Predictors and course of chronic fatigue in long-term breast cancer survivors

BACKGROUND: The course of fatigue in long-term breast cancer survivors (BCSs) is unknown. The current study examined chronic fatigue (CF) cross-sectionally and longitudinally in relapse-free women up to 10 years after multimodal treatment for BC stage II/III. The prevalence of persistent fatigue (PF: having CF at two assessments separated by >2 years) and its predictors were also investigated. METHODS: Data from questionnaires (including the Fatigue Questionnaire and questions regarding socio-demographics and physical symptoms) were collected twice from 249 BCSs: 2.5–7 years post-BC diagnosis (T1) and 2.5–3 years thereafter (T2). A physical examination including blood sampling was performed at T1. RESULTS: CF was diagnosed in 33% of the women at T1 and in 39% at T2, including 57 (23%) subjects with PF. Current psychological distress, treatment-area related discomfort and high body mass index (BMI) were associated with CF at T1 and predicted PF. Increased leukocyte count also predicted PF. Treatment for mental problems prior to the BC, increased hsCRP-level and respiratory symptoms were associated with CF at T1 but did not predict PF. CONCLUSIONS: Women may experience fatigue up to 10 years after multimodal BC treatment, with about one third having CF and about one fourth having PF. IMPLICATIONS FOR CANCER SURVIVORS: During follow-up, BCSs and their doctors should maximize their efforts to reduce psychological distress, overweight and pain within the BC-treated area, all linked to the development of persistent fatigue.