study.
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.
Nieboer
Peter
P
University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Buijs
Ciska
C
Rodenhuis
Sjoerd
S
Seynaeve
Caroline
C
Beex
Louk V A M
LV
van der Wall
Elsken
E
Richel
Dick J
DJ
Nooij
Marianne A
MA
Voest
Emile E
EE
Hupperets
Pierre
P
Mulder
Nanno H
NH
van der Graaf
Winette T A
WT
TenVergert
Els M
EM
van Tinteren
Harm
H
de Vries
Elisabeth G E
EG
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
D000970:Antineoplastic Agents; D006454:Hemoglobins