title: Fatigue During and After Breast Cancer Therapy-A Prospective Study.
abstract: Chronic fatigue (CF) in breast cancer (BC) survivors is multifactorial and may be caused by immune activation triggered by BC or its treatment. In the Neoadjuvant Avastin in Breast Cancer study, BC patients received neoadjuvant chemotherapy (FEC100→taxane) ± bevacizumab, a monoclonal antibody with fatigue as a potential side effect.
  
  
  
  To examine fatigue levels and prevalence of CF before and during chemotherapy and at follow-up, and their associations with C-reactive protein (CRP) and clinical variables.
  
  
  
  Eighty-four HER2-negative patients with cT2-4N0-3M0 BC responded to questionnaires and had CRP measured before treatment (T0), after FEC100 (T1), after taxanes before surgery (T2), and at two-year follow-up (T3).
  
  
  
  The prevalence of CF increased from 8% at T0 to 36% at T3, P < 0.0001. Fatigue levels peaked during chemotherapy from 12.0 at T0 to 20.0 at T2, and declined to 16.7 at T3, P < 0.001. Women with CF at T3 had higher fatigue levels at T0, T2, and T3 than those without CF (P ≤ 0.01). Psychological distress (P = 0.03) and pain (P = 0.04) at T3 were associated with CF at T3. Only psychological distress remained a significant predictor in multivariate analysis. CRP increased from T0 to T1 (P < 0.01) and declined to baseline values at T3, but changes were not associated with bevacizumab treatment. No association was found between bevacizumab or CRP, and fatigue levels or CF.
  
  
  
  Neither bevacizumab treatment nor low-grade systemic inflammation as measured by CRP was associated with the increased fatigue levels and raised prevalence of CF, observed during and after BC therapy. Increased fatigue levels at baseline and psychological distress at T3 were associated with CF at T3.
authors.affiliation: National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway. Electronic address: kvr@ous-hf.no.
authors.forename: Kristin V
authors.initials: KV
authors.lastname: Reinertsen
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Olav
authors.initials: O
authors.lastname: Engebraaten
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway; Department of Behavioral Sciences in Medicine, University of Oslo, Oslo, Norway.
authors.forename: Jon H
authors.initials: JH
authors.lastname: Loge
authors.affiliation: National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway; Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Oslo, Norway.
authors.forename: Milada
authors.initials: M
authors.lastname: Cvancarova
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Naume
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Wist
authors.affiliation: Department of Genetics, Institute for Cancer Research, Oslo University Hospital, Oslo, Norway; Abbvie AS, Fornebu, Norway.
authors.forename: Hege
authors.initials: H
authors.lastname: Edvardsen
authors.affiliation: Department of Oncology, Oslo University Hospital, Oslo, Norway.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Wille
authors.affiliation: Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
authors.forename: Trine
authors.initials: T
authors.lastname: Bjøro
authors.affiliation: National Advisory Unit on Late Effects after Cancer Treatment, Oslo University Hospital, Oslo, Norway.
authors.forename: Cecilie E
authors.initials: CE
authors.lastname: Kiserud
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D000068258:Bevacizumab / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D002097:C-Reactive Protein / Q000378:metabolism; D005221:Fatigue / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D008137:Longitudinal Studies; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D015995:Prevalence; D011446:Prospective Studies; D013315:Stress, Psychological / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D000068258:Bevacizumab; D002097:C-Reactive Protein
keywords: Breast cancer; C-reactive protein (CRP); bevacizumab; chronic fatigue; fatigue