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Fatigue, anxiety, and quality of life in breast cancer patients compared to non-cancer controls: a nationwide longitudinal analysis

  • Epidemiology
  • Published:
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Abstract

Purpose

Fatigue and anxiety are common and significant symptoms reported by cancer patients. Few studies have examined the trajectory of multidimensional fatigue and anxiety, the relationships between them and with quality of life.

Methods

Breast cancer patients (n = 580) from community oncology clinics and age-matched controls (n = 364) completed fatigue and anxiety questionnaires prior to chemotherapy (A1), at chemotherapy completion (A2), and six months post-chemotherapy (A3). Linear mixed models (LMM) compared trajectories of fatigue /anxiety over time in patients and controls and estimated their relationship with quality of life. Models adjusted for age, education, race, BMI, marital status, menopausal status, and sleep symptoms.

Results

Patients reported greater fatigue and anxiety compared to controls at all time points (p’s < 0.001, 35% clinically meaningful anxiety at baseline). From A1 to A2 patients experienced a significant increase in fatigue (β = 8.3 95%CI 6.6,10.0) which returned to A1 values at A3 but remained greater than controls’ (p < 0.001). General, mental, and physical fatigue subscales increased from A1 to A2 remaining significantly higher than A1 at A3 (p < 0.001). Anxiety improved over time (A1 to A3 β =  − 4.3 95%CI -2.6,-3.3) but remained higher than controls at A3 (p < 0.001). Among patients, fatigue and anxiety significantly predicted one another and quality of life. Menopausal status, higher BMI, mastectomy, and sleep problems also significantly predicted change in fatigue.

Conclusion

Breast cancer patients experience significant fatigue and anxiety up to six months post-chemotherapy that is associated with worse quality of life. Future interventions should simultaneously address anxiety and fatigue, focusing on mental and physical fatigue subdomains.

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Data Availability

Please contact the authors for any questions related to data.

Code Availability

SAS Code is available upon request.

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Acknowledgments

This work was supported by grants from the National Institutes of Health (DP2CA195765 to M.C.J.) and the National Cancer Institute at the National Institutes of Health (F99CA222742 to A.M.W., R01CA231014 to M.C.J.). We thank the participants in this study and all staff at the University of Rochester Cancer Center National Cancer Institute (NCI) Community Clinical Oncology Research Program (NCORP) Research Base and our NCORP affiliate sites who recruited and observed participants. We thank the National Cancer Institute Clinical Community Oncology Program (CCOP) and NCORP programs for their funding and support of this project. The following CCOP/NCORPs participated in this study: Central Illinois, Columbus, Cancer Research Consortium of West Michigan, Dayton, Delaware, Grand Rapids, Greenville, Hematology-Oncology Associates of Central New York, Kalamazoo, Kansas City, Marshfield, Metro Minnesota, Nevada, North Shore, Pacific Cancer Research Consortium, Southeast Cancer Control Consortium, Southeast Clinical Oncology Research Consortium, Upstate Carolina, Virginia Mason, Wichita, Wisconsin NCORP, and Western Oncology Research Consortium.

Funding

This work was supported by grants from the National Institutes of Health (DP2CA195765 to M.C.J.) and the National Cancer Institute at the National Institutes of Health (F99CA222742 to A.M.W., R01CA231014 to M.C.J.).

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Authors and Affiliations

  1. University of Rochester Medical Center, James P. Wilmot Cancer Institute, St. Jude Children’s Research Hospital, Rochester, USA

    AnnaLynn M. Williams, Charles E. Heckler, Amber S. Kleckner, Karen M. Mustian, Luke J. Peppone, Charles S. Kamen & Michelle C. Janelsins

  2. Patient-Centered Outcomes Research Initiative, Rochester, USA

    Carly Paterson Khan

  3. School of Nursing, University of Michigan, Ann Arbor, USA

    Debra L. Barton

  4. Dayton Clinical Oncology Program, Dayton, USA

    Mary Ontko

  5. Metro Minnesota Community Oncology Research Program, St Louis Park, USA

    Jodi Geer

  6. Wichita NCORP, Wichita, USA

    Shaker Dakhil

  7. Columbus NCORP, Columbus, USA

    Jerry Mitchell

  8. National Cancer Institute, Bethesda, USA

    Victor Kipnis & Ann M. O’Mara

  9. Department of Epidemiology and Cancer Control, Postdoctoral Research Fellow, St. Jude Children’s Research Hospital, 262 Danny Thomas Blvd, Memphis, TN, 38106, USA

    AnnaLynn M. Williams

  10. Department of Surgery, Cancer Control and Director Psychoneuroimmunology Laboratory, University of Rochester Medical Center, James P. Wilmot Cancer Institute, 265 Crittenden Blvd, Box 658, Rochester, NY, 14642, USA

    Michelle C. Janelsins

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  1. AnnaLynn M. Williams
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Corresponding authors

Correspondence to AnnaLynn M. Williams or Michelle C. Janelsins.

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Conflicts of interest

The authors declare no conflicts of interest. The role of the funder: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decisions to submit the manuscript for publication.

Ethical approval

This study was approved by the Institutional Review Board of the University of Rochester Cancer Center NCORP Research Base and each NCORP location; the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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Williams, A.M., Khan, C.P., Heckler, C.E. et al. Fatigue, anxiety, and quality of life in breast cancer patients compared to non-cancer controls: a nationwide longitudinal analysis. Breast Cancer Res Treat 187, 275–285 (2021). https://doi.org/10.1007/s10549-020-06067-6

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  • DOI: https://doi.org/10.1007/s10549-020-06067-6

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