One-Year Longitudinal Study of Fatigue, Cognitive Functions, and Quality of Life After Adjuvant Radiotherapy for Breast Cancer

Noal, Sabine; Lévy, Christelle; Hardouin, Agnès; Rieux, Chantal; Heutte, Natacha; Ségura, Carine; Collet, Fabienne; Allouache, Djelila; Switsers, O.; Delcambre, Corinne; Delozier, T.; Henry-Amar, Michel; Joly, Florence

doi:10.1016/j.ijrobp.2010.06.037

Cited by 94 publications

(93 citation statements)

References 37 publications

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“…Additionally, chemotherapy has been implicated as a likely contributor; patients undergoing RT for breast cancer, for example, have been demonstrated to experience worse fatigue if they had previously undergone chemotherapy [42–44]. Finally, mental health comorbidities and other complex psychobehavioral factors have been associated with persistent fatigue following cancer therapy [42,43,45]. …”

Section: Discussionmentioning

confidence: 99%

Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy

Ferris

Zhong

Switchenko

et al. 2018

Radiotherapy and Oncology

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Background and purpose Radiation (RT) dose to the central nervous system (CNS) has been implicated as a contributor to treatment-related fatigue in head and neck cancer (HNC) patients undergoing radiation therapy (RT). This study evaluates the association of RT dose to CNS structures with patient-reported (PRO) fatigue scores in a population of HNC patients. Materials and methods At pre-RT (baseline), 6th week of RT, and 1-month post-RT time points, Multidimensional Fatigue Inventory (MFI-20) scores were prospectively obtained from 124 patients undergoing definitive treatment for HNC. Medulla, pons, midbrain, total brainstem, cerebellum, posterior fossa, and pituitary dosimetry were evaluated using summary statistics and dose-volume histograms, and associations with MFI-20 scores were analyzed. Results Maximum dose (Dmax) to the brainstem and medulla was significantly associated with MFI-20 scores at 6th week of RT and 1-month post-RT time points, after controlling for baseline scores (p < 0.05). Each 1 Gy increase in medulla Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p = 0.026), and 0.25 (p = 0.037), at the 6th week of RT and 1-month post-RT, respectively. Each 1 Gy increase in brainstem Dmax resulted in an increase in total MFI-20 score over baseline of 0.30 (p = 0.027), and 0.25 (p = 0.037) at the 6th week of RT, 1-month post-RT, respectively. Statistically significant associations were not found between dosimetry for the other CNS structures and MFI-20 scores. Conclusions In this analysis of PRO fatigue scores from a population of patients undergoing definitive RT for HNC, maximum dose to the brainstem and medulla was associated with a significantly increased risk of acute patient fatigue.

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Section: Discussionmentioning

confidence: 99%

Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy

Ferris

Zhong

Switchenko

et al. 2018

Radiotherapy and Oncology

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“…6,7 In fact, one study found that up to 40% of patients who received radiotherapy for BCa reported fatigue 1 year after treatment. 8 Fatigue has been demonstrated to be the strongest predictor of quality of life in women after radiotherapy, 9 and fatigue has pervasive and detrimental effects on numerous aspects of patients' functioning. 7,[10][11][12] Fatigue is a multidimensional construct.…”

Section: Introductionmentioning

confidence: 99%

“…13 Although cancer treatments are clearly one source of fatigue, psychological factors also contribute. 6,8,[14][15][16] Meta-analysis has indicated that psychological interventions, such as cognitive-behavioral therapy (CBT), are efficacious in reducing cancerrelated fatigue. 17 Meta-analyses (in studies of pain, anxiety, and weight loss) have indicated that adding hypnosis to CBT significantly increases effect sizes relative to CBT alone.…”

Section: Introductionmentioning

confidence: 99%

Randomized Controlled Trial of a Cognitive-Behavioral Therapy Plus Hypnosis Intervention to Control Fatigue in Patients Undergoing Radiotherapy for Breast Cancer

Montgomery

David

Kangas

et al. 2014

JCO

106

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Purpose The objective of this study was to test the efficacy of cognitive-behavioral therapy plus hypnosis (CBTH) to control fatigue in patients with breast cancer undergoing radiotherapy. We hypothesized that patients in the CBTH group receiving radiotherapy would have lower levels of fatigue than patients in an attention control group. Patients and Methods Patients (n = 200) were randomly assigned to either the CBTH (n = 100; mean age, 55.59 years) or attention control (n = 100; mean age, 55.97 years) group. Fatigue was measured at four time points (baseline, end of radiotherapy, 4 weeks, and 6 months after radiotherapy). Fatigue was measured using the Functional Assessment of Chronic Illness Therapy (FACIT) –Fatigue subscale and Visual Analog Scales (VASs; Fatigue and Muscle Weakness). Results The CBTH group had significantly lower levels of fatigue (FACIT) at the end of radiotherapy (z, 6.73; P < .001), 4-week follow-up (z, 6.98; P < .001), and 6-month follow-up (z, 7.99; P < .001) assessments. Fatigue VAS scores were significantly lower in the CBTH group at the end of treatment (z, 5.81; P < .001) and at the 6-month follow-up (z, 4.56; P < .001), but not at the 4-week follow-up (P < .07). Muscle Weakness VAS scores were significantly lower in the CBTH group at the end of treatment (z, 9.30; P < .001) and at the 6-month follow-up (z, 3.10; P < .02), but not at the 4-week follow-up (P < .13). Conclusion The results support CBTH as an evidence-based intervention to control fatigue in patients undergoing radiotherapy for breast cancer. CBTH is noninvasive, has no adverse effects, and its beneficial effects persist long after the last intervention session. CBTH seems to be a candidate for future dissemination and implementation.

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“…However, the chemo+ and chemo− pairing presents differences in treatment. For example, the chemo− group may receive radiation treatment or anti-estrogen regimens, both which may contribute to fatigue (Noal et al, 2010) and be implicated in cognitive dysfunction in BC patients (Castellon et al, 2004). Regardless, the presence of cancer is an important factor to consider as ongoing studies have revealed elevated cytokine levels in cancer patients (Vardy et al, 2007) compared to healthy controls.…”

Section: Introductionmentioning

confidence: 99%

Pre-Chemotherapy Differences in Visuospatial Working Memory in Breast Cancer Patients Compared to Controls: An fMRI Study

Scherling¹,

Collins²,

MacKenzie³

et al. 2011

Front. Hum. Neurosci.

105

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Introduction: Cognitive deficits are a side-effect of chemotherapy, however pre-treatment research is limited. This study examines neurofunctional differences during working memory between breast cancer (BC) patients and controls, prior to chemotherapy. Methods: Early stage BC females (23), scanned after surgery but before chemotherapy, were individually matched to non-cancer controls. Participants underwent functional magnetic resonance imaging (fMRI) while performing a Visuospatial N-back task and data was analyzed by multiple group comparisons. fMRI task performance, neuropsychological tests, hospital records, and salivary biomarkers were also collected. Results: There were no significant group differences on neuropsychological tests, estrogen, or cortisol. Patients made significantly fewer commission errors but had less overall correct responses and were slower than controls during the task. Significant group differences were observed for the fMRI data, yet results depended on the type of analysis. BC patients presented with increased activations during working memory compared to controls in areas such as the inferior frontal gyrus, insula, thalamus, and midbrain. Individual group regressions revealed a reverse relationship between brain activity and commission errors. Conclusion: This is the first fMRI investigation to reveal neurophysiological differences during visuospatial working memory between BC patients pre-chemotherapy and controls. These results also increase the knowledge about the effects of BC and related factors on the working memory network. Significance: This highlights the need to better understand the pre-chemotherapy BC patient and the effects of associated confounding variables.

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One-Year Longitudinal Study of Fatigue, Cognitive Functions, and Quality of Life After Adjuvant Radiotherapy for Breast Cancer

Cited by 94 publications

References 37 publications

Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy

Brainstem dose is associated with patient-reported acute fatigue in head and neck cancer radiation therapy

Randomized Controlled Trial of a Cognitive-Behavioral Therapy Plus Hypnosis Intervention to Control Fatigue in Patients Undergoing Radiotherapy for Breast Cancer

Pre-Chemotherapy Differences in Visuospatial Working Memory in Breast Cancer Patients Compared to Controls: An fMRI Study

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