Fatigue among long-term breast cancer survivors: a controlled cross-sectional study

Saskia Accord-Maass, Daan Brandenbarg, Laurine Van Der Wal, Geertruida De Bock

Keywords: breast neoplasms; fatigue; cancer survivors; long-term adverse effects

Background:

Fatigue is the most common and persistent symptom among women in the first five years after a breast cancer diagnosis. However, the long-term prevalence of fatigue among breast cancer survivors needs further investigation.

Research questions:

What is the prevalence of multidimensional fatigue and its persistence over time among long-term breast cancer survivors compared to a reference population? Also, what is the association of multidimensional fatigue with factors such as breast cancer treatment, cardiac dysfunction, depression, and anxiety?

Method:

We performed a cross-sectional cohort study of 350 breast cancer survivors ≥ 5 years after diagnosis and a reference population of 350 women matched by age and general practitioner. Fatigue was measured using the Multidimensional Fatigue Inventory (MFI-20), and a sum score of >60 (multidimensional fatigue) was the primary outcome. Logistic regression was applied to compare the prevalence of multidimensional fatigue between the survivor and reference populations, adjusted for body mass index (BMI) and cardiovascular and psychological variables. Odds ratios (ORs) and 95% confidence intervals (95%CIs) were estimated. Logistic regression was applied to evaluate the determinants of multidimensional fatigue among the survivors.

Results:

Breast cancer survivors (median 10 years after diagnosis) more often experienced multidimensional fatigue than the reference population (26.6% versus 15.4%; OR, 2.0 [95%CI, 1.4-2.9]), even after adjusting for confounders. The odds of multidimensional fatigue were also higher among survivors with symptoms of depression (32.2% versus 2.7%; OR, 17.0 [95%CI, 7.1-40.5]) or anxiety (41.9% versus 10.1%; OR, 6.4 [95%CI, 3.6-11.4]).

Conclusions:

One in four breast cancer survivors experiences multidimensional fatigue, which occurs more frequently than in women of the same age and general practitioner. This fatigue appears to be associated with symptoms of depression and anxiety.
A follow-up study is being conducted in the same population 8 years later. This study will provide more details about the trajectory of long-term fatigue among breast cancer survivors.

Points for discussion:

How can we improve fatigue among long-term breast cancer survivors?

Should we actively follow up long-term breast cancer survivors as general practitioners?

Are we underestimating the prevalence by choosing multidimensional fatigue?

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