Tool May Help Predict Fatigue After Breast Cancer Treatment

Tool May Help Predict Fatigue After Breast Cancer Treatment

Researchers have developed a tool that may help doctors figure out who has the highest risk of fatigue after breast cancer treatment.
Mar 24, 2022.

Using information from more than 5,600 women, researchers have developed a tool that may help doctors figure out who has the highest risk of fatigue after breast cancer treatment.

The research was published online on Jan. 21, 2022, by the Journal of Clinical Oncology. Read “Development and Validation of a Predictive Model of Severe Fatigue After Breast Cancer Diagnosis: Toward a Personalized Framework in Survivorship Care.”


About fatigue

Fatigue is one of the most common side effects of breast cancer treatment. This study’s researchers found that up to 30% of people diagnosed with breast cancer have fatigue symptoms up to 10 years after they finish treatment.

Fatigue can make you feel like you are tired all the time even if there isn’t a specific cause. Usually, people feel better if they get enough sleep after having exerted themselves. But with fatigue, people feel drained all the time, regardless of how much rest they get. A person with fatigue may lose interest in family, friends, and even regular activities. Fatigue from treatment can appear suddenly — at any time — and can be overwhelming.

Even though fatigue is so common, most people don’t ask their doctors about it. And many doctors don’t usually try to manage fatigue proactively — meaning before someone has symptoms. It’s also not clear which people have the highest risk of developing fatigue.

In this study, the researchers wanted to:

  • identify factors linked to a higher risk of fatigue after breast cancer treatment

  • develop a tool that identifies people with a high risk of developing fatigue

Doctors can then use the tool to help people manage any fatigue early, before it becomes severe.


About the study

The researchers used information from people diagnosed with stage I to stage III breast cancer between 2012 and 2015 enrolled in the CANcer TOxicity (CANTO) study. The CANTO study was designed to collect information about the side effects of breast cancer treatment and included the following:

  • cancer characteristics

  • treatments

  • patient characteristics

  • patient-report outcomes, including side effects, quality of life, and physical and emotional changes linked to treatment

The CANTO study collected information:

  • at diagnosis, before the breast cancer was treated

  • one year after diagnosis

  • two years after diagnosis

  • three years after diagnosis

The researchers had information from:

  • 5,640 people one year after diagnosis

  • 5,000 people two years after diagnosis

  • 3,400 people three years after diagnosis

The percentage of people with severe fatigue was:

  • about 25% at diagnosis before any treatment started

  • about 37% one year after diagnosis

  • about 34.5% two years after diagnosis

  • about 34% three years after diagnosis

The researchers’ analysis found that several factors were linked to a higher risk of developing fatigue after breast cancer treatment:

  • having severe fatigue before treatment started

  • being younger and pre-menopausal

  • being overweight or obese

  • smoking

  • having anxiety before treatment started

  • having trouble sleeping before treatment started

  • being in pain before treatment started

  • being treated with hormonal therapy

The researchers also found that although chemotherapy was linked to a higher risk of developing fatigue in the year after diagnosis, the link became much weaker two and three years after diagnosis, probably because people had completed chemotherapy and its effects had lessened.

The researchers also offered recommendations for doctors to help people manage fatigue early, before it becomes severe, including:

  • nutrition and exercise plans to help people lose excess weight

  • physical therapy to help ease pain

  • cognitive behavioral therapy, counseling, or other psychotherapy to help ease anxiety and sleeping problems

  • yoga and acupuncture to help with anxiety, sleeping problems, and pain

  • programs to help people stop smoking

“Substantial evidence shows that cancer-related fatigue is underaddressed and that the utilization of strategies to manage this symptom may be suboptimal,” the researchers wrote. “We envision a clinical care setting where incoming new patients are systematically screened for fatigue and risk factors at breast cancer diagnosis, before the initiation of any cancer treatment.”


What this means for you

If you’ve been diagnosed with breast cancer and are experiencing fatigue, it’s a good idea to tell your doctor. It also makes sense to talk to your doctor even if you haven’t started treatment — especially if one or more of the factors linked to a higher risk of developing fatigue applies to you. Your doctor can help you proactively manage symptoms.

In addition to the techniques this study recommends, other possible ways to manage fatigue include:

  • massage

  • meditation

  • Reiki

  • tai chi

  • antidepressants

  • sticking to a daily routine

  • joining a support group

Learn more about fatigue.

Written by: Jamie DePolo, senior editor

— Last updated on July 14, 2022, 4:33 PM

Reviewed by 1 medical adviser
Brian Wojciechowski, MD
Crozer Health System, Philadelphia area, PA
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