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One in five breast cancer patients experiences persistent or recurring fatigue throughout the decade following diagnosis and treatment, a new study reveals.
An even larger pool -- just over one-third of those ultimately deemed cancer-free after treatment -- say that despite their "cure" they have nonetheless felt tired, weak or lacking in energy either in the first five years following diagnosis or in the second five years.
The study is the first to examine the long-term role fatigue can play years after a cancer diagnosis.
"The issue is that fatigue is a problem that persists for a minority of women, although some of them who were initially fatigued get better, so it may not last forever. But, for some, it may continue," says study co-author Dr. Patricia A. Ganz. She is director of cancer prevention and control research at the Jonsson Comprehensive Cancer Center, University of California, Los Angeles.
In 1998, Ganz and her colleagues gave quality-of-life questionnaires to 763 women recruited from the Los Angeles and Washington D.C. areas, all of whom had completed their cancer treatment (other than longer-term use of the cancer-suppressing drug tamoxifen). All the patients were assessed as being cancer-free at least five years following their treatment.
The women had all participated in a larger 1994 to 1997 study conducted by the same research team. At that time, 35 percent of the breast cancer patients were found to have been "fatigued" one to five years after diagnosis.
The new follow-up study found that 34 percent of the women were similarly fatigued between five and 10 years after diagnosis.
However, not all the women who had been battling fatigue in the first five years continued to be similarly disabled in the second half of the decade, the study found.
Reporting in the Feb. 15 issue of the journal Cancer, the authors note that 12 percent of patients had regained their normal energy levels sometime after five years following treatment.
On the other hand, 13 percent of the women who had not initially described themselves as tired during the first five years after diagnosis went on to become fatigued at some point after the five-year mark.
In all, 63 percent of the initially fatigued women remained clinically tired in the second half of the decade, Ganz and her associates found.
But the researchers emphasized that the vast majority of breast cancer survivors had never had to combat fatigue at any point in the decade following their treatment.
Certain factors did appear to be associated with a greater likelihood of becoming fatigued at some point during the recovery process, the researchers says.
Patients coping with depression, pain, diabetes, arthritis, heart disease, and/or high blood pressure following their cancer diagnosis were more likely to encounter fatigue issues, the study found.
Similarly, women who had undergone what they termed "more aggressive" breast cancer treatments -- such as radiation combined with chemotherapy, as opposed to either therapy alone -- also appeared more susceptible to long-term fatigue, the study found.
Ganz and her team cautioned that the jury is still out on how much fatigue might wax and wane among those affected, and how intense bouts of fatigue might be.
They noted that in some cases, fatigue could be a characteristic of an individual, rather than a side effect of breast cancer.
"In the early stages people are sorting out, they're either getting better or getting worse," Ganz says. "But about five to 10 years into it, they are in a relatively stable state. Whatever level of fatigue they've had is probably where they're going to be.
If you haven't recovered by that point in time, it's unlikely you're going to get better."
Dr. Claudine Isaacs, director of the clinical breast cancer program at Georgetown University, called the study well done, but added that determining the cause of fatigue is a complex matter.
"What it suggests to me is that fatigue is an issue that can be seen in the long term, but the question is: how much of it is attributable to a breast cancer diagnosis and how much is related to something else?" she says.
"But it's an important thing to evaluate with our patients, and it's important for us to communicate about the underlying causes," Isaacs says. "I just wouldn't want patients to always anticipate fatigue following a breast cancer diagnosis. Because, in fact, this study suggests that the majority of people didn't have it."
In a second study published in the same issue of Cancer, researchers from UCLA and Ohio University College of Osteopathic Medicine report that breast cancer patients who consult their family as a final treatment decision-maker are more likely to undergo a mastectomy than other breast-saving alternatives.
Hispanic women, they noted, are the most likely to consult their families, more so than African-Americans or whites, the study found.
The authors encouraged physicians to relate to family members as important decision-makers in the treatment process.
(The HealthDay Web site is at http://www.HealthDay.com.)
c.2006 HealthDay News
