Fatigue and quality of life in breast cancer survivors: temporal courses and long-term pattern

• Published in: Journal of cancer survivorship Vol. 6; no. 1; pp. 11 - 19
• Main Authors: Schmidt, Martina E., Chang-Claude, Jenny, Vrieling, Alina, Heinz, Judith, Flesch-Janys, Dieter, Steindorf, Karen
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01-03-2012; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents - adverse effects; Antineoplastic Agents, Hormonal - adverse effects; Breast cancer; Case-Control Studies; Chemotherapy; Chronic Disease; Combined Modality Therapy - adverse effects; Fatigue; Fatigue - epidemiology; Female; Follow-Up Studies; Germany; Health Informatics; Health Promotion and Disease Prevention; Humans; Medicine; Medicine & Public Health; Middle Aged; Neoplasms - psychology; Neoplasms - therapy; Oncology; Primary Care Medicine; Public Health; Quality of Life; Quality of Life Research; Radiotherapy - adverse effects; Severity of Illness Index; Socioeconomic Factors; Surveys and Questionnaires; Survivors; Tamoxifen - adverse effects; Time Factors; Germany; Fatigue; Breast cancer; Adjuvant therapy; Cancer survivorship; Quality of life
• ISSN: 1932-2259; 1932-2267
• DOI: 10.1007/s11764-011-0197-3

Introduction
Fatigue is a frequent problem during and after cancer treatment. We investigated different courses of fatigue from pre-diagnosis, through therapy, to long-term survivorship and evaluated potential implications on long-term quality of life (QoL).
Methods
Breast cancer patients diagnosed in 2001–2005 were recruited in a case–control study in Germany (MARIE). At follow-up in 2009 (median 5.8 years, MARIEplus), patients self-reported current fatigue and QoL status using validated questionnaires (FAQ, EORTC QLQ-C30). In addition, survivors retrospectively rated fatigue levels pre-diagnosis, during different treatment phases, and 1 year post-surgery. Our analyses included 1,928 disease-free cancer survivors and comparisons with fatigue and QoL scores from the general population.
Results
Fatigue levels were substantially increased during chemotherapy and radiotherapy. Among patients who received both therapies, 61.4% reported higher, 30.0% same, and 8.6% lower fatigue levels during chemotherapy compared to radiotherapy. Courses of fatigue varied widely between individuals. Survivors with persisting long-term fatigue had significantly and markedly worse scores for all QoL functions and symptoms about 6 years post-diagnosis than other survivors and compared to the general population. Survivors without substantial fatigue post-treatment had QoL scores largely comparable to the general population.
Discussions/conclusion
Chemotherapy appears to have a stronger impact on fatigue than radiotherapy. Breast cancer survivors may experience long-term QoL comparable to the general population, even when suffering from substantial fatigue during treatment. Yet, persistent fatigue post-treatment may lead to extensive long-term loss in QoL concerning physical, social, cognitive, and financial aspects.
Implications for cancer survivors
Fatigue management should be obligatory during and post cancer treatment.