Fatigue in Breast Cancer Underrecognized, Particularly in Postmenopausal Women

NEW ORLEANS--Fatigue may be underrecognized as a disturbing symptomof breast cancer, especially in postmenopausal women, but exercise mayhelp combat it, according to several presentations at the Oncology NursingSociety's 22nd Annual Congress.

Fatigue has been found to have an impact on physical well-being, abilityto work, and ability to "enjoy living in the moment" in morethan half of patients with cancer, according to an Ortho Biotech surveyof 419 cancer patients.

It is hypothesized that menopause may deal a double whammy, by its characteristicsleep disturbances, mood changes, and depression.

Barbara F. Piper, DNSc, associate professor of nursing, University ofNebraska Medical Center, Omaha, said that menopausal status may significantlyinfluence not only the emotional meaning ascribed to the fatigue experiencebut also the amount and severity of the fatigue.

Dr. Piper reported the results of a survey of 715 survivors of breastcancer (32% of 2,250 women returned questionnaires), using the 22-itemPiper Fatigue Scale. Her colleagues in the study were Marylin J. Dodd,PhD, and Sue Dibble, DNSc, of the University of California School of Nursing,San Francisco, and Marissa Weiss, MD, Paoli Memorial Hospital, Paoli, Pennsylvania.

The typical respondent was 53 years old, married, Caucasian, and postmenopausal,and had been previously treated with combination cancer therapy for early-stagedisease. Time since treatment ranged from 17 days to 27 years.

The investigators found that peri-menopausal women had significantlyhigher mean fatigue scores than women who were premenopausal.

Benefits of Exercise

Exercise may be one of the best strategies for treating the fatigueexperienced by breast cancer patients, several investigators said at themeeting.

Victoria Mock, DNSc, director of oncology nursing research, Johns HopkinsUniversity, reported that an exercise intervention program can objectivelyreduce fatigue in patients with breast cancer.

She evaluated the impact of a self-paced, moderately intense walkingprogram on fatigue, physical function, and emotional distress during cancertherapy. Patients walked 20 to 30 minutes per session, four to five timesa week, during their six-week radiotherapy treatment.

Exercise or Usual Care

The study included 50 women with stage I and II breast cancer, aged35 to 65, randomized to an exercise program or usual care.

They were objectively measured with a 12-minute walking test, and physicalfunctioning and emotional distress were evaluated by symptom assessmentscales. Scores were obtained at baseline, midtest (three weeks), and post-test.

Patients randomized to the exercise program were able to walk significantlygreater distances in 12 minutes at the post-test assessment, as comparedto the usual care group: 3,371 feet versus 3,089 feet. Their exercise levelwas rated 4.51 versus 0.92 for the usual care patients. These differenceswere statistically and clinically significant.

Symptom intensity was significantly higher in the usual care group,especially fatigue, anxiety, and difficulty sleeping. Fatigue was the mostfrequent and intense subjective symptom, reported by 100% of patients.Significant correlations were found between fatigue and difficulty sleeping,anxiety, and depression.

"With diminished exercise, you lose functional capacity and areleft with less coping ability," Dr. Mock commented. "Walkingmay have helped the women sleep better and wake up refreshed."

She said that the psychosocial aspect of exercise may have been as influentialas the cardiorespiratory improvements, since it typically takes 10 or 12weeks to show a training effect. Patients receiving chemotherapy for breastcancer have also been shown to benefit similarly from exercise, she added.

More Minutes May Be Better

Another presentation by Louann Koopermeiners, MSN, RN, of the Universityof Minnesota, Minneapolis, confirmed the impact of exercise on fatigue.

Among the 42 participants in the eight-week study, the total numberof exercise minutes correlated with fatigue, with higher minutes predictingdecreased fatigue in the Fatigue Impact Scale regression model. However,simply participating in the exercise program did not correlate with reducedfatigue.

Women had greater fatigue if they were between the ages of 45 and 55,had more depression, or had more insomnia. While exercise certainly appearedto diminish fatigue, Ms. Koopermeiners added that fatigue appears to bemultifactorial in breast cancer patients.