Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov;37(11):1025-1034.
doi: 10.1037/hea0000652.

Fatigue after breast cancer treatment: Biobehavioral predictors of fatigue trajectories

Julienne E Bower  1 , Joshua Wiley  2 , Laura Petersen  3 , Michael R Irwin  1 , Steve W Cole  4 , Patricia A Ganz  3
Affiliations

Fatigue after breast cancer treatment: Biobehavioral predictors of fatigue trajectories

Julienne E Bower et al. Health Psychol. 2018 Nov.

Abstract

Objective: Fatigue is a common side effect of cancer treatment, but there is considerable variability in fatigue severity and persistence among survivors. This study aimed to characterize longitudinal trajectories of fatigue after breast cancer treatment and to identify predictors of varying fatigue trajectories.

Methods: Women (N = 191) from the Mind-Body Study completed assessments after primary treatment for early stage breast cancer and at regular follow-ups that occurred up to 6 years after treatment (M = 4.3 years). Growth mixture models were used to characterize fatigue trajectories, and demographic, medical, and biobehavioral risk factors were examined as predictors of trajectory group.

Results: Five trajectories were identified, characterized as High, Recovery, Late, Low, and Very Low fatigue. The High and Recovery groups (40% of sample) evidenced elevated fatigue at posttreatment that declined in Recovery but persisted in the High group. In bivariate analyses, trajectory groups differed significantly on depressive symptoms, sleep disturbance, childhood adversity, body mass index, and the inflammatory marker soluble TNF receptor type II, which were higher in the High and/or Recovery groups. In multivariate models, depressive symptoms and childhood adversity distinguished High and Recovery from other groups. Rates of chemotherapy were higher in the Recovery than in the High or Late group, whereas rates of endocrine therapy were higher in the High than in the Recovery group.

Conclusions: There are distinct longitudinal trajectories of fatigue after breast cancer treatment. Psychological factors are strongly associated with adverse fatigue trajectories, and together with treatment exposures may increase risk for cancer-related fatigue. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Flow chart indicating the number of patients who completed each assessment. Note that some patients were not eligible for the T5 and/or T6 assessments, as the final study assessment (TF) occurred before they reached these assessment points.
Figure 2.
Figure 2.
Estimated trajectories of fatigue in the 5 groups over the follow-up period.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Andrykowski MA, Donovan KA, Laronga C, & Jacobsen PB (2010). Prevalence, predictors, and characteristics of off-treatment fatigue in breast cancer survivors. Cancer, 116(24), 5740–5748. doi: 10.1002/cncr.25294 - DOI - PMC - PubMed
    1. Andrykowski MA, Schmidt JE, Salsman JM, Beacham AO, & Jacobsen PB (2005). Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer. J Clin Oncol, 23(27), 6613–6622. - PMC - PubMed
    1. Avis NE, Levine BJ, Case LD, Naftalis EZ, & Van Zee KJ (2015). Trajectories of depressive symptoms following breast cancer diagnosis. Cancer Epidemiol Biomarkers Prev, 24(11), 1789–1795. doi: 10.1158/1055-9965.EPI-15-0327 - DOI - PMC - PubMed
    1. Barsevick A, Frost M, Zwinderman A, Hall P, & Halyard M (2010). I’m so tired: biological and genetic mechanisms of cancer-related fatigue. Qual.Life Res, 19(10), 1419–1427. - PMC - PubMed
    1. Beck AT, Steer RA, Brown GK (1996). BDI-II Manual (Vol. 2). San Antonio: The Psychological Corporation.