Do all patients with cancer experience fatigue? A longitudinal study of fatigue trajectories in women with breast cancer

Abstract

BACKGROUND: Fatigue is a common and expected side effect of cancer treatment. However, the majority of studies to date have focused on average levels of fatigue, which may obscure important individual differences in the severity and course of fatigue over time. The current study was designed to identify distinct trajectories of fatigue from diagnosis into survivorship in a longitudinal study of women with early-stage breast cancer. METHODS: Women with stage 0 to stage IIIA breast cancer (270 women) were recruited before (neo)adjuvant therapy with radiotherapy, chemotherapy, and/or endocrine therapy and completed assessments at baseline; posttreatment; and at 6 months, 12 months, and 18 months of follow-up. Growth mixture modeling was used to identify trajectories of fatigue, and differences among the trajectory groups with regard to demographic, medical, and psychosocial variables were examined. RESULTS: Five distinct trajectories of fatigue were identified: Stable Low (66%), with low levels of fatigue across assessments; Stable High (13%), with high fatigue across assessments; Decreasing (4%), with high fatigue at baseline that resolved over time; Increasing (9%), with low fatigue at baseline that increased over time; and Reactive (8%), with increased fatigue after treatment that resolved over time. Both psychological and treatment-related factors were found to be associated with fatigue trajectories, with psychological factors most strongly linked to high fatigue at the beginning of and over the course of treatment. CONCLUSIONS: There is considerable variability in the experience of fatigue among women with early-stage breast cancer. Although the majority of women report relatively low fatigue, those with a history of depression and elevated psychological distress may be at risk of more severe and persistent fatigue.

Long-Term Longitudinal Patterns of Patient-Reported Fatigue After Breast Cancer: A Group-Based Trajectory Analysis

“… 15 Recently, the same authors identified consistent trajectories among 270 BC survivors, defining five fatigue groups: stable low (66%), stable high (13%), decreasing (4%), increasing (9%), and reactive (8%). 28 Our study confirms and expands on these previous studies. Particularly, our study calls for the implementation of several actions in the clinical care of patients with BC.…”

Predictors of cancer‐related fatigue in women with breast cancer undergoing 21 days of a cyclic chemotherapy

“…Anxiety and depression ranked as the first predictors of change in CRF, similar to the Fabi et al (2017) study, even though we shared different measuring periods. Our results indicating that depression remained higher than at initiation might be a potential risk of growing CRF after a single chemotherapy cycle echoed the observation from Bower et al (2021), that is, elevated depression and psychological distress would cause later CRF exacerbation.…”

“…Simultaneously, depression and anxiety accumulate gradually with the CRF (Oh & Cho, 2020). Additionally, more severe sleep disturbances and depression symptoms precipitate a higher risk of prolonged CRF (Bower et al, 2021). The factors mentioned above include neuromuscular fatigue as one of the distress symptoms; however, anxiety, depression, and sleep disturbance explained 56% of CRF variance (Chartogne et al, 2021).…”

“…Additionally, more severe sleep disturbances and depression symptoms precipitate a higher risk of prolonged CRF (Bower et al, 2021).…”

Psychosocial Resilience to Inflammation-Associated Depression: A Prospective Study of Breast-Cancer Survivors

“…study) examining cancer-related fatigue (Bower et al, 2019(Bower et al, , 2020. Recruitment occurred between January 2013 and July 2015.…”