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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    ABSTRACT: The treatment of breast cancer invariably results in severe and often debilitating symptoms that can cause significant distress and severely impair daily function and quality-of-life (QOL). We treated a series of 20 female breast cancer patients with the botanical compound LCS101 as adjuvant to conventional chemotherapy. At the end of the treatment regimen, patients rated their symptoms. 70% reported that they had either no or mildly severe levels of fatigue; 60% none to mildly severe weakness; 85% none to mildly severe pain; 70% none to mildly severe nausea; and 80% none to mildly severe vomiting. Only 20% reported severe impairment of overall function, and only 40% severely impaired QOL. No toxic effects were attributed by patients to the LCS101 treatment, and 85% reported that they believed the botanical compound had helped reduce symptoms. The effects of LCS101 on clinical outcomes in breast cancer should be tested further using randomized controlled trials.
    Full-text · Article · Jan 2013 · Integrative Medicine Insights
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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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    ABSTRACT: This paper examines the relationships between indicators of positive and negative dimensions of mental health, social well-being and physical health. The paper reports on data collected in the third National Survey of Lifestyle, Attitudes and Nutrition (SLÁN 2007), a cross-sectional survey conducted with a representative sample of 10,364 Irish adults. The survey included measures of positive mental health and non-specific psychological distress from the SF-36 questionnaire, together with measures of social well-being, subjective health, and selected health behaviours. Positive mental health is predicted by lower levels of loneliness and higher levels of social support. Better self-rated health, positive health behaviours and lower GP consultation rates are associated with higher levels of positive mental health. Lower levels of social well-being, were found to be the strongest predictors of negative mental health. Social well-being and health behaviours correlate with both positive and negative mental health. These findings highlight the need to endorse comprehensive approaches to population mental health promotion. The inclusion of both positive and negative mental health indicators in future population health surveys is supported by the findings.
    Full-text · Article · Apr 2012 · International Journal of Public Health
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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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    ABSTRACT: Fatigue is a notable clinical problem in cancer survivors, and understanding its pathophysiology is important. The current study sought to determine biomarkers of fatigue that exist before cancer treatment. Relationships between the expression of latent Epstein-Barr virus (EBV) and cytomegalovirus (CMV) and fatigue were examined in 158 women newly diagnosed with breast cancer or awaiting a positive diagnostic result. Higher CMV antibody titers, but not EBV antibody titers, were associated with a greater likelihood of being fatigued. Associations between fatigue and higher CMV antibody titers remained after controlling for alcohol use, smoking, comorbidities, depressive symptoms, age, BMI, cancer stage, and sleep problems. More sleep problems and higher levels of depressive symptoms were also associated with a greater likelihood of being fatigued. CMV antibody titers, but not EBV antibody titers, were associated with higher levels of C-reactive protein (CRP), but CRP was not associated with fatigue. When the cellular immune system is compromised, reactivation of latent herpesviruses may fuel chronic inflammatory responses. Prior work has suggested that fatigue may be related to inflammation and its associated sickness behaviors; accordingly, our findings may be tapping into this same physiological substrate.
    Full-text · Article · Mar 2012 · Brain Behavior and Immunity
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