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Effect of Pretreatment Distress on Daily Fatigue After Chemotherapy for Breast Cancer

Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences; Biobehavioral Medicine Program, Department of Oncological Sciences, Mount Sinai School of Medicine, New York, NY

Corresponding author: Sara C. Higgins, PhD, Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, Box 1170, 1176 Fifth Ave, New York, NY 10029-6574, sara.higgins{at}mssm.edu

Purpose: Fatigue is one of the most frequently reported and adverse effects of cancer chemotherapy. The present study tested the hypothesis that women's levels of emotional distress at the time of their initial outpatient chemotherapy treatment would predict the severity of their postinfusion fatigue.

Methods: Sixty stage I (32.6%) and II (67.4%) patients with breast cancer (mean age, 44.5 years) who were receiving standard outpatient chemotherapy participated. The independent variable, emotional distress, was assessed for "last night," "this morning," and "right now" with a visual analog scale (0 to 100). The dependent variable, post-treatment fatigue (PTF), was assessed (0 to 100) over each of the subsequent 6 days using end-of-day diaries, which also included assessments of distress and nausea (0 to 100). For the statistical analyses, post-treatment fatigue was divided into three phases with means calculated for days 1 through 2 (phase 1), 3 to 4 (phase 2), and 5 to 6 (phase 3).

Results: Consistent with the study hypothesis, patients' pretreatment distress level in the clinic was a significant (P < .001) predictor of PTF. There was also a significant (P < .025) interaction with phase, with distress becoming a predictor of PTF after phase 1. Multivariate analysis indicated that prior levels of distress were not independent predictors of PTF.

Conclusions: This study is the first to demonstrate time-specific effects of pretreatment distress on PTF. Possible mechanisms of these effects now warrant investigation, as do possible benefits of brief interventions to reduce patient distress immediately before treatment.

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