Impact of early integrated rehabilitation on fatigue in 600 patients with breast cancer – a prospective study

Auprih, Masa; Zagar, Tina; Kovacevic, Nina; Smrdel, Andreja Cirila Skufca; Besic, Nikola; Homar, Vesna

doi:10.2478/raon-2024-0016

Figures & Tables

A flowchart of patients’ inclusion in our study.

Data and statistical analysis from EORTC C30 questionnaires about the global health quality of life scale, physical, role, emotional, cognitive, and social function scale, symptom scales about fatigue, pain and insomnia in the intervention and control group of patients before treatment, half a year, and a year after the beginning of treatment.

Data and statistical analysis from EORTC BR23 questionnaires.

The sum of responses to EORTC questions 10, 12 and 18 in the intervention and control groups before, half a year, and a year after treatment.

Mean values of psychological factors and pain reported by patients before, half a year and one year after the beginning of treatment

Factor	Time of assessment	Group	Mean value	Standard deviation	p-value
Depression level	Before therapy	Control	4.2	2.8	0.013
	Before therapy	Intervention	3.6	2.5	0.013
	After half year	Control	3.0	2.4	< 0.001
	After half year	Intervention	2.2	1.7	< 0.001
	After one year	Control	3.2	2.4	< 0.001
	After one year	Intervention	2.3	1.9	< 0.001
Anxiety level	Before treatment	Control	4.2	2.7	0.041
	Before treatment	Intervention	3.8	2.6	0.041
	After half year	Control	3.2	2.5	< 0.001
	After half year	Intervention	2.4	1.8	< 0.001
	After one year	Control	3.5	2.6	< 0.001
	After one year	Intervention	2.6	2.0	< 0.001
Level of difficulty concentrating	Before treatment	Control	3.2	2.5	0.96
	Before treatment	Intervention	3.1	2.3	0.96
	After half year	Control	3.2	2.4	0.02
	After half year	Intervention	2.8	2.1	0.02
	After one year	Control	3.6	2.4	< 0.001
	After one year	Intervention	2.7	2.1	< 0.001
Constant fatigue	Before treatment	Control	3.2	2.4	0.59
	Before treatment	Intervention	3.1	2.2	0.59
	After half year	Control	3.8	2.6	0.018
	After half year	Intervention	3.3	2.4	0.018
	After one year	Control	4.0	2.7	0.001
	After one year	Intervention	3.3	2.3	0.001
Disturbing fatigue	Before treatment	Control	2.8	2.3	0.50
	Before treatment	Intervention	2.9	2.2	0.50
	After half year	Control	3.9	2.5	0.003
	After half year	Intervention	3.3	2.3	0.003
	After one year	Control	3.8	2.5	< 0.001
	After one year	Intervention	3.2	2.2	< 0.001
Insomnia	Before treatment	Control	4.2	3.0	0.22
	Before treatment	Intervention	3.9	2.8	0.22
	After half year	Control	4.8	3.0	0.002
	After half year	Intervention	4.0	2.7	0.002
	After one year	Control	4.8	3.0	< 0.001
	After one year	Intervention	3.9	2.9	< 0.001
Pain	Before treatment	Control	2.8	2.4	0.005
	Before treatment	Intervention	2.3	2.0	0.005
	After half year	Control	3.4	2.4	0.006
	After half year	Intervention	2.9	2.1	0.006
	After one year	Control	3.7	2.5	< 0.001
	After one year	Intervention	2.7	1.8	< 0.001

The influence of all included variables simultaneously on fatigue half a year and a year after the beginning of treatment

	Half a year after treatment			One year after treatment

	OR	95% CI	p-value	OR	95% CI	p-value
Control group	1.4	0.9–2.0	0.100	1.5	1.0–2.2	0.044
Age group 45–54 years	1.1	0.7–1.7	0.822	1.1	0.7–1.9	0.617
Age group 55–64 years	1.0	0.6–1.6	0.931	0.6	0.3–1.0	0.052
Chemotherapy – yes	1.6	1.1–2.5	0.025	1.3	0.9–2.1	0.206
Hormonal therapy – yes	1.1	0.7–1.8	0.616	1.6	0.9–2.6	0.088
Radiotherapy – yes	0.7	0.4–1.2	0.196	0.7	0.4–1.3	0.277
Surgery – not done	1.2	0.3–4.4	0.745	0.9	0.2–3.9	0.879
Surgery – Tumorectomy – yes	1.6	0.9–2.6	0.080	1.4	0.8–2.4	0.256
Axillary lymphadenectomy – yes	0.7	0.4–1.2	0.232	0.7	0.4–1.2	0.148
Presence of distant metastases	1.4	0.5–3.7	0.491	2.1	0.8–5.9	0.145

Demographic and clinical characteristics of patients, pathological characteristics of tumors and treatment_ P-value refers to difference between control and intervention group; it is calculated by t-test in case of comparing means and by chi-squared test in case of counts

Factor	Subgroup	All patients (N = 600)	Control group (N = 301)	Intervention group (N = 299)	P-value
Mean age of patients (years)		50.78	50.59	50.97	0.601
Living areas	Urban	287	125	162	0.003
	Suburban	105	53	52
	Rural	208	123	85
Education (N = 599)	Primary school	66	39	27	0.290
	Secondary school	242	117	125
	Higher	291	144	147
Socioeconomic status	Low	71	36	35	0.940
	Middle	432	217	215
	Higher	95	46	49
With whom they live (N = 597)	Alone	58	24	34	0.600
	With partner only	145	71	74
	Partner and children	289	147	142
	With children only	42	22	20
	Other	63	35	28
Employment (N = 581)	Unemployed	54	35	19	0.067
	Employed	433	209	224
	Retired	94	45	49
Mean primary tumor size (mm)		26.3	25.5	27.2	0.285
Tumor stage	In situ	10	5	5	0.152
	I	260	133	127
	II	214	97	117
	III	81	50	31
	IV	35	16	19
Concomitant diseases	No	301	154	147	0.624
Concomitant diseases	Yes	299	147	152	0.624
Neoadjuvant chemotherapy and/or anti-HER-2 therapy	No	465	227	237	0.241
Neoadjuvant chemotherapy and/or anti-HER-2 therapy	Yes	135	74	61	0.241
Breast surgery	Mastectomy	252	135	117	0.357
	Tumorectomy	326	156	170
	No surgery	22	10	12
Lymph node surgery	Lymphadenectomy	151	83	86	0.337
	Sentinel node biopsy	417	204	213
	No surgery	32	14	18
Breast reconstruction	No	431	214	217	0.402
	Tissue expander	127	69	58
	Free-flap	42	18	24
Breast external beam radiotherapy	No	149	83	66	0.131
Breast external beam radiotherapy	Yes	451	218	233	0.131
Chemotherapy	No	280	137	143	0.623
Chemotherapy	Yes	320	164	156	0.623
Anti-HER2 therapy	No	522	264	258	0.629
Anti-HER2 therapy	Yes	78	37	41	0.629
Hormone therapy	No	132	69	63	0.623
Hormone therapy	Yes	468	232	236	0.623

The influence of each individual variable on fatigue (univariate models) by individual logistic regressions before treatment, half a year and one year after the beginning of treatment_ OR – odds ratio; CI – confidence interval

Before treatment	OR	95% CI	p-value
Control group	1.3	0.8–2.2	0.245
Half a year after the beginning of treatment	OR	95% CI	p-value
Control group	1.3	0.9–1.9	0.114
Age group 45–54 years	1.0	0.7–1.6	0.855
Age group 55–64 years	0.9	0.6–1.5	0.803
Chemotherapy – yes	1.3	0.9–1.9	0.135
Hormonal therapy – yes	0.9	0.6–1.4	0.689
Radiotherapy – yes	0.8	0.5–1.3	0.364
Neoadjuvant chemotherapy and/or anti-HER2 therapy	1.3	0.9–1.9	0.227
Surgery – not done	1.7	0.6–4.4	0.308
Surgery – Tumorectomy – yes	1.3	0.9–1.8	0.208
Axillary lymphadenectomy – yes	0.7	0.5–1.1	0.162
Breast reconstruction – yes	0.8	0.5–1.2	0.256
Presence of distant metastases	1.4	0.7–2.8	0.403
A year after the beginning of treatment	OR	95% CI	p-value
Control group	1.5	1.0–2.2	0.046
Age group 45–54 years	1.2	0.8–2.0	0.387
Age group 55–64 years	0.6	0.4–1.0	0.064
Chemotherapy – yes	1.4	0.8–1.7	0.493
Hormonal therapy – yes	1.3	0.8–2.2	0.246
Radiotherapy – yes	0.7	0.5–1.2	0.191
Neoadjuvant chemotherapy and/or anti-HER2 therapy	1.2	0.8–1.9	0.347
Surgery – not done	1.7	0.5–5.2	0.371
Surgery – Tumorectomy – yes	1.1	0.7–1.6	0.961
Axillary lymphadenectomy – yes	0.7	0.5–1.1	0.161
Breast reconstruction – yes	0.9	0.6–1.3	0.454
Presence of distant metastases	1.8	0.8–4.0	0.130

Impact of early integrated rehabilitation on fatigue in 600 patients with breast cancer – a prospective study

Figures & Tables

FIGURE 1.

FIGURE 2.

FIGURE 3.

FIGURE 4.

Mean values of psychological factors and pain reported by patients before, half a year and one year after the beginning of treatment

The influence of all included variables simultaneously on fatigue half a year and a year after the beginning of treatment

Demographic and clinical characteristics of patients, pathological characteristics of tumors and treatment_ P-value refers to difference between control and intervention group; it is calculated by t-test in case of comparing means and by chi-squared test in case of counts

The influence of each individual variable on fatigue (univariate models) by individual logistic regressions before treatment, half a year and one year after the beginning of treatment_ OR – odds ratio; CI – confidence interval

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