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

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.