Subscribe to RSS
Prevalence, Characteristics, and Correlates of Fatigue in Indian Breast Cancer Survivors: A Cross-Sectional Study
Background Fatigue is one of the commonest sequelae of breast cancer treatment that adversely impacts quality of life (QOL) of breast cancer survivors (BCSs). However, very limited data are available about cancer-related fatigue in Indian patients. Hence, this study was planned with the objectives to study (1) prevalence of fatigue in short-, intermediate-, and long-term follow-up; (2) severity and characteristics of fatigue; (3) impact of fatigue on QOL; and (4) correlation of fatigue with other survivorship issues.
Materials and Methods The study was conducted on (n = 230) BCSs who had completed their primary treatment (surgery, radiotherapy, and chemotherapy) and were coming for follow-up. The prevalence of fatigue was noted from a screening tool, which comprised of 14 commonly reported survivorship issues. Assessment of fatigue was done by using survivorship fatigue assessment tool-1 score and QOL was assessed by functional assessment of cancer therapy-breast (FACT-B) questionnaires. To understand how fatigue evolved over time, survivors were divided into three groups according to the time elapsed since initial treatment: Group 1: <2 years (n = 105); Group 2: 2–5 years (n = 70); Group 3: >5 years (n = 55).
Statistical Analysis Data was analyzed by using simple descriptive statistics, one way analysis of variance followed by Tukey's test for comparison of quantitative data among the three groups, and Pearson correlation coefficients for association of fatigue with other survivorship issues.
Results Clinically significant fatigue (≥4) was noted in 38% of BCSs. However, high overall prevalence of fatigue (60%) was seen, which persisted in long-term survivors (51%) as well. Severity of fatigue was mostly mild (37.7%) to moderate (47.1%). Fatigue scores were significantly higher in short-term survivors (5.01 ± 2.06) than intermediate- (4.03 ± 1.42) and long-term BCSs (3.57 ± 1.37). The mean score on FACT-B was 90.07 ± 10.17 in survivors with fatigue and 104.73 ± 7.13 in those without fatigue (p = 0.000). Significant correlation of fatigue was seen with other survivorship issues like limb swelling, chronic pain, premature menopause, and its related symptoms and emotional distress.
Conclusion Fatigue is highly prevalent in BCSs. Survivorship care programs should include appropriate measures to evaluate and address fatigue.
Source(s) of Support
Study approved by the Institutional Review Board and Ethics Committee.
Article published online:
23 August 2022
© 2022. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
- 1 Mock V, Atkinson A, Barsevick A. et al; National Comprehensive Cancer Network. NCCN practice guidelines for cancer-related fatigue. Oncology (Williston Park) 2000; 14 (11A): 151-161
- 2 Bower JE. Cancer-related fatigue–mechanisms, risk factors, and treatments. Nat Rev Clin Oncol 2014; 11 (10) 597-609
- 3 Kim SH, Son BH, Hwang SY. et al. Fatigue and depression in disease-free breast cancer survivors: prevalence, correlates, and association with quality of life. J Pain Symptom Manage 2008; 35 (06) 644-655
- 4 Bower JE, Ganz PA, Desmond KA. et al. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer 2006; 106 (04) 751-758
- 5 Curt GA, Breitbart W, Cella D. et al. Impact of cancer-related fatigue on the lives of patients: new findings from the fatigue coalition. Oncologist 2000; 5 (05) 353-360
- 6 Groenvold M, Petersen MA, Idler E, Bjorner JB, Fayers PM, Mouridsen HT. Psychological distress and fatigue predicted recurrence and survival in primary breast cancer patients. Breast Cancer Res Treat 2007; 105 (02) 209-219
Screening for fatigue assessment tool (SFAT-1) NCCN Guidelines Version 1.
2013 www.nccn.org Accessed April 2014
8 www.facit.org/LiteratureRetrieve.aspx?ID=42249 Accessed May 7, 2022
- 9 Brady MJ, Cella DF, Mo F. et al. Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol 1997; 15 (03) 974-986
- 10 Cella DF, Tulsky DS, Gray G. et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 1993; 11 (03) 570-579
- 11 Patel V, Kirkwood BR, Weiss H. et al. Chronic fatigue in developing countries: population based survey of women in India. BMJ 2005; 330 (7501): 1190
- 12 Minton O, Stone P. How common is fatigue in disease-free breast cancer survivors? A systematic review of the literature. Breast Cancer Res Treat 2008; 112 (01) 5-13
- 13 Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 2000; 18 (04) 743-753
- 14 Servaes P, Verhagen C, Bleijenberg G. Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions. Eur J Cancer 2002; 38 (01) 27-43
- 15 Prue G, Rankin J, Allen J, Gracey J, Cramp F. Cancer-related fatigue: a critical appraisal. Eur J Cancer 2006; 42 (07) 846-863
- 16 Tabrizi FM, Alizadeh S. Cancer related fatigue in breast cancer survivors: in correlation to demographic factors. Maedica (Bucur) 2017; 12 (02) 106-111
- 17 Abrahams HJG, Gielissen MFM, Schmits IC, Verhagen CAHHVM, Rovers MM, Knoop H. Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12 327 breast cancer survivors. Ann Oncol 2016; 27 (06) 965-974
- 18 Mao H, Bao T, Shen X. et al. Prevalence and risk factors for fatigue among breast cancer survivors on aromatase inhibitors. Eur J Cancer 2018; 101: 47-54
- 19 Bauml J, Chen L, Chen J. et al. Arthralgia among women taking aromatase inhibitors: is there a shared inflammatory mechanism with co-morbid fatigue and insomnia?. Breast Cancer Res 2015; 17: 89-91
- 20 Haghighat S, Akbari ME, Holakouei K, Rahimi A, Montazeri A. Factors predicting fatigue in breast cancer patients. Support Care Cancer 2003; 11 (08) 533-538
- 21 Ruiz-Casado A, Álvarez-Bustos A, de Pedro CG, Méndez-Otero M, Romero-Elías M. Cancer-related fatigue in breast cancer survivors: a review. Clin Breast Cancer 2021; 21 (01) 10-25
- 22 Bjerkeset E, Röhrl K, Schou-Bredal I. Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: prevalence and characteristics. Breast Cancer Res Treat 2020; 180 (01) 63-71
- 23 Meeske K, Smith AW, Alfano CM. et al. Fatigue in breast cancer survivors two to five years post diagnosis: a HEAL Study report. Qual Life Res 2007; 16 (06) 947-960
- 24 Reinertsen KV, Cvancarova M, Loge JH, Edvardsen H, Wist E, Fosså SD. Predictors and course of chronic fatigue in long-term breast cancer survivors. J Cancer Surviv 2010; 4 (04) 405-414
- 25 Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2012; 11: CD006145
- 26 Gielissen MF, Verhagen S, Witjes F, Bleijenberg G. Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. J Clin Oncol 2006; 24 (30) 4882-4887
- 27 Minton O, Richardson A, Sharpe M, Hotopf M, Stone P. A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. J Natl Cancer Inst 2008; 100 (16) 1155-1166
- 28 Kim S, Ko YH, Song Y. et al. Pre-post analysis of a social capital-based exercise adherence intervention for breast cancer survivors with moderate fatigue: a randomized controlled trial. Support Care Cancer 2020; 28 (11) 5281-5289