Fatigue During Radiation Therapy of Patients with Breast Cancer
William Levin, MD
OncoLink Assistant Editor
Last Modified: October 25, 2000
Presenter: H. Geinitz
Affiliation: Technical University Munich, Muenchen, Germany
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
- 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
- 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-
- 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
- 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.
- 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.
- 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
- 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.