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Longitudinal Patterns of Fatigue After Breast Cancer Diagnosis and Treatment


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In an analysis from the French prospective CANTO study reported in the Journal of Clinical Oncology, Vaz-Luis et al identified three trajectory groups for the risk of severe global fatigue over time among women treated for breast cancer, consisting of a high-risk group, deteriorating group, and low-risk group. Factors associated with the different trajectories were identified.

The study involved 4,173 women with stage I to III breast cancer treated between 2012 to 2015. Fatigue was assessed at diagnosis and at 1, 2, and 4 years postdiagnosis using the EORTC Quality of Life Questionnaire–C30. Scores were converted to a 0 to 100 scale, with scores ≥ 40 representing severe fatigue.

Key Findings

Three trajectory groups were identified for severe global fatigue:

  • A total of 890 patients (21%) were in the high-risk group, with risk estimates of severe global fatigue of 94.8% (95% confidence interval [CI] = 86.6%–100.0%) at diagnosis and 64.6% (95% CI = 59.2%–70.1%) at year 4.
  • A total of 794 patients (19%) were in the deteriorating group, with risk estimates of severe global fatigue of 13.8% (95% CI = 6.7%–20.9%) at diagnosis and 64.5% (95% CI = 57.3%–71.8%) at year 4.
  • A total of 2,489 patients (60%) were in the low-risk group, with risk estimates of 3.6% (95% CI = 2.5%–4.7%) at diagnosis and 9.6% (95% CI = 7.5%-11.7%) at year 4.

Among patient, disease, and treatment factors, those significantly associated with risk of being in the deteriorating group consisted of increasing body mass index (BMI) as a continuous measure (adjusted odds ratio [OR] = 1.05, 95% CI = 1.03–1.07), current or former smoking status (OR = 1.38, 95% CI = 1.10–1.74), marital status of not partnered (OR = 1.37, 95% CI = 1.04–1.80), receipt of hormonal therapy (OR = 1.38, 95% CI = 1.02–1.86), higher pain score on the EORTC-C30 as a continuous measure (OR = 1.03, 95% CI = 1.02–1.04), higher insomnia score on the EORTC-C30 as a continuous measure (OR = 1.01, 95% CI = 1.00–1.01), and hot flashes (OR  = 1.33, 95% CI = 1.04–1.71).  

Factors significantly associated with being in the high-risk group consisted of increasing BMI as a continuous measure (OR = 1.03, 95% CI = 1.00–1.06), current or former smoking status (OR = 1.65, 95% CI = 1.2–-2.15), Charlson comorbidity index ≥ 1 (OR = 1.65, 95% CI = 1.19–2.29), marital status of not partnered (OR = 1.58, 95% CI = 1.14–2.18), borderline depression or depression on the Hospital Anxiety and Depression Scale (OR = 3.89, 95% CI = 2.79–5.41), higher pain score on the EORTC-C30 as a continuous measure (OR = 1.07, 95% CI = 1.06–1.08), and higher insomnia score on the EORTC-C30 as a continuous measure (OR = 1.03, 95% CI = 1.02–1.03).

The investigators concluded, “Our findings highlight the multidimensional nature of cancer-related fatigue and the complexity of its risk factors. This study helps to identify patients with increased risk of severe fatigue and to inform personalized interventions to ameliorate this problem.”

Ines Vaz-Luis, MD, PhD, of Institut Gustave Roussy, Villejuif, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by a grant from Susan G. Komen, Odyssea, French Foundation for Cancer Research, and others. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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