Fatigue and relating factors in high-risk breast cancer patients treated with adjuvant standard or high-dose chemotherapy: A longitudinal study

University of Groningen, Groningen, Groningen, Netherlands
Journal of Clinical Oncology (Impact Factor: 18.43). 11/2005; 23(33):8296-304. DOI: 10.1200/JCO.2005.10.167
Source: PubMed


Determine whether standard or high-dose chemotherapy leads to changes in fatigue, hemoglobin (Hb), mental health, muscle and joint pain, and menopausal status from pre- to post-treatment and to evaluate whether fatigue is associated with these factors in disease-free breast cancer patients.
Eight hundred eighty-five patients were randomly assigned between two chemotherapy regimens both followed by radiotherapy and tamoxifen. Fatigue was assessed using vitality scale (score < or = 46 defined as fatigue), poor mental health using mental health scale (score < or = 56 defined as poor mental health) both of Short-Form 36, muscle and joint pain with Rotterdam Symptom Checklist, and Hb levels were assessed before and 1, 2, and 3 years after chemotherapy.
Fatigue was reported in 20% of 430 assessable patients (202 standard-dose, 228 high-dose) with at least a 3-year follow-up, without change over time or difference between treatment arms. Mean Hb levels were lower following high-dose chemotherapy. Only 5% of patients experienced fatigue and anemia. Mental health score was the strongest fatigue predictor at all assessment moments. Menopausal status had no effect on fatigue. Linear mixed effect models showed that the higher the Hb level (P = .0006) and mental health score (P < .0001), the less fatigue was experienced. Joint (P < .0001) and muscle pain (P = .0283) were associated with more fatigue.
In 3 years after treatment, no significant differences in fatigue were found between standard and high-dose chemotherapy. Fatigue did not change over time. The strongest fatigue predictor was poor mental health.

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    • "A Dutch study (n = 430) found that 20% of breast cancer patients report persistent fatigue, without any improvement over a 3-year follow-up period. The strongest predictors of fatigue among these patients were mental health score, hemoglobin levels, joint pain and muscle pain.17 "
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    Integrative Medicine Insights 01/2013; 8(8):1-8. DOI:10.4137/IMI.S10841
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    • "No formal cut-off is established to distinguish those with high levels of positive mental health or 'flourishing' from those with lower levels. For the purposes of this study, following Nieboer et al. (2005) and Braunholtz and Scotland Social Research (2007), a cut-off point was generated to identify a 'high energy and vitality group' (High EVI), based on EVI scores that were equal to or over one standard deviation above the mean (i.e. 87 in the current sample) indicating optimal levels of mental health or 'flourishing'. "
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    International Journal of Public Health 04/2012; 57(2):421-30. DOI:10.1007/s00038-011-0317-x · 2.70 Impact Factor
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    • "Although we are unaware of any studies that have simultaneously assessed inflammation and fatigue before and after treatment to date, one study demonstrated that the number of fatigued breast cancer survivors remain constant before and 1, 2, and 3 years post-treatment (Nieboer et al., 2005). Furthermore, fatigue remained stable among a proportion of these women across time points (Nieboer et al., 2005). Based on evidence linking inflammation and fatigue among long-term breast cancer survivors, pretreatment differences in the steady state expression of latent herpesviruses could be an important biomarker for persistent fatigue. "
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