Clinical Indicators of Psychosocial Distress Predict for Acute Radiation-Induced Fatigue in Patients Receiving Adjuvant Radiation Therapy for Breast Cancer: An Analysis of Patient-Reported Outcomes.
To assess the magnitude and predictors of patient-reported fatigue among breast cancer patients receiving radiation therapy (RT).



Patients receiving breast RT completed a survey querying fatigue at each weekly on-treatment visit. Patient-reported fatigue severity and interference was assessed on an ordinal scale of 0 to 4, using a validated scoring system. Baseline anxiety and depression scores were also obtained. The kinetics of mean fatigue scores per week and the maximum fatigue scores over the course of the entire treatment were assessed, and clinical predictors were identified by univariate and multivariate regression.



The average fatigue severity and interference scores were 0.6 and 0.46. The average fatigue scores increased to an equivalent extent from week to week, with expected increases of 0.99 in fatigue severity and 0.85 in interference over 7 weeks. Patients treated with hypofractionated RT (HF-RT) versus conventionally fractionated RT (CF-RT) had significantly fewer maximum fatigue severity or interference scores that were >2 (ie, severe or very severe; 29% vs 10% for severity, and 26% vs 8% for interference, P<.01). Age ≤45 years, presence of psychiatric/pain-related comorbidities, and baseline sadness and anxiety severity were predictive of average and maximum fatigue scores (P<.05), but variables related to treatment intensity (eg, mastectomy vs lumpectomy, chemotherapy use, radiation target volumes) and other host factors (working, children, marital status, proximity to RT facility) were not.



Patient-reported fatigue modestly increases over RT courses, with less maximum fatigue reported with HF-RT. Younger age and baseline sadness, anxiety, and psychiatric/pain-related comorbidities are powerful predictors of fatigue, whereas other factors, such as treatment intensity, are not. Future studies will investigate interventions for patients at high risk for fatigue.
Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Amar U
AU
Kishan
Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Pin-Chieh
PC
Wang
Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Jamal
J
Sharif
Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Patrick A
PA
Kupelian
Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Michael L
ML
Steinberg
Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California. Electronic address: smccloskey@mednet.ucla.edu.
Susan A
SA
McCloskey
D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000532:radiotherapy*; D015984:Causality; D015897:Comorbidity; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data; D005221:Fatigue / Q000523:psychology*; D005260:Female; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D011832:Radiation Injuries / Q000453:epidemiology / Q000523:psychology*; D018714:Radiotherapy, Adjuvant / Q000523:psychology* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012307:Risk Factors; D057566:Self Report; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D016896:Treatment Outcome