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Supportive Care in Cancer
Published in: Supportive Care in Cancer 9/2015

01-09-2015 | Original Article

Identification of distinct fatigue trajectories in patients with breast cancer undergoing adjuvant chemotherapy

Authors: Doerte U. Junghaenel, Jules Cohen, Stefan Schneider, Anu R. Neerukonda, Joan E. Broderick

Published in: Supportive Care in Cancer | Issue 9/2015

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Abstract

Purpose

The goal of this study was to characterize changes in daily fatigue in women undergoing chemotherapy for breast cancer. We examined whether there are subgroups of patients with distinct fatigue trajectories and explored potential psychosocial and biomedical predictors of these subgroups.

Methods

Participants were 77 women with breast cancer receiving adjuvant chemotherapy with AC-T (2-week cycle) and TC or TCH (3-week cycle) regimens. They completed 28 daily ratings online using an adapted version of the Patient-Reported Outcomes Measurement Information System (PROMIS®) fatigue instrument.

Results

Both regimens followed an “inverted-U-shaped” fatigue pattern over approximately 2 weeks. Growth mixture modeling identified three patient subgroups with distinct trajectories. Fatigue scores in the “low fatigue” group (23 %) increased following the infusion and quickly abated. The “transient fatigue” (27 %) group had a very pronounced increase. Patients in the “high fatigue” (50 %) group reported consistently elevated fatigue with a relatively small increase. Demographic and medical variables were not associated with fatigue trajectory. Patients in the “high fatigue” group reported significantly poorer physical, emotional, and social functioning, poorer general health, and more depressed mood than patients in the “low fatigue” group. The “transient fatigue” group reported significantly better physical and social functioning than the “high fatigue” group, but emotional distress and depression similar to the “high fatigue” group.

Conclusions

The identification of patient subgroups with distinct fatigue trajectories during chemotherapy is an essential step for developing preventative strategies and tailored interventions. Our results suggest that different trajectories are associated with patients’ psychosocial and general health.
Footnotes
1
The equation used is as follows: y = β 0 + β 1 sin (2πt/14) + β 2 cos (2πt/14), where t represents the day of the cycle, β 0 is an intercept (representing the “overall” fatigue level), and β 1 and β 2 express amplitude (magnitude of increase and subsequent decrease) and phase shift (the “timing”) of sinusoidal change.
 
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Metadata
Title
Identification of distinct fatigue trajectories in patients with breast cancer undergoing adjuvant chemotherapy
Authors
Doerte U. Junghaenel
Jules Cohen
Stefan Schneider
Anu R. Neerukonda
Joan E. Broderick
Publication date
01-09-2015
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 9/2015
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-2616-x

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