Abstract
BackgroundCancer related fatigue (CRF), reported in about 90% of breast cancer patients receiving chemotherapy, and has a profound impact on physical function, psychological distress and quality of life. Although several etiological factors such as anemia, depression, chronic inflammation, neurological pathology and alterations in metabolism have been proposed, the mechanisms of CRF are largely unknown.MethodsWe conducted a pilot, prospective, case-control study to estimate the magnitude of change in thyroid function in breast cancer patients from baseline to 24 months, compared to cancer-free, age-matched controls. Secondary objectives were to correlate changes in thyroid function and obesity over time with fatigue symptoms scores in this patient population.ResultsThe proportion of women with breast cancer who developed subclinical or overt hypothyroidism (TSH >4.0 mIU/L) from baseline to year 1 was significantly greater compared to controls (9.6% vs. 5%; p=0.02). Subjects with breast cancer reported significantly worse fatigue symptoms than age-matched controls, as indicated by higher disruption indices (p<0.001 at baseline, p=0.02 at year 1, p=0.09 at year 2). Additionally, a significant interaction effect on disruption index score (p=0.019), general level of activity over time (p=0.006) and normal work activity (p= 0.002) was observed in the subgroup of women with BMI>30.ConclusionScreening breast cancer patients for thyroid function status at baseline and serially post-treatment to evaluate the need for thyroid hormone replacement may provide for a novel strategy for treating chemotherapy-induced fatigue.
Highlights
In 2017, it is estimated that there will be 252,710 new cases of female breast cancer and an estimated 40,610 women will die of this disease in the United States (US) [1]
Screening breast cancer patients for thyroid function status at baseline and serially post-treatment to evaluate the need for thyroid hormone replacement may provide for a novel strategy for treating chemotherapy-induced fatigue
The proportion of women who had subclinical or overt hypothyroidism at baseline was not different between breast cancer cases and controls, our study demonstrated that the proportion of women with breast cancer who developed subclinical or overt hypothyroidism post treatment for breast cancer was significantly greater compared to controls
Summary
In 2017, it is estimated that there will be 252,710 new cases of female breast cancer and an estimated 40,610 women will die of this disease in the United States (US) [1]. Breast cancer survivors report symptoms of fatigue, weight gain, pain, poor sleep, cognitive impairment and depression that persists post treatment. Of these symptoms, persistent cancer related fatigue (CRF) has been reported as one of the most distressing long-term side-effects of cancer treatment [2,3,4,5]. Because of its significant effect on physical function and ability to perform activities of daily living, resulting in psychological distress, the impact of CRF on a cancer patient's quality of life (QoL) is profound [20,21,22]. Cancer related fatigue (CRF), reported in about 90% of breast cancer patients receiving chemotherapy, and has a profound impact on physical function, psychological distress and quality of life. Several etiological factors such as anemia, depression, chronic inflammation, neurological pathology and alterations in metabolism have been proposed, the mechanisms of CRF are largely unknown
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