An analysis of a clinical trial on adverse effects of cancer and its treatment in patients with breast cancer identified 3 risk groups for fatigue. Results of the study were published in the Journal of Clinical Oncology.1

The study was a longitudinal analysis of patients in the Breast Cancer Toxicity trial (CANTO; Identifier: NCT01993498) who were treated for breast cancer stage I to III in the period from 2012 through 2015. Fatigue was measured at diagnosis and follow-up visits at years 1, 2, and 4 after diagnosis. These follow-up visits occurred after completion of treatments, including primary surgery, chemotherapy, and/or radiation, but certain adjuvant therapies were allowed in the follow-up period.

Global fatigue was the primary outcome of this analysis, measured using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30. Other fatigue-related quality-of-life dimensions were also evaluated using the EORTC QLQ-FA12. Using multiple patient, disease-related, and treatment-related data, the researchers developed a model to stratify patients into groups for predicting trajectories of fatigue.

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The cohort included 5692 patients, with a mean age of 56.2 years at diagnosis. Half of the patients (50%) had stage I breast cancer, and 79.8% of participants in the total cohort did not have relevant comorbidities. Data from 4173 patients were included in development of the model of fatigue trajectories.

The researchers identified 3 groups related to trajectories of fatigue. The high-risk group (21% of the patients) was marked by risk estimates for severe global fatigue of 94.8% (95% CI, 86.6-100.0) at diagnosis and 64.6% (95% CI, 59.2-70.1) at year 4.

Risk estimates for several global fatigue in the group characterized by deteriorating risk (19%) were 13.8% (95% CI, 6.7-20.9) at diagnosis and 64.5% (95% CI, 57.3-71.8) at year 4. This group experienced low risk of severe fatigue at diagnosis, but risk increased substantially over time. The third group (low risk; 60%) had severe global fatigue risk estimates of 3.6% (95% CI, 2.5-4.7) at diagnosis and 9.6% (95% CI, 7.5-11.7) at year 4.

Factors associated with worse fatigue trajectories included younger age, tobacco use, marital status of single, various clinical characteristics, and use of hormonal therapy. Analyses of fatigue-related dimensions using the EORTC QLQ-FA12 scale revealed different clusters of patients in fatigue-related trajectories, ranging from 4 groups for both severe physical fatigue and severe emotional fatigue, to 2 groups for severe cognitive fatigue. Most patients appeared to be in the lower-risk categories for these dimensions.

“This study highlights the multidimensional nature of cancer-related fatigue and the complexity of its risk factors that include both common and dimension-specific determinants,” the study investigators stated.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Vaz-Luis I, Di Meglio A, Havas J, et al. Long-term longitudinal patterns of patient-reported fatigue after breast cancer: a group-based trajectory analysis. J Clin Oncol. Published March 15, 2022. doi:10.1200/JCO.21.01958