Cancer-related Fatigue In Patients Research Articles

Impact of chemotherapy on cancer-related fatigue and cytokines in 1312 patients: a systematic review of quantitative studies.

Cancer-related fatigue (CRF) is the most common psychosomatic distress experienced by cancer patients before, during and after chemotherapy. Its impact on functional status and Health Related Quality of Life is a great concern among patients, healthcare professionals and researchers. The primary objective of this systematic review is to determine whether the different chemotherapies affect the association of CRF with individual pro- and anti-inflammatory cytokines. The PRISMA statement guideline has been followed to systematically search and screen article from PubMed and Embase. This review has examined 14 studies which included a total of 1312 patients. These studies assayed 20 different kinds of cytokines. The cytokines interleukin-6, interleukin-1RA, TGF-β and sTNF-R2 were associated with CRF in patients receiving anthracycline-based chemotherapy. However, only interleukin-13 was identified in the taxane-based chemotherapy. Similarly, different sets of cytokines were linked with CRF in patients with chemotherapy regimens containing platinum, cyclophosphamides, topotecan or bleomycin. This review has identified that cytokines are differentially linked with CRF according to the various types of chemotherapy regimens.

Management of Fatigue Following Breast Cancer Treatment

Cancer-related fatigue (CRF) is a very distressing symptom experienced by most cancer patients. CRF is a complex symptom and there is no agreement regarding the exact definition, the best measurement instrument or even the optimal treatment. CRF is an important problem especially in breast cancer patients, during and after treatment, in long-term survivors. In the last few decades survival rates have dramatically improved. Thus, the number of breast cancer survivors has increased and preservation of quality of life has become very important. This paper is a literature review of the studies published in the last 5 years on management of CRF and breast cancer patients. We distinguished CRF during and after oncological therapy and examined both pharmacological and nonpharmacological interventions.

Cancer Related Fatigue and Clinical Outcome of Dendritic Cell Vaccine in Combination with Cytokine-Induced Killer Cell Therapy in Cancer Patients

Cancer related fatigue significantly disrupts normal life for a portion of cancer survivors, and may persist for many years with cancer patients. Fatigue lasts longer than other treatment side-effects. There are increasing reports of using immunocyte therapy to treat cancer, and if it could be alternative relieve therapy in persons with cancer related fatigue is not so clear. Herein, we retrospectively evaluated the improvement of cancer related fatigue and safety of this therapy administered to cancer patients. 539 patients were treated with immunocyte therapy after conventional treatment. Methods: The delayed-type hyper-sensitivity (DTH) skin test was used to measure the immune response. Investigated into cancer related fatigue, physical strength, appetite and sleep as clinical efficacy. Results: The DTH skin tests showed that the positive cell-mediated cytotoxicity response rate was 82.7%. A large proportion of patients’ cancer related fatigue (80%); appetite (94.1%), sleeping status (96.6%) and metal state (92.9%) were improved. Adverse reactions were fever (35.1%), insomnia (21.4%), anorexia (15.7%), arthralgia (8%), rash (3.3%). DC (dendritic cell) therapy combined with CIK (cytokine-induced killer cell) was observed no toxicity in patients. Conclusion: This is the first time we reported combination of DC and CIK therapy to relieve the cancer related fatigue of patients after conventional therapy (surgery, radiotherapy, and chemotherapy). It may be an effective immunotherapy to reduce adverse reactions and a safety treatment. The data of CIK treatment time and CIK cell number provide strong support for further clinical treatment.

Tai Chi Exercise for Cancer-Related Fatigue in Patients With Lung Cancer Undergoing Chemotherapy: A Randomized Controlled Trial

ContextTai Chi is a traditional Chinese health-promoting exercise. It has been shown to enhance mental health and improve psychological condition. ObjectivesWe aimed to assess the effectiveness of Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy. MethodsWe conducted a randomized trial of Tai Chi exercise as compared with low-impact exercise as a control intervention. Exercises were practiced every other day, a one-hour session for 12 weeks for each of the study groups. The primary end point was a change in total score of the Multidimensional Fatigue Symptom Inventory–Short Form (MFSI-SF). Secondary end points were changes in five subscale scores of the MFSI-SF. All assessments were repeated at three time points, T0: before first course of chemotherapy; T1: before third course of chemotherapy; and T2: at the end of the fourth course of chemotherapy. ResultsBetween January 2012 and December 2014, 96 patients were enrolled in this trial. At six and 12 weeks, the Tai Chi group had a lower MFSI-SF total score compared with the control group (59.5 ± 11.3 vs. 66.8 ± 11.9, P < 0.05; 53.3 ± 11.8 vs. 59.3 ± 12.2, P < 0.05). At six weeks, the Tai Chi group had lower MFSI-SF general subscale scores (18.1 ± 4.6 vs. 20.4 ± 4.5, P < 0.05) and physical subscale scores (17.5 ± 4.4 vs. 19.1 ± 4.5, P < 0.05), and higher MFSI-SF vigor subscale scores (14.5 ± 3.3 vs. 11.6 ± 3.4, P < 0.05), compared with the control group. But no significant differences were found in emotional subscale (20.2 ± 3.6 vs. 20.0 ± 3.5, P > 0.05) and mental subscale (18.2 ± 4.0 vs. 18.9 ± 3.9, P > 0.05) scores between the Tai Chi group and the control group. At 12 weeks, the MFSI-SF subscale scores showed the same trends as at six weeks. ConclusionTai Chi is an effective intervention for managing cancer-related fatigue in patients with lung cancer undergoing chemotherapy, especially for decreasing general fatigue and physical fatigue, and increasing vigor.

Defining cancer-related fatigue for biomarker discovery.

Cancer-related fatigue (CRF) is a prominent and distressing symptom for cancer patients that can impair their overall health-related quality of life [1]. CRF is often described as a complex and multidimensional concept consisting of physical, cognitive, affective, spiritual, psychosocial, and environmental factors [1, 2]. Assessment of CRF is obtained from responses on various valid, self-report questionnaires established from several theoretical models of CRF. The complexity of CRF as a concept and the variability in the method of CRF assessment pose a challenge to investigators attempting to understand the etiology of CRF. Establishing a clear definition of a phenomenon, such as CRF, is an essential starting point for phenotypic characterization and biomarker discovery [3]. Therefore, this commentary aims to increase our awareness of the need for better definition and clearer phenotypic characterization of CRF. Several organizations have proposed definitions for CRF such as the National Comprehensive Cancer Network (NCCN), the American Society of Clinical Oncology (ASCO), and the Pan Canadian Practice Guidelines [2, 4, 5]. However, a recent review conducted by the Multinational Association of Supportive Care in Cancer Fatigue Study Group– Biomarker Working Group found that CRF is defined in various ways [6]. Some studies referenced a specific definition used by national organizations such as the National Comprehensive Cancer Network [2], while other studies defined CRF using specific cancer treatment-related tools, such as the National Cancer Institute Common Toxicity criteria, as well as diagnostic criteria from a proposed ICD-10 definition of CRF [7, 8]. The lack of a consistent operational definition for CRF in the empirical literature makes it challenging to develop a CRF phenotype, which in turn poses a major obstacle for researchers investigating the biological mechanisms of CRF [9]. Therefore, consistent use of an agreed upon definition would be of benefit for biomarker discovery. In addition to the variability in the definition of CRF, numerous questionnaires were reported in the reviewed articles to assess CRF. In fact, 23 different questionnaires were used to assess CRF in the 47 articles reviewed. Even when the same questionnaire was used, different scoring rubrics were often applied to phenotype CRF or to determine its clinical relevance [10, 11]. The significance of this variability when investigating different biologic pathways to determine molecular correlates of CRF is pronounced. For example, we recently assessed genetic correlates of CRF using two different cut-off scores on the Functional Assessment of Cancer TherapyFatigue (FACT-F) questionnaire (http://www.facit.org/ FACITOrg/Questionnaires) in the same group of men with prostate cancer who received radiation therapy. The FACT-F subscale is a 13-item widely-used, readily available questionnaire validated to explore fatigue symptoms in the oncology population. Our unpublished findings revealed that different functional biologic pathways were found when different approaches were utilized to phenotype CRF patients using previously reported FACT-F cut-off scores (Fig. 1). Investigating causal relationships of CRF with specific physiologic mechanisms will remain difficult, unless the complex concept of CRF is better defined, and clearly phenotyped. Perhaps, describing the disease and/or treatment associated with the CRF experience can better define the construct, especially if the intention is for biomarker discovery. CRF is often believed to be induced by the tumor itself and/or the * Leorey N. Saligan saliganl@mail.nih.gov

Analysis on relevant factors of cancer-related fatigue in patients with cancer and nursing intervention

Objective To explore the occurrence of malignant tumors in patients with cancer related fatigue reason and care interventions for cancer fatigue. Methods The patients with malignant tumors and cancer related fatigue patients were randomly divided into observation group given nursing intervention and control group treated with conventional care to observe the patient's activity status and quality of life. Results The number of chemotherapy patients, the number of radiotherapy patients and VAS score, HAMD score,HAMA score showed a weary group<mild fatigue group<moderate fatigue group< severe fatigue group;care in the observation group KPS score, physical function, psychological function, social function, cognitive function and overall quality of life score were significantly higher. Conclusions Radiotherapy and chemotherapy,pain and anxiety, depression is an important reason for cancer patients with cancer related fatigue, targeted to nursing intervention help the treatment of cancer related fatigue. Key words: Cancer; Cancer related fatigue; Nursing intervention

Cancer-related Fatigue in Patients with Advanced Cancer Treated with Autonomic Nerve Pharmacopuncture

The purpose of this study was to observe the effects of autonomic nerve pharmacopuncture (ANP) treatment on cancer-related fatigue (CRF) in patients with advanced cancer. This observational case study was conducted at the East West Cancer Center of Daejeon University's Dunsan Korean Medical Hospital. Two patients were observed. One patient was diagnosed with left thymic cancer metastatic to the left pleura. The other patient had terminal-stage cervical cancer with iliac bone and lumbar 5 metastases. We injected mountain ginseng pharmacopuncture (MGP) into acupoints alongside the spine (Hua-Tuo-Jia-Ji-Xue, EX B2). We examined the patients for CRF using the Korean version of the Revised Piper Fatigue Scale (RPFS-K), which is a self-assessment tool. The scores on the RPFS-K for both patients tended to decrease during the treatment. Laboratory findings, including hematological changes, were also checked. Liver and renal function tests showed that the treatment was safe. Although further large-population studies are necessary, this case study suggests that ANP has a favorable effect on CRF in patients with advanced cancer.

Training in self-needling and performing it as part of a clinical trial: the practitioner and patient experience.

To explore the experience of training and performing self-needling from both the practitioners' and patients' perspective. A qualitative study was conducted using focus groups and interviews, nested within our multi-site randomised controlled trial, Acupuncture for Cancer-Related Fatigue in Patients with Breast Cancer. Patients allocated to self-needling across two UK study sites and all therapists who were involved in the trial were invited to participate. The interviews/focus groups were then transcribed verbatim and analysed thematically by the process of content analysis. Of the 67 eligible patients, 8 (12%) contributed to the focus groups and 15 practitioners (100%), contributed to the study by either attending a focus group or being interviewed. Themes identified for patients included: the allocation to self-needling, teaching techniques and practical considerations and whether they would self-needle again. Themes identified for practitioners included: views on self-needling, teaching self-needling and future implications of self-needling. Self-needling was found to be acceptable to, and manageable by, patients, and enthusiastically adopted by most practitioners. Methods of teaching self-needling need to be developed and evaluated with guidelines recommended for best practice.

Influence of family function on cancer-related fatigue of patients with cervical cancer radiotherapy

Objective To study the current family function situation of patients with cervical cancer radiotherapy, and analyze its impact on cancer-related fatigue. Methods Using the quota sampling, 124 cervical cancer patients in the radiotherapy department were included in the study. The general information questionnaire, Family Assessment Device(FAD) and Fatigue Assessment Instrument(FAI)were used to survey. Results The patients with mild, moderate and severe family dysfunction accounted for 41.9%, 32.3% and 25.8% respectively. Patients with light, moderate and severe cancer-related fatigue accounted for 31.5%, 11.3% and 57.3% respectively. Pearson correlation analysis showed that family function dimension were negatively correlated with cancer-related fatigue (r=0.336-0.933, P<0.01). The degree of cancer-related fatigue was the heaviest of patients with severe family dysfunction. Patients with mild, moderate and severe family dysfunction were statistically significant (P<0.01). Conclusions Patients with cervical cancer radiotherapy have different degree of family dysfunction and cancer-related fatigue. The family function and cancer-related fatigue is closely related to each other. Medical staff must strengthen the knowledge learning of family function, understand cervical cancer family problems, target guidance of family members of patients care and support them. To some extent, we can prevent and reduce the cancer-related fatigue. Key words: Cervical cancer; Radiotherapy; Family function; Cancer-related fatigue

Evidence of significant central fatigue in patients with cancer-related fatigue during repetitive elbow flexions till perceived exhaustion.

ObjectiveTo investigate whether fatigue induced by an intermittent motor task in patients with cancer-related fatigue (CRF) is more central or peripheral.MethodsTen patients with CRF who were off chemo and radiation therapies and 14 age-matched healthy controls were enrolled. Participants completed a Brief Fatigue Inventory (BFI) and performed a fatigue task consisting of intermittent elbow-flexion contractions at submaximal (40% maximal voluntary contraction) intensity till self-perceived exhaustion. Twitch force was elicited by an electrical stimulation applied to the biceps brachii muscle. The relative degree of peripheral (muscle) vs. central contribution to fatigue induced by the intermittent motor task (IMT) was assessed using twitch force ratio (TFratio) defined as post IMT twitch force to pre IMT twitch force. The total number of trials (intermittent contractions) and total duration of all trials performed by each subject were also quantified.ResultsBFI scores were higher (p<0.001) in CRF than controls, indicating greater feeling of fatigue in CRF patients than controls. A significantly smaller number of trials and shorter total duration of the trials (p<0.05) were observed in CRF than control participants. The TFratio (0.81±0.05) in CRF was higher (p<0.05) compared with that of controls (0.62±0.05), suggesting CRF patients experienced a significantly lower degree of muscle (peripheral) fatigue at the time of perceived exhaustion.ConclusionConsistent with prior findings for fatigue under submaximal sustained contraction, our results indicate that motor fatigue in CRF is more of central than peripheral origin during IMT. Significant central fatigue in CRF patients limits their ability to prolong motor performance.

Effect of the extended nursing on the cancer-related fatigue and life quality of patients with breast cancer

Objective To explore the effect of extended nursing on the cancer-related fatigue and life quality of patients with breast cancer.Methods Seventy-six patients with breast cancer were chosen and divided into the control group and the observation group according to the random number table, each with 38 cases.The control group received the routine nursing of breast cancer, and the observation group received the extended nursing which was carried out through the QQ software, telephone interview and home visit on the basis of the routine nursing.The cancer-related fatigue and life quality of patients were compared between two groups. Results The scores of cancer-related fatigue scale including cognition, emotion, feeling and behavior were respectively （3.24 ±1.51）,（3.15 ±1.42）,（3.13 ±1.58） and （3.11 ±1.31） in the observation group after the intervention, and were （4.02 ±1.81）,（4.23 ±1.72）,（4.15 ±2.01） and （4.14 ±1.85） in the control group, and the differences were statistically significant （t=2.04,2.98,2.46,2.80, respectively;P〈0.05）. The score of life quality was （87.24 ±6.53） in the observation group after the intervention, and was （82.67 ± 5.34 ） in the control group, and the difference was statistically significant （ t =3.340, P 〈0.01 ）. Conclusions The extended nursing including the dynamic health education, psychological counseling, diet and medication guidance through the QQ software, telephone interview and home visit can reduce the cancer-related fatigue of patients with breast cancer, improve their life quality, and is worthy of clinical promotion and application. Key words: Breast cancer; Cancer-related fatigue; Life quality; Extended nursing

Cancer-related fatigue in patients before and after radical prostatectomy. Results of a prospective multi-centre study.

A multi-centre, longitudinal study was conducted to assess the prevalence of fatigue amongst men with localized prostate cancer, to describe several dimensions of fatigue and to explore the predictability of fatigue by psychological distress and physical function. The prevalence of fatigue was evaluated using the Multidimensional Fatigue Inventory in 329 prostate cancer patients before, 3, 6 and 12 months after surgery. Psychological distress was assessed using the Hospital Anxiety and Depression Scale. Physical function was measured using the EORTC QLQ-C30. After surgery, about 14 % of the patients were screened with chronic fatigue. For all dimensions of fatigue, only small longitudinal changes could be observed. Psychological distress could be identified as a good predictor of fatigue after but not before surgery. Radical prostatectomy has no or little impact on the prevalence of fatigue. However, about 14 % of patients with chronic fatigue could possibly benefit from psychosomatic interventions. Interventions should consider the simultaneous appearance of fatigue and psychological distress and a reduced physical function.

Longitudinal study of cancer-related fatigue in patients with colorectal cancer.

Dynamic changes of cancer-related fatigue (CRF) among hospitalized patients with colorectal cancer were determined. This longitudinal, descriptive study involved 96 hospitalized patients with colorectal cancer, all recruited from a tertiary general hospital in Guangzhou, China. Patients completed questionnaires three times to assess the degree of fatigue, and measurement points were within one week of admission, at 2 to 3 days after surgery and 3 weeks after surgery. Significant differences among the three measurement points (p<0.01) were observed. The scores of fatigue in the second survey were the highest, followed by the third and first surveys. Colon cancer patient scores were higher than those of rectal cancer patients with a significant difference (p<0.05). Colorectal patients experienced different degrees of fatigue at different periods during hospitalization. This study highlights the importance of interventions that are carefully tailored to patients based on the characteristics at different periods to alleviate fatigue.

Traditional Chinese medicine in the treatment of symptoms in patients with advanced cancer.

Patients with advanced malignancies are often suffered from deficient vital qi, which is clinically presented as cancer-related pain, anorexia, nausea/vomiting, fatigue, fever, indigestion, and constipation, which severely lower the quality of life and even shorten the survival of these patients. Traditional Chinese medicine (TCM) has a long history and rich experiences in treating malignancies. In addition to surgery, radiotherapy, chemotherapy, and other modern therapies, the TCM-based treatment can dramatically alleviate the clinical symptoms and improve the quality of life. This article analyzes the TCM treatment for the cancer pain, nausea/vomiting and cancer-related fatigue in patients with advanced malignancies, and the TCM-based emotional care for these patients are also discussed.

Relationship between cancer‐related fatigue and personality in patients with breast cancer after chemotherapy

This study aimed to explore the relationship between cancer-related fatigue (CRF) and personality in patients with breast cancer after chemotherapy. A cross-sectional study was conducted to study the relationship between CRF and personality in breast cancer patients after chemotherapy. CRF and personality were measured by the cancer fatigue score and the Eysenck Personality Questionnaire, respectively. A total of 300 breast cancer patients who had received chemotherapy were recruited to this study. Eysenck Personality Questionnaire scores of psychoticism, introversion, and extroversion in the patients were lower than the norm level (p < 0.01), but those of neuroticism and lie were higher than the norm level (p < 0.01). Multivariate analyses showed positive correlation between psychoticism and affective fatigue, neuroticism and total fatigue, and physical fatigue and cognitive fatigue. Multivariate analyses also showed negative correlation between introversion or extroversion and total fatigue, physical fatigue or affective fatigue, and lie and total fatigue or cognitive fatigue. There was CRF in patients with breast cancer after chemotherapy. Psychoticism, extroversion/introversion, neuroticism, and lie are correlated with CRF in breast cancer patients after chemotherapy.

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The Relationship Between Learned Resourcefulness and Cancer-Related Fatigue in Patients With Non-Hodgkin Lymphoma

To investigate the effect of learned resourcefulness on fatigue symptoms in patients with non-Hodgkin lymphoma (NHL) receiving chemotherapy. Quasi-experimental with repeated measures. Two large hospitals in Israel. 46 patients with NHL. On the first day of a cycle of chemotherapy treatment, participants completed questionnaires assessing fatigue and learned resourcefulness. Fatigue was assessed again after 10 and 21 days. Cancer-related fatigue, learned resourcefulness. Fatigue increased 10 days following chemotherapy treatment and returned to pretreatment levels at day 21. Learned resourcefulness correlated negatively with each of the three measurements of fatigue. In addition, a calculated partial correlation showed the specific effect of learned resourcefulness on chemotherapy-related fatigue. The findings showed a negative correlation between a physiologic variable (fatigue) and a psychological variable (learned resourcefulness), which is related to individual coping ability. Nurses should receive education about learned resourcefulness to potentially help patients with cancer cope with chemotherapy-related fatigue. As learned resourcefulness was negatively correlated with chemotherapy-related fatigue in patients with NHL, having this personality trait may help those patients manage fatigue.

Acupuncture for Cancer-Related Fatigue in Patients With Breast Cancer: A Pragmatic Randomized Controlled Trial

We aimed to assess the effectiveness of acupuncture for cancer-related fatigue (CRF) in patients with breast cancer. We conducted a pragmatic, randomized controlled trial comparing acupuncture with enhanced usual care. Three hundred two outpatients with breast cancer participated. We randomly assigned 75 patients to usual care and 227 patients to acupuncture plus usual care (random assignment of 1:3 respectively) with minimization controlling for baseline general fatigue and maintenance treatment. Treatment was delivered by acupuncturists once a week for 6 weeks through needling three pairs of acupoints. The usual care group received a booklet with information about fatigue and its management. Primary outcome was general fatigue at 6 weeks, measured with the Multidimensional Fatigue Inventory (MFI). Other measurements included the Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy-General quality-of-life scale, and expectation of acupuncture effect. Analyses were by intention to treat. Two hundred forty-six of 302 patients randomly assigned provided complete data at 6 weeks. The difference in the mean General Fatigue score, between those who received the intervention and those who did not, was -3.11 (95% CI, -3.97 to -2.25; P < .001). The intervention also improved all other fatigue aspects measured by MFI, including Physical Fatigue and Mental Fatigue (acupuncture effect, -2.36 and -1.94, respectively; both at P < .001), anxiety and depression (acupuncture effect, -1.83 and -2.13, respectively; both at P < .001), and quality of life (Physical Well-Being effect, 3.30; Functional Well-Being effect, 3.57; both at P < .001; Emotional Well-Being effect, 1.93; P = .001; and Social Functioning Well-Being effect, 1.05; P < .05). Acupuncture is an effective intervention for managing the symptom of CRF and improving patients' quality of life.

Prevalence, predictors, and prognostic impact of fatigue among Brazilian outpatients with advanced cancers

The purposes of this study are to evaluate the impact of cancer-related fatigue (CRF) on quality of life (QoL), and to identify its clinical predictors. In addition, the authors investigated the prognostic impact of CRF and its relationship with the inflammatory marker C-reactive protein. Data regarding patient characteristics, symptom scores, and QoL indices were collected at the initial evaluation. At the same time, blood samples were collected in order to evaluate some laboratorial markers. Patients were followed by telephone interviews every 15 days until death. CRF was defined as ≥66.67 points on EORTC QLQ-C30 fatigue subscale. The examined patients had a median age of 61 years (range, 21-86 years) and 50.7 % were male. Median Karnofsky performance score (KPS) was 75.5 (SD, 15.1). The prevalence of CRF was 25 % (55 out of 221). Overall, patients with CRF presented higher symptom burden and also worst QoL scores. The following variables were independently associated with CRF: nausea (OR 1.22, p = 0.009), dyspnea (OR 1.33, p = 0.002), KPS (OR 0.96, p = 0.009), body mass index (OR 0.93, p = 0.046), and C-reactive protein (OR 1.08, p = 0.004). The median overall survival (OS) was lower in CRF patients (p < 0.0001). Only KPS (HR = 0.96, p < 0.001) and C-reactive protein (HR = 1.07, p < 0.001) were independent prognostic factors for OS. Advanced cancer patients (ACP) with CRF had a higher burden of symptoms and impaired QoL. Our findings support the hypothesis that chronic inflammatory state (CIS) could play a role in the pathogenesis of fatigue in ACP. Moreover, CIS seems to have greater prognostic impact than the associated fatigue.

A prospective longitudinal study of cancer-related fatigue in patients undergoing breast-conserving surgery and radiation with or without chemotherapy for breast cancer.

9122 Background: We prospectively evaluated risk factors for persistent cancer-related fatigue in women with breast cancer undergoing lumpectomy with or without chemotherapy (CTX) prior to whole breast radiotherapy (XRT). We assessed the potential role of inflammatory mediators, demographic characteristics, and treatment history including CTX. Methods: Following lumpectomy, 60 women received a definitive course of whole breast XRT (50 Gy plus a 10 Gy boost). Prior to XRT, at week 6 of XRT, and 6 weeks post XRT, subjects completed the Multidimensional Fatigue Inventory (MFI) and underwent blood draws for inflammatory mediators (protein and mRNA). Results: Independent multivariate analyses of clinical and demographic factors revealed that CTX (p&lt;.001) , given neoadjuvantly or adjuvantly, and age &lt;50 (p=.03) were significant predictors of higher fatigue scores post XRT. Mean MFI scores in patients treated with CTX (n=24) were 20 points higher than patients not treated with CTX (p&lt;.001) with a clinically meaningful difference in scores being 10 points on the MFI. Gene ontology analysis of differentially expressed genes indicated increased activation of genes involved in immune and inflammatory responses in fatigued vs. non-fatigued patients (p&lt;.001). Of the inflammatory mediators, plasma IL-6 prior to XRT was the strongest predictor of post XRT fatigue (p=.02). Moreover, plasma IL-6 concentrations prior to XRT were significantly higher in patients who received CTX (mean 4.96 vs. 2.53, p=.01). Patients who received CTX also had significantly higher levels of NF Kappa B DNA binding 6 weeks post XRT (p&lt;.001), and transcription factor binding analysis revealed a greater representation of genes with the NF Kappa B DNA binding motif in fatigued vs. non-fatigued patients (p =.05). Conclusions: Collectively, these data suggest an interaction between CTX and XRT leading to inflammation and fatigue several weeks post XRT. This relationship was independent of whether CTX was given pre or post-operatively. Treatments targeting inflammation before XRT may reduce fatigue post therapy, particularly in patients previously treated with CTX.