title: Factors predicting clinically significant fatigue in women following treatment for primary breast cancer.
abstract: 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.
authors.affiliation: George Mason University, Fairfax, VA, USA. ngerber1@gmu.edu
authors.forename: Lynn H
authors.initials: LH
authors.lastname: Gerber
authors.forename: Nicole
authors.initials: N
authors.lastname: Stout
authors.forename: Charles
authors.initials: C
authors.lastname: McGarvey
authors.forename: Peter
authors.initials: P
authors.lastname: Soballe
authors.forename: Ching-yi
authors.initials: CY
authors.lastname: Shieh
authors.forename: Guoqing
authors.initials: G
authors.lastname: Diao
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Springer
authors.forename: Lucinda A
authors.initials: LA
authors.lastname: Pfalzer
mesh_terms: D000328:Adult; D000367:Age Factors; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000503:physiopathology* / Q000628:therapy*; D005221:Fatigue / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007958:Leukocyte Count; D008875:Middle Aged; D009043:Motor Activity; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents