Patient reported causes of fatigue in relation to adjuvant radiotherapy after breast conserving surgery.

Abstract

Abstract Abstract #4094 Background: Fatigue is one of the most frequent symptoms experienced by cancer patients, and it adversely affects the quality of life. Fatigue is multidimensional and associated with the malignancy itself, but also with anti-neoplastic treatment and probably with several other causes. The aim of the study was to assess the level of fatigue during and after adjuvant radiotherapy in breast cancer patients and to uncover the kind of factors believed by patients to play a role in the generation of fatigue in relation to radiotherapy.
 Methods: 70 patients (ages 33-76 years, mean 57 years) with early-stage breast cancer were included after breast conserving surgery. Patients were treated with adjuvant radiotherapy (48Gy/24 fractions/5 weeks; 20 patients received boost 10Gy/5 fractions/1 week with tumor-bed). The subjective feeling of fatigue was measured according to the 10-score visual analog scale (VAS). RTOG Acute Radiation Morbidity Scoring Criteria (0-4) were used for the estimation of the acute skin reaction.
 Results: 53% of the patients demonstrated no fatigue (VAS 0-1) before the start of adjuvant postoperative radiotherapy. Patients after adjuvant chemotherapy manifested a little higher level of fatigue; there were no differences between patients with or without anti estrogen therapy. Fatigue intensity increased gradually during radiotherapy, but about 1/3 of the patients felt no fatigue. The majority of the patients reported radiotherapy as a cause of fatigue (33 of 47 patients (70%) with fatigue VAS ≥ 2 at the end of radiotherapy). 25% of the patients believed that their fatigue was still associated with previously given adjuvant chemotherapy, but in fact, the patients after chemotherapy did not demonstrate a higher fatigue level at the end of the radiotherapy course. 5 patients (10%) associated their fatigue with the anti estrogen therapy. There was correlation between fatigue level and intensity of radiotherapy-induced skin toxicity – patients with strong acute skin reaction demonstrated a higher fatigue level. But only 8 patients (17%) indicated the skin reaction as a cause of fatigue. Fatigue level was associated with traveling time to the hospital, especially when the journey took 2 hours or more/day. 45% of the patients gave the transport time to the hospital as a reason for fatigue.
 Conclusion: Fatigue increased over the course of adjuvant radiotherapy of breast cancer patients after breast conserving surgery. Fatigue seems to be multidimensional, but most of the patients indicate radiotherapy treatment as the cause of fatigue. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4094.