How much do age, clinical and psychological factors contribute to fatigue following radiotherapy for early breast cancer? Evidence from the START Trials (UK Standardisation of Breast Radiotherapy)


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Judith Mills1, Georges Sumo1, Joanne Haviland1, Judith Bliss1, Penelope Hopwood2, on behalf of the START Trial Management Group1

1ICR-CTSU, The Institute of Cancer Research, Sutton, UK, 2Psycho-oncology Services, Christie Hospital NHS Foundation Trust, Manchester, UK

Abstract

How much do age, clinical and psychological factors contribute to fatigue following radiotherapy for early breast cancer? Evidence from the START Trials (UK Standardisation of Breast Radiotherapy)

Background

Fatigue is a frequently reported symptom in women following early breast cancer treatment and may be increased with adjuvant breast radiotherapy (RT). Within the START Quality of Life (QoL) sub study the effect of a range of clinical and psychological factors and symptoms on fatigue is investigated in women following RT for early stage breast cancer.

Method

A subgroup of women were recruited to the QoL study and completed the EORTC QLQ C-30, BR23 and HADS at baseline (after surgery +/- chemotherapy (CT) but before RT) and at 6, 12, 24 and 60 months. Fatigue was measured as a symptom subscale comprised of 3 individual items. The effect of age, time from surgery, type of surgery, CT, endocrine therapy, RT schedule and change over time were tested using a GEE model. Correlations between fatigue and anxiety, depression, insomnia and physical functioning were examined.

Results

2180 (99%) women completed baseline QoL. Fatigue levels were highest pre RT (median 33.33) and decreased during follow-up (median 22.2). An early effect of CT on fatigue was seen (p<0.001) but decreased over time. RT schedule had no significant effect. Worse fatigue during follow-up was associated with worse fatigue at baseline (p<0.001), earlier follow-up time (p<0.001) and older age (p=0.007). Worse fatigue scores were associated with worse depression, anxiety, physical functioning levels and insomnia (p<0.001).

Conclusion

There was no evidence of persistent fatigue after RT although a transient effect due to earlier CT was found; fatigue levels improved over time for the majority of women. Significant associations were found with older age, initial fatigue level, mood, insomnia and physical functioning but clinical factors were not predictive.