Long-Term Longitudinal Patterns of Patient-Reported Fatigue After Breast Cancer: A Group-Based Trajectory Analysis

• DOI: 10.1200/jco.21.01958
• Publication Date: 2022-03-15T19:59:40Z
• Authors: Ines Vaz-Luis; Antonio Di Meglio; Julie Havas; Mayssam El-Mouhebb; Pietro Lapidari; Daniele Presti; Davide Soldato; Barbara Pistilli; Agnes Dumas; Gwenn Menvielle; Cecile Charles; Sibille Everhard; Anne-Laure Martin; Paul H. Cottu; Florence Lerebours; Charles Coutant; Sarah Dauchy; Suzette Delaloge; Nancy U. Lin; Patricia A. Ganz; Ann H. Partridge; Fabrice André; Stefan Michiels
• Keywords: Prevention; Rehabilitation; Clinical Sciences; Oncology and Carcinogenesis; 610; Breast Neoplasms; ORIGINAL REPORTS; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Clinical Research; Breast Cancer; Quality of Life; Humans; Female; Oncology & Carcinogenesis; Longitudinal Studies; Patient Reported Outcome Measures; Prospective Studies; Survivors; Fatigue; Cancer

PURPOSE Fatigue is recognized as one of the most burdensome and long-lasting adverse effects of cancer and cancer treatment. We aimed to characterize long-term fatigue trajectories among breast cancer survivors. METHODS We performed a detailed longitudinal analysis of fatigue using a large ongoing national prospective clinical study (CANcer TOxicity, ClinicalTrials.gov identifier: NCT01993498 ) of patients with stage I-III breast cancer treated from 2012 to 2015. Fatigue was assessed at diagnosis and year 1, 2, and 4 postdiagnosis. Baseline clinical, sociodemographic, behavioral, tumor-related, and treatment-related characteristics were available. Trajectories of fatigue and risk factors of trajectory-group membership were identified by iterative estimates of group-based trajectory models. RESULTS Three trajectory groups were identified for severe global fatigue (n = 4,173). Twenty-one percent of patients were in the high-risk group, having risk estimates of severe global fatigue of 94.8% (95% CI, 86.6 to 100.0) at diagnosis and 64.6% (95% CI, 59.2 to 70.1) at year 4; 19% of patients clustered in the deteriorating group with risk estimates of severe global fatigue of 13.8% (95% CI, 6.7 to 20.9) at diagnosis and 64.5% (95% CI, 57.3 to 71.8) at year 4; 60% were in the low-risk group with risk estimates of 3.6% (95% CI, 2.5 to 4.7) at diagnosis and 9.6% (95% CI, 7.5 to 11.7) at year 4. The distinct dimensions of fatigue clustered in different trajectory groups than those identified by severe global fatigue, being differentially affected by sociodemographic, clinical, and treatment-related factors. CONCLUSION Our findings highlight the multidimensional nature of cancer-related fatigue and the complexity of its risk factors. This study helps to identify patients with increased risk of severe fatigue and to inform personalized interventions to ameliorate this problem.