The following study is available in J. Clin. Oncol · April 05, 2022: "Long-Term Longitudinal Patterns of Patient-Reported Fatigue After Breast Cancer".
I thought some of you might be interested in reading the comment (given below) which appeared today online in Oncology since it summaries the study. Do note that there is a passing reference to the fact that endocrine therapy also contributes to fatique. The group studied consisted of 6619 women followed up four or more years after a diagnosis of breast cancer. I'd be interested in your thoughts after reading this.
"The most frequent symptom reported by my patients after breast cancer treatment is fatigue, and often, we are at a loss to address it, in part because it is difficult to understand its time course relative to the other factors in a patient’s life. This prospective study assessed fatigue from diagnosis and repeatedly through 4 years of follow-up. Importantly, the investigators looked at the trajectory of fatigue since single time-point measurements do not accurately reflect the impact on quality of life. High-risk patients (ie, 21% of all patients) had severe global fatigue at diagnosis, and 2 out of 3 still noted severe fatigue at year 4; 19% of the patients followed a deteriorating course, with fatigue going from 14% at diagnosis to 65% at year 4, whereas 60% were in the low-risk group (<4% severe at diagnosis, and <10% at year 4).
In determining the characteristics of each group, univariate factors associated with severe global fatigue included depression, pain, insomnia, smoking, Charlson score, and marital status. Clinical cancer features, treatment type, and socioeconomic factors had no impact, with the exception of endocrine therapy and hot flashes in the deteriorating group. The authors suggest a survivorship framework that measures risk factors at diagnosis and addresses modifiable elements, including insomnia, depression, anxiety, and pain, to avoid deteriorating or elevated levels of fatigue. Given that a minority of patients fall into the high-risk/deteriorating categories, it should be possible to support vulnerable patients appropriately with currently available resources. This important work could have a meaningful impact on survivorship. Studies to address the effect of early and repeat measurements of fatigue, coupled with mitigation strategies in the real-world setting, are eagerly awaited."
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Hazelgreen
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I do hope some researchers respond to this commentator's comment: "Studies to address the effect of early and repeat measurements of fatigue, coupled with mitigation strategies in the real-world setting, are eagerly awaited." I, too, would like to sign up!
Phew.. its a bit convoluted. Are they including MBC? if so, I am surprised that they are surprised that people on heavy medication are experiencing fatigue!
Only people with stage 1 to stage 3 were included in the study so none with MBC.
I was surprised that fatique was already prominent in early BC so, assuming that they were all taking adjuvant endocrine therapy in the four years after initial diagnosis, the fatigue could be attributed to that as well as personal attributes.
It seems that fatigue is taken for granted with MBC, but it seems to me that it should also be studied to see how it could be minimized....
I asked my oncologist about whether my fatigue/feeling of being 10 years older than I dhould was related to my 9 years of endocrine therapy and she said a lot of her patients on hormone suppression reported it. It's been so bad I have cut down work to 3 days per week and booked a week off in May. I don't have anaemia or thyroid problems, its just bad fatigue.
Given that you are clearly much younger than I am, I really sympathize with your situation. Although I'm 76 now, so age is a factor, it does seem to me that I have aged 10 years + since being diagnosed in 2019.
I retired in 2013 at age 67, and was happily traveling overseas a couple of times a year with all the walking that entails. Now, my joints bother me just walking upstairs in the house; my hair is so thin, I'll soon need a wig, and I sleep 10 to 12 hours a night. Fatigue and aging are indeed ongoing issues!
Thanks! We do fit in some fun! A friend just telephoned to suggest we all go for a walk in this gorgeous spring weather, and we soon will be venturing to lakes in our RV (not sure I'll tolerate the cold water I once did). We hope the new car we bought last week will arrive in time for a friend's visit from the U.K. in June. I definitely shouldn't be complaining when I think of all the troubles in this world!
What are you doing for fun these days? Do you enjoy your work?
Wow, that sounds lovely. Work is sometimes stressful but is not boring. And the autumn weather here in NZ right now is just gorgeous! Water just warm enough to swim, air temp just right. Have the best time at the lakes!
HI Cindy--I will have to look for the article, but I do think they use "fatigue" for a catch-all that must include a variety of other things. I am more tired now after 4 years of drugs--just can't do as much in a day as I used to. Since I was able to completely go off drugs for almost 8 months, my ability to think, multi-task, have incentive to do things, and memory have all increased. Brain fog is way less or gone--that alcohol intoxication feeling like having had too many brandies. I wonder if people call that "fatigue." Talk to you soon! Kay
I think the patients described their reactions as "fatigue". The original paper only followed people with stage 1 to stage 3 for four years so none with MBC were included. However, some people do react negatively to adjuvant treatments.
I agree that we likely are at our best when we are able to go off cancer drugs completely ... but, the fear is that cancer may cause an early death ...
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