Determinants of long-term fatigue in breast cancer survivors: results of a prospective patient cohort study.
OBJECTIVE
Fatigue is among the most distressing symptoms across the breast cancer continuum. However, little is known about the factors contributing to long-term persisting fatigue. Therefore, we explored determinants of long-term physical, affective, and cognitive fatigue in a prospective cohort of breast cancer patients.


METHODS
Breast cancer patients recruited in a population-based case-control study (MARIE study) provided comprehensive data on sociodemographics, lifestyle, and preexisting medical conditions. At follow-up (median 6.3 years post-diagnosis, MARIEplus), disease-free cancer survivors (N = 1928) reported current fatigue using a validated multidimensional questionnaire. Additionally, survivors retrospectively rated their fatigue levels before diagnosis, during the treatment phase, and 1 year post-surgery. Linear regression analyses were performed.


RESULTS
As major determinants of long-term physical, affective, and cognitive fatigue, multiple regression analyses revealed preexisting psychological or depressive disorders, migraine, analgesic use, peripheral arterial obstructive disease (PAOD), and arthritis. A physically inactive lifestyle and obesity were associated with persisting physical fatigue. Aromatase inhibitors were also associated with long-term fatigue, especially cognitive fatigue. Chemotherapy and, to a lower extent, radiotherapy were major contributors to the development of fatigue during the treatment phase, yet were not associated with long-term fatigue.


CONCLUSIONS
Although the development of fatigue in breast cancer patients seems largely impacted by cancer therapy, for the long-term persistence of fatigue, preexisting medical or psychological conditions related to depression or pain and lifestyle factors appear to be more relevant. Physicians, psycho-oncologists, and researchers may need to distinguish between acute fatigue during therapy and long-term persisting fatigue with regard to its pathophysiology and treatment.
German Cancer Research Center, Heidelberg, Germany.
Martina E
ME
Schmidt
Jenny
J
Chang-Claude
Petra
P
Seibold
Alina
A
Vrieling
Judith
J
Heinz
Dieter
D
Flesch-Janys
Karen
K
Steindorf
D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D047072:Aromatase Inhibitors / Q000627:therapeutic use*; D001168:Arthritis / Q000453:epidemiology; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000628:therapy; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D005221:Fatigue / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D005222:Mental Fatigue / Q000453:epidemiology; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000453:epidemiology*; D011446:Prospective Studies; D011878:Radiotherapy; D012307:Risk Factors; D057185:Sedentary Behavior; D017741:Survivors
D000700:Analgesics; D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors
breast cancer; determinants; fatigue; oncology; survivorship