Fatigue During Radiation Therapy of Patients with Breast Cancer

William Levin, MD
OncoLink Assistant Editor
Last Modified: October 25, 2000

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Presenter: H. Geinitz
Affiliation: Technical University Munich, Muenchen, Germany


Background:

The purpose of this study was to evaluate the course and the possible causes of fatigue during postoperative radiation therapy (RT) of patients with breast cancer.


Materials and Methods:

  • 41 patients with postoperative RT after breast conserving surgery were prospectively analyzed.

  • Median age was 54 years (34 - 77 years).

  • 25 patients (61%) received hormone therapy during the study period and 16 (39%) did not.

  • Exclusion criteria were: Metastasis, chemotherapy during RT, second malignancies, infectious disease, depression and thyroid disease.

  • Before, weekly during and 6 - 8 weeks after RT patients completed a standardized questionnaire on fatigue (Fatigue Assessment Questionnaire, FAQ), a visual analog scale on fatigue (VAS) and the Hospital Anxiety and Depression Scale (HADS).

  • A differential blood count was taken on each occasion.


Results:

  • There was a significant increase in fatigue until the fourth week of therapy as measured by the FAQ and the VAS (FAQ: p=0.03; VAS: p=0.002).

  • Fatigue remained elevated on the same level between the fourth and fifth week.

  • Physical fatigue was most prominent while affective - and cognitive fatigue did not raise significantly during RT.

  • Patients younger than 55 had higher FAQ-values and a steeper increase than older patients but there was no significant difference in VAS- values.

  • The use of hormone therapy did not have an influence on fatigue measured in either score.

  • Anxiety (HADS-A) decreased during therapy (p=0.012) while depression (HADS-D) did not change significantly.

  • Leukocytes, lymphocytes and platelets declined during therapy and were still decreased 6 - 8 weeks after RT (p=0.001). Lymphocytes were reduced to almost 50% of the initial values on the fifth week of therapy. Monocytes and hemoglobin did not significantly change during RT.


Authors' Conclusions

  • There was no evidence that anxiety, depression or declining hemoglobin levels are a cause of fatigue during localized RT.

  • The decline in blood cell numbers during localized RT should be taken into account when applying concomitant chemotherapy.


Clinical/Scientific Implications:

  • Fatigue is a significant problem for many patients undergoing radiation therapy.

  • The etiology of this process may not be due to decreased hemoglobin levels as is commonly thought.

  • While anxiety and depression were not correlated to fatigue in this study, these psychological entities should be identified and aggressively treated in the cancer patient.


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