Fatigue after breast cancer may be related to conditions other than the cancer The impact of comorbidity is essential Randi J. Reidunsdatter 1,2, Marianne Hjermstad 2,3, Line Oldervoll 4, Steinar Lundgren 2,5 1 Faculty of Technology, HiST / Research Centre for Health Promotion and Resources 2 Department of Cancer Research and Molecular Medicine, Faculty of Medicine, NTNU 3 Regional Centre for Excellence in Palliative Care, Dept of Oncology, Oslo University Hospital 4 4 LHL Health, Røros Rehabilitation 5 Department of Oncology, St.Olavs University Hospital 1
Background Advancements in diagnostics and treatments Improved survival - more survivors Information of treatment side effects and HRQoL - former treatment regimens Methodological challenges study design heterogeneous samples time since treatment baseline information Moulder et al. Clin Pharm and Ther 2008; 83: 26 36.
The prevalence of fatigue 40 35 30 25 20 15 10 5 0 Diagnosis Fatigue is a common reported symptom in cancer patients and survivors Fatigue is also prevalent in people with chronic conditions Storey et al. Ann Oncol 2007; 18: 1861 1869. Fosså et al. Acta Oncol 2007; 46: 425 461 Alonso et al. Qual of Life Res 2004; 13: 283 298
Baseline RT end of RT 3 months 6 months 12 months A longitudinal, explorative, prospective study on HRQoL and adverse events after radiotherapy Consecutive BC patients (n = 250) referred for postoperative radiotherapy at St.Olavs University Hospital in Trondheim 4
Baseline RT end of RT 3 months 6 months 12 months Aims Explore the influence of all adjuvant treatments on the course and level of fatigue the impact of comorbidity Compare fatigue levels in BC patients with the general population in Norway (GenPop) 5
Baseline RT end of RT 3 months 6 months 12 months Measures The core EORTC QLQ-C30 Fatigue subscale Baseline information Tired, weak, lack of energy during the past week Sociodemographics (self-report) Clinical data (physician-recorded) Comorbidity (cardiovascular diseases, pulmonary disorders, diabetes, depression) Aaronson NK et al; J.Natl.Cancer Inst.1993; 85:365 376 6
Data from the General Norwegian Female Population (n=949) EORTC QLQ-C30 (fatigue subscale) Self-reported chronic conditions Cardiovascular, pulmonary disorders, diabetes Cancer diagnoses were excluded Age-adjustments (29-79 years) Eligible for analysis, n= 652 Hjermstad MJ et al; J Clin Oncol 1998; 16: 1188 1196 Fosså SD et al; Acta Oncol 2007; 46: 252-461
Results
Extent of radiotherapy Course (interaction with time) Level Extent of radiotherapy P = 0.56 P = 0.22
Chemotherapy Course (interaction with time) Level Extent of radiotherapy P = 0.56 P = 0.22 Chemotherapy P < 0.001 P = 0.33
Hormonal therapy Course (interaction with time) Level Extent of radiotherapy P = 0.56 P = 0.22 Chemotherapy P < 0.001 P = 0.33 Hormonal therapy P = 0.13 P = 0.24
Comorbidity Course (interaction with time) Level Extent of radiotherapy P = 0.56 P = 0.22 Chemotherapy P < 0.001 P = 0.33 Hormonal therapy P = 0.13 P = 0.24 Comorbidity P = 0.11 P = 0.008
Mean fatigue score ± 95% CI 45 Fatigue scores total samples 40 35 30 25 20 150 Before RT After RT 3 Months 6 Months 12 Months
Mean fatigue Fatigue stratified by comorbidity groups 45 BC patients and GenPop 40 35 30 25 20 15 10 5 0 BC patients GenPop Comorbidity - 23,9 25,8 Comorbidity + 33,5 39,1
Mean fatigue Conclusions Temporary influence of adjuvant treatments Comorbidity was the most important determinant for elevated fatigue levels Similar levels to GenPop BC patients and GenPop 45 40 35 30 25 20 15 10 5 0 Comorbidity - Comorbidity + BC patients GenPop 23,9 25,8 33,5 39,1
Considerations Longer follow-up Extended measurements of fatigue Multi-center data
Implications Consideration of chronic conditions when evaluating the impact of cancer treatment on fatigue in rehabilitation programs when designing future studies
Thank you for your attention!
Reidunsdatter RJ, Albrektsen G, Hjermstad MJ, Rannestad T, Oldervoll L, Lundgren S. One-Year Course of Fatigue after Postoperative Radiotherapy in Norwegian Breast Cancer Patients - Comparison to Genaral Population. Acta Oncologica 2012; Up-coming Special Issue. Contact: Randi.J.Reidunsdatter@hist.no
Sociodemographic characteristics BC Patients N = 245 GenPop N = 652 Age (year, SD) 57.8 (9.1) 52.2 (14.1) Comorbidity, n (%) 56 (23) 207 (32) Marital status Married /cohabited Single /widow Educational level Elementary school High school College / univerity Employment status Working / student Stay-at-home Unemployed On sick leave /insured Retirement pensioners 186 (77) 56 (23) 145 (59) 34 (14) 63 (26) 118 (48) 3 (1) 0 (0) 70 (29) 52 (21) 413 (63) 437 (68) 67 (10) 138 (21) 363 (56) 63 (10) 19 (3) 68 (10) 28 (4)