Fatigue as a complicating factor in the recovery of breast cancer survivors treated at an oncology clinic in South West Nigeria: a case–control study

Abstract

Purpose: Recovering cancer survivors hope to return to their premorbid lifestyle after treatment and be free from the disease. They are, however, faced with some psychosocial issues, including fatigue, which could negatively impact their quality of life. With increasing cancer awareness and improvement in treatment, it is expected that the number of cancer survivors will increase in Nigeria. Little has, however, been done with regard to survivorship care in the country. It is important to explore fatigue in this group of patients with a view to find ways of reducing it to the barest minimum. Aim:To assess the level of fatigue in breast cancer survivors on follow-up visit at a radiation oncology clinic and compare it with age and sex-matched apparently healthy controls.Materials and Methods: Fatigue levels were obtained using the Fatigue Symptom Inventory (FSI). Kruskal-Wallis H test was used to compare the FSI scores in cases and controls. Chi-squared test was used for comparison of proportions. Level of significance was set at 5%.Results: Seventy cancer survivors (cases) and 70 apparently healthy age (±1)-matched controls were recruited. The prevalence of fatigue was higher among cases than controls (24.3% versus 10%; p = 0.025). Breast cancer survivors reported significantly worse fatigue on the day they were most fatigued (p = 0.017), least fatigued (0.047) and fatigued on average (p = 0.006) compared to controls. Fatigue also significantly interferes with the ability to concentrate (p = 0.040) and relate with people (p = 0.002) more in cases compared to controls. While fatigue was more common in the morning and afternoon in breast cancer survivors, fatigue either occurred more in the evening or followed no daily pattern in the controls. Conclusion:Breast cancer survivors reported worse fatigue, suggesting the need to include fatigue screening as part of post-treatment follow-up. There is also a need to investigate the factors responsible for this and explore ways of reducing or eliminating it.

Sociodemographic and treatment-related correlates of fatigue in breast cancer survivors at an oncology clinic in Nigeria

“…where n is the sample size for populations greater than 10,000 people; Z = confidence interval is 1.96; p = prevalence (of fatigue in BCS = 24%) [ 11 ]; q = 1− p = 1− = 0.76 ; D = desired precision value = 0.05.…”

“…The FSI is a tool that has been validated to assess fatigue in cancer patients as well as survivors [ 18 ]. It was previously used to compare the severity of fatigue in BCS and apparently healthy individuals in south-western Nigeria [ 11 ]. According to the FSI, participants were asked to rate their level of fatigue (tiredness, exhaustion or lack of energy) on average in the last week.…”

“…Fatigue is a major complaint during and after cancer treatments [ 9 ]. It could occur in up to 90% of breast cancer patients receiving chemotherapy and persist in up to 25% of patients several months after chemotherapy [ 10 , 11 ]. Patients and caregivers often describe fatigue as a lack of energy, vigor or vitality.…”

“…The National Comprehensive Cancer Network defined ‘cancer-related fatigue (CRF) as a distressing persistent subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and that interferes with usual functioning’ [ 8 ]. Fatigue in cancer patients occurs more in the morning or afternoon as opposed to that of a healthy individual which usually occur in the evening or follow no definite pattern [ 11 ].…”

“…In Nigeria, a study compared the magnitude of fatigue between BCS and apparently healthy individuals [ 11 ]. Another study assessed the prevalence and determinants of chronic fatigue syndrome in apparently healthy individuals in a selected community [ 17 ].…”