title: Cancer-related fatigue in women with breast cancer: outcomes of a 5-year prospective cohort study.
abstract: OBJECTIVE
  Prolonged and disabling fatigue is prevalent after cancer treatment, but the early natural history of cancer-related fatigue (CRF) has not been systematically examined to document consistent presence of symptoms. Hence, relationships to cancer, surgery, and adjuvant therapy are unclear.
  
  
  METHODS
  A prospective cohort study of women receiving adjuvant treatment for early-stage breast cancer was conducted. Women (n = 218) were enrolled after surgery and observed at end treatment and at 1, 3, 6, 9, and 12 months as well as 5 years. Structured interviews and self-report questionnaires were used to record physical and psychologic health as well as disability and health care utilization. Patients with CRF persisting for 6 months were assessed to exclude alternative medical and psychiatric causes of fatigue. Predictors of persistent fatigue, mood disturbance, and health care utilization were sought by logistic regression.
  
  
  RESULTS
  The case rate for CRF was 24% (n = 51) postsurgery and 31% (n = 69) at end of treatment; it became persistent in 11% (n = 24) at 6 months and 6% (n = 12) at 12 months. At each time point, approximately one third of the patients had comorbid mood disturbance. Persistent CRF was predicted by tumor size but not demographic, psychologic, surgical, or hematologic parameters. CRF was associated with significant disability and health care utilization.
  
  
  CONCLUSIONS
  CRF is common but generally runs a self-limiting course. Much of the previously reported high rates of persistent CRF may be attributable to factors unrelated to the cancer or its treatment.
authors.affiliation: Prince of Wales Hospital, Randwick, Australia. d.goldstein@unsw.edu.au
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Bennett
authors.forename: Kate
authors.initials: K
authors.lastname: Webber
authors.forename: Fran
authors.initials: F
authors.lastname: Boyle
authors.forename: Paul L
authors.initials: PL
authors.lastname: de Souza
authors.forename: Nicholas R C
authors.initials: NR
authors.lastname: Wilcken
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Scott
authors.forename: Ruth
authors.initials: R
authors.lastname: Toppler
authors.forename: Penelope
authors.initials: P
authors.lastname: Murie
authors.forename: Linda
authors.initials: L
authors.lastname: O'Malley
authors.forename: Junie
authors.initials: J
authors.lastname: McCourt
authors.forename: Michael
authors.initials: M
authors.lastname: Friedlander
authors.forename: Ian B
authors.initials: IB
authors.lastname: Hickie
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Lloyd
mesh_terms: D000328:Adult; D000339:Affect; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D016009:Chi-Square Distribution; D015897:Comorbidity; D004185:Disability Evaluation; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D016015:Logistic Models; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D009517:New South Wales; D016017:Odds Ratio; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden