(ChemotherapyAdvisor) – A 5-year prospective cohort study of Australian women who received adjuvant treatment for early-stage breast cancer found that cancer-related fatigue, while common, generally runs a self-limiting course, with much of the previously reported high rates of persistent fatigue attributable to factors unrelated to the cancer or its treatment, investigators reported in the Journal of Clinical Oncology online April 16.
They sought to determine the early natural history of cancer-related fatigue, which has not been systematically examined to document consistent presence of symptoms. The 218 women were enrolled following surgery and observed at end of treatment as well as at 1, 3, 6, 9, 12 months and 5 years post-treatment.
Physical and psychologic health, disability, and health care utilization were recorded using structured interviews and self-report questionnaires. Patients with cancer-related fatigue persisting for six months were assessed to exclude alternative medical and psychiatric causes of fatigue.
The case rate for cancer-related fatigue was 24% (n=51) postsurgery and 31% (n=69) at end of treatment. At six months, cancer-related fatigue became persistent in 11% (n=24) and, at 12 months, in 6% (n=12).
“At each time point, approximately one-third of the patients had comorbid mood disturbance,” they noted. Tumor size was found to be predictive of persistent cancer-related fatigue; however, demographic, psychologic, surgical, or hematologic parameters were not predictive.
“The majority of women can be reassured that they are unlikely to experience long-term repercussions arising from their surgery and adjuvant therapy with the associated benefits of reduction in tumor recurrence,” they wrote.
However, a small minority of women do experience substantive disability and increased health resource utilization associated with breast cancer beyond six months after completing adjuvant therapy. “Application of cognitive-behavioral therapy, including early interventions to manage disturbances in mood, together with activity pacing and graded exercise, offers the potential to achieve this outcome,” the authors concluded.