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Impact of adjuvant breast radiotherapy on patient-reported fatigue

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Abstract

Purpose

Breast cancer patients receiving adjuvant radiotherapy (RT) benefit from local control. However, RT can give rise to increased fatigue, lowering quality of life. The aim of this study was to prospectively identify trends and risk factors in patient-reported fatigue associated with breast RT.

Material and methods

Patients were assessed using the Edmonton Symptom Assessment Scale (ESAS) before, once per week during RT, up to 6 weeks after RT completion, and 1–3 months post RT. Patients were included in the analysis if the ESAS was completed before, at least once during, and at least once after RT.

Results

A total of 651 patients were included. Fatigue scores increased significantly during weeks 1–3 (p < 0.001) and weeks 5–6 (p < 0.0001) during RT compared to baseline. After RT completion, fatigue scores did not change significantly compared to baseline. Mastectomy patients who received previous chemotherapy experienced significantly more fatigue compared to mastectomy patients without previous chemotherapy (p = 0.0002). Patients less than 50 (p = 0.002), 50–59 (p = 0.007), or 60–69 (p = 0.048) years of age at RT start were more likely to have higher proportions of moderate or severe fatigue compared to patients ≥ 70 years of age.

Conclusions

Fatigue associated with breast irradiation increased up to 6 weeks during RT and returned to near baseline scores at 1–3 months post treatment. Given that fatigue was significant in mastectomy patients, further research is needed to reduce fatigue among this cohort, especially those who have received previous chemotherapy and younger patients who are receiving breast RT.

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Data availability

All data generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

All code generated during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.

Author information

Authors and Affiliations

  1. Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Emily Lam, Gina Wong, Irene Karam, Yasmeen Razvi, Erin McKenzie & Edward Chow

  2. MacroStat Inc, Toronto, ON, Canada

    Liying Zhang & Julia Lou

  3. Havergal College, Toronto, ON, Canada

    Emma McCurdy-Franks

  4. Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Edward Chow

Authors
  1. Emily Lam
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  2. Gina Wong
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  3. Irene Karam
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  4. Liying Zhang
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  5. Julia Lou
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  6. Emma McCurdy-Franks
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  7. Yasmeen Razvi
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  8. Erin McKenzie
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  9. Edward Chow
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Contributions

Emily Lam, Gina Wong, Yasmeen Razvi, and Erin McKenzie conceived and designed the analysis, collected data, contributed data or analysis tools, and contributed to manuscript writing.

Emma McCurdy-Franks, Irene Karam, and Edward Chow conceived and designed the analysis and contributed to manuscript writing.

Liying Zhang and Julia Lou conceived, designed, and performed the analysis and contributed to manuscript writing.

Corresponding author

Correspondence to Edward Chow.

Ethics declarations

Ethics approval

This study was approved by the research ethics board at Sunnybrook Health Sciences Centre. REB #331–2017.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

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Informed consent was obtained from all individual participants regarding the publishing of their de-identified data.

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Not applicable.

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Lam, E., Wong, G., Karam, I. et al. Impact of adjuvant breast radiotherapy on patient-reported fatigue. Support Care Cancer 30, 1283–1291 (2022). https://doi.org/10.1007/s00520-021-06521-1

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  • DOI: https://doi.org/10.1007/s00520-021-06521-1

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