A multi-dimensional assessment of fatigue among patients undergoing breast radiotherapy

Cancer-related fatigue (CRF) is one of the most common and distressing symptoms among patients undergoing radiotherapy (RT), impacting quality of life and treatment adherence. While assessment of patient-reported outcomes (PROs) offers a patient-centered approach to symptom monitoring, uptake remains variable. This study examined predictors of fatigue PRO completion, patterns of fatigue across clinician- and patient-reported data sources, and the relationship between baseline physical activity and fatigue severity among patients with breast cancer receiving RT.

This retrospective cohort study included patients with breast cancer treated with RT from 2019 to 2023 at a multi-site academic cancer center. PROs were collected using the PRO-CTCAE fatigue item at 2- and 4-weeks post-RT. Logistic and ordinal logistic regressions were used to identify predictors of completion of PRO assessments, clinician-reported fatigue, and fatigue severity. Baseline physical activity collected at diagnosis from 2021 to 2023 was categorized according to National Comprehensive Cancer Network (NCCN) guidelines.

Among 756 eligible patients, 463 (61%) completed at least one PRO assessment. Non-Hispanic White patients and English speakers were more likely to complete PROs (p < 0.05). Patients with clinician-reported fatigue were less likely to complete PROs (OR 0.61, 95% CI 0.43-0.87). Clinician-reported fatigue was associated with larger RT treatment volumes, while patient-reported fatigue correlated with more RT fractions and race/ethnicity. Meeting exercise guideline recommendations was associated with a trend toward lower clinician-reported fatigue (p = 0.054), but not patient-reported fatigue.

Fatigue during and after breast RT remains prevalent yet inconsistently captured across data sources. Comprehensive symptom monitoring approaches may enhance early detection and management of fatigue in diverse patient populations.