title: Fatigue and quality of life in breast cancer survivors: temporal courses and long-term pattern.
abstract: BACKGROUND
  Fatigue is a frequent problem during and after cancer treatment. We investigated different courses of fatigue from pre-diagnosis, through therapy, to long-term survivorship and evaluated potential implications on long-term quality of life (QoL).
  
  
  METHODS
  Breast cancer patients diagnosed in 2001-2005 were recruited in a case-control study in Germany (MARIE). At follow-up in 2009 (median 5.8 years, MARIEplus), patients self-reported current fatigue and QoL status using validated questionnaires (FAQ, EORTC QLQ-C30). In addition, survivors retrospectively rated fatigue levels pre-diagnosis, during different treatment phases, and 1 year post-surgery. Our analyses included 1,928 disease-free cancer survivors and comparisons with fatigue and QoL scores from the general population.
  
  
  RESULTS
  Fatigue levels were substantially increased during chemotherapy and radiotherapy. Among patients who received both therapies, 61.4% reported higher, 30.0% same, and 8.6% lower fatigue levels during chemotherapy compared to radiotherapy. Courses of fatigue varied widely between individuals. Survivors with persisting long-term fatigue had significantly and markedly worse scores for all QoL functions and symptoms about 6 years post-diagnosis than other survivors and compared to the general population. Survivors without substantial fatigue post-treatment had QoL scores largely comparable to the general population.                                               DISCUSSIONS/CONCLUSION:                          Chemotherapy appears to have a stronger impact on fatigue than radiotherapy. Breast cancer survivors may experience long-term QoL comparable to the general population, even when suffering from substantial fatigue during treatment. Yet, persistent fatigue post-treatment may lead to extensive long-term loss in QoL concerning physical, social, cognitive, and financial aspects.
  
  
  CONCLUSIONS
  Fatigue management should be obligatory during and post cancer treatment.
authors.affiliation: Unit of Environmental Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 280, Heidelberg, Germany. m.schmidt@dkfz.de
authors.forename: Martina E
authors.initials: ME
authors.lastname: Schmidt
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
authors.forename: Alina
authors.initials: A
authors.lastname: Vrieling
authors.forename: Judith
authors.initials: J
authors.lastname: Heinz
authors.forename: Dieter
authors.initials: D
authors.lastname: Flesch-Janys
authors.forename: Karen
authors.initials: K
authors.lastname: Steindorf
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects; D016022:Case-Control Studies; D002908:Chronic Disease; D003131:Combined Modality Therapy / Q000009:adverse effects; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy*; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D017741:Survivors; D013629:Tamoxifen / Q000009:adverse effects; D013997:Time Factors
chemical_list: D000970:Antineoplastic Agents; D018931:Antineoplastic Agents, Hormonal; D013629:Tamoxifen