Long-Term Fatigue and Cognitive Disorders in Breast Cancer Survivors

Abstract

Survivors of early-stage breast cancer may report treatment-related side effects that persist for several years after the end of primary treatment. Among these, fatigue and cognitive disorders are frequent complaints and can negatively impact quality of life. Cancer-related fatigue is a very prevalent and distressing long-term side effect among breast cancer survivors that typically improves after completion of treatment, although many patients report severe fatigue several years post-treatment. Cognitive disorders are also common among survivors of breast cancer, especially if treated with chemotherapy. These symptoms are usually mild-to-moderate and often transient. Cognitive recovery is frequently observed within months or a few years after completion of chemotherapy or endocrine therapy. However, some breast cancer survivors may have persistent cognitive difficulties. Several types of interventions have proved to be beneficial in reducing cancer-related fatigue and cognitive difficulties. Most of these interventions for cancer-related fatigue are thought to be effective by reducing inflammation or disrupting pro-inflammatory circuits. Further studies are needed on cognitive management that has showed promising results. This narrative review summarizes the state of the art regarding long-term fatigue and cognitive disorders in patients with early breast cancer, describing prevalence, impact, pathophysiology, and risk factors, and focusing on available interventions.

Impact of Rehabilitation on Breast Cancer Related Fatigue: A Pilot Study

“…According to the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) guidelines, specific screening programs for BCF should be performed (7,12). In this respect, the gold standard for the evaluation of BCF is self-reporting using scales, questionnaires, and/or inventories (13). Regrettably, the great heterogeneity in these diagnostic methods, coupled with the lack of widely adopted guidelines, represents a major limitation in the clinical management of BCF (13,14).…”

“…In this respect, the gold standard for the evaluation of BCF is self-reporting using scales, questionnaires, and/or inventories (13). Regrettably, the great heterogeneity in these diagnostic methods, coupled with the lack of widely adopted guidelines, represents a major limitation in the clinical management of BCF (13,14).…”

“…Several types of interventions have been proposed to treat or reduce BCF, including counseling, psycho-education, physical and mind-body activity, massage therapy, acupuncture, music therapy, supplements (e.g., ginseng, vitamin D, psychostimulants), and physical exercise (13). Among these, the supervised physical exercise is supported by the strongest evidence of safety and effectiveness in reducing BCF (15)(16)(17)(18)(19).…”

Editorial: Quality of Life in Breast Cancer Patients and Survivors

“…As not all patients can be assessed beyond their mother language, this work may help to implement this useful tool through a crosscultural approach. Another important concern is represented by breast cancer fatigue (BCF), a condition characterized by persistent physical and/or mental stiffness (8). A prospective clinical study (Invernizzi, de Sire et al) evaluated the feasibility and the effectiveness of a rehabilitation protocol for BCF, confirming how physical exercise may help improve the quality of life in breast cancer survivors.…”

Effect of strength training and antioxidant supplementation on perceived and performance fatigability in breast cancer survivors: a randomized, double-blinded, placebo-controlled study

“…Furthermore, this debilitating fatigue experienced by the majority of cancer survivors may persist for years after completion of treatment (Wang et al 2014). This persistent fatigue has been associated with decreases in functionality, quality of life, and the ability to respond to work demands (Wang et al 2014; Wang and Woodruff 2015;Joly et al 2019). Noteworthy, the increased fatigue could contribute to dysregulation of endocrine activity, via behavioral pathways, causing a cyclical relationship between fatigue, physical inactive and physiological disturbances (Thornton et al 2010;Berger et al 2012;Neil-Sztramko et al 2014) Although cancer-related fatigue has a multifactorial pathophysiology, several studies have proposed underlying biological pathways of fatigue in cancer (Gutstein 2001; Barsevick et al 2010;Saligan et al 2015;Sha et al 2015;Gerber 2017).…”