Recent advances in understanding chemotherapy-induced fatigue in BC patients residing in high-altitude regions: a review

Breast cancer (BC) is a frequent women-specific malignancy, and one of the treatment options is chemotherapy. Chemotherapy-related fatigue (CRF) is however a common side effect with a prevalence of 30-60% of BC patients throughout the treatment process and some patients experience long-term fatigue which affects their quality of life and prognosis rates. Hypoxia, low atmospheric pressure, and temperature changes are some of the environmental factors that can worsen fatigue among BC patients in high-altitude zones. CRF mechanisms are multifactorial, which means they include chronic inflammation, immune dysregulation, neuroendocrine outliers, and mitochondrial dysfunction. The primary factors are inflammation and immune readjustment, and high-altitude hypoxia only adds to the processes. Nondpharmacological treatments such as physical activity, cognitive behavioral therapy, and mindfulness have been effective in the control of fatigue. Treatment is yet to be conclusive on the pharmacological side but reversible factors (e.g., anemia, sleep disorders) should be managed. Future studies are to consider CRF mechanisms in elevated areas and devise the customized treatments to enhance patient quality of life.