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Fatigue and quality of life in breast cancer survivors: temporal courses and long-term pattern

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Abstract

Introduction

Fatigue is a frequent problem during and after cancer treatment. We investigated different courses of fatigue from pre-diagnosis, through therapy, to long-term survivorship and evaluated potential implications on long-term quality of life (QoL).

Methods

Breast cancer patients diagnosed in 2001–2005 were recruited in a case–control study in Germany (MARIE). At follow-up in 2009 (median 5.8 years, MARIEplus), patients self-reported current fatigue and QoL status using validated questionnaires (FAQ, EORTC QLQ-C30). In addition, survivors retrospectively rated fatigue levels pre-diagnosis, during different treatment phases, and 1 year post-surgery. Our analyses included 1,928 disease-free cancer survivors and comparisons with fatigue and QoL scores from the general population.

Results

Fatigue levels were substantially increased during chemotherapy and radiotherapy. Among patients who received both therapies, 61.4% reported higher, 30.0% same, and 8.6% lower fatigue levels during chemotherapy compared to radiotherapy. Courses of fatigue varied widely between individuals. Survivors with persisting long-term fatigue had significantly and markedly worse scores for all QoL functions and symptoms about 6 years post-diagnosis than other survivors and compared to the general population. Survivors without substantial fatigue post-treatment had QoL scores largely comparable to the general population.

Discussions/conclusion

Chemotherapy appears to have a stronger impact on fatigue than radiotherapy. Breast cancer survivors may experience long-term QoL comparable to the general population, even when suffering from substantial fatigue during treatment. Yet, persistent fatigue post-treatment may lead to extensive long-term loss in QoL concerning physical, social, cognitive, and financial aspects.

Implications for cancer survivors

Fatigue management should be obligatory during and post cancer treatment.

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Acknowledgements

Funding: The MARIE/MARIEplus study is funded by the Deutsche Krebshilfe e.V. [grant no. 70-2892-BR I and 108253/108419], the Hamburg Cancer Society, the German Cancer Research Center, and the German Federal Ministry for Education and Research [grant no. 01KH0402]. We thank U. Eilber, C. Krieg, S. Behrens, R. Birr, and T. Olchers for data collection and management.

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Authors and Affiliations

  1. Unit of Environmental Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany

    Martina E. Schmidt & Karen Steindorf

  2. Division of Preventive Oncology, National Center for Tumor Diseases (NCT), Heidelberg, Germany

    Karen Steindorf

  3. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Jenny Chang-Claude & Alina Vrieling

  4. Department of Medical Biometry and Epidemiology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Judith Heinz & Dieter Flesch-Janys

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  1. Martina E. Schmidt
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  2. Jenny Chang-Claude
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  3. Alina Vrieling
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  4. Judith Heinz
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  5. Dieter Flesch-Janys
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  6. Karen Steindorf
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Correspondence to Martina E. Schmidt.

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Schmidt, M.E., Chang-Claude, J., Vrieling, A. et al. Fatigue and quality of life in breast cancer survivors: temporal courses and long-term pattern. J Cancer Surviv 6, 11–19 (2012). https://doi.org/10.1007/s11764-011-0197-3

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  • DOI: https://doi.org/10.1007/s11764-011-0197-3

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