Uptake of Recommendations for Posttreatment Cancer-Related Fatigue Among Breast Cancer Survivors
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Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes-Sorbonne Paris Cité, Boulogne-Billancourt;
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Background: Physical activity (PA) and psychosocial interventions are recommended management strategies for cancer-related fatigue (CRF). Randomized trials support the use of mind–body techniques, whereas no data show benefit for homeopathy or naturopathy. Methods: We used data from CANTO (ClinicalTrials.gov identifier: NCT01993498), a multicenter, prospective study of stage I–III breast cancer (BC). CRF, evaluated after primary treatment completion using the EORTC QLQ-C30 (global CRF) and QLQ-FA12 (physical, emotional, and cognitive dimensions), served as the independent variable (severe [score of ≥40/100] vs nonsevere). Outcomes of interest were adherence to PA recommendations (≥10 metabolic equivalent of task [MET] h/week [GPAQ-16]) and participation in consultations with a psychologist, psychiatrist, acupuncturist, or other complementary and alternative medicine (CAM) practitioner (homeopath and/or naturopath) after CRF assessment. Multivariable logistic regression examined associations between CRF and outcomes, adjusting for sociodemographic, psychologic, tumor, and treatment characteristics. Results: Among 7,902 women diagnosed from 2012 through 2017, 36.4% reported severe global CRF, and 35.8%, 22.6%, and 14.1% reported severe physical, emotional, and cognitive CRF, respectively. Patients reporting severe global CRF were less likely to adhere to PA recommendations (60.4% vs 66.7%; adjusted odds ratio [aOR], 0.82; 95% CI, 0.71–0.94; P=.004), and slightly more likely to see a psychologist (13.8% vs 7.5%; aOR, 1.29; 95% CI, 1.05–1.58; P=.014), psychiatrist (10.4% vs 5.0%; aOR, 1.39; 95% CI, 1.10–1.76; P=.0064), acupuncturist (9.8% vs 6.5%; aOR, 1.46; 95% CI, 1.17–1.82; P=.0008), or CAM practitioner (12.5% vs 8.2%; aOR, 1.49; 95% CI, 1.23–1.82; P<.0001). There were differences in recommendation uptake by CRF dimension, including that severe physical CRF was associated with lower adherence to PA (aOR, 0.74; 95% CI, 0.63–0.86; P=.0001) and severe emotional CRF was associated with higher likelihood of psychologic consultations (aOR, 1.37; 95% CI, 1.06–1.79; P=.017). Conclusions: Uptake of recommendations to improve CRF, including adequate PA and use of psychosocial services, seemed suboptimal among patients with early-stage BC, whereas there was a nonnegligible interest in homeopathy and naturopathy. Findings of this large study indicate the need to implement recommendations for managing CRF in clinical practice.
Submitted August 20, 2020; final revision received November 5, 2020; accepted for publication April 26, 2021. Published online February 7, 2022.
Previous presentation: Results of this study were partly presented at the ESMO Breast Cancer Virtual Meeting; May 23–24, 2020. Proffered Paper session 1. Ann Oncol 2020;31(Suppl 2):S83–87.
Author contributions: Study concept: Di Meglio, Charles, E. Martin, Flaysakier, A.L. Martin, Everhard, Laas, Chopin, Vanlemmens, Jouannaud, Levy, Rigal, Fournier, Soulie, Scotte, Pistilli, Dumas, Menvielle, André, Michiels, Dauchy, Vaz-Luis. Data curation: Di Meglio, Havas, Gbenou, Vaz-Luis. Formal analysis: Di Meglio, Havas, Gbenou, Vaz-Luis. Funding acquisition: Di Meglio, Vaz-Luis. Investigation: Di Meglio, Charles, E. Martin, Flaysakier, A.L. Martin, Everhard, Laas, Chopin, Vanlemmens, Jouannaud, Levy, Rigal, Fournier, Soulie, Scotte, Pistilli, Dumas, Menvielle, André, Michiels, Dauchy, Vaz-Luis. Methodology: All authors. Project administration: Di Meglio, A.L. Martin, Everhard, Vaz-Luis. Resources: Di Meglio, A.L. Martin, Everhard, Vaz-Luis. Software: Di Meglio, Vaz-Luis. Supervision: Di Meglio, Vaz-Luis. Validation: Di Meglio, Charles, E. Martin, Flaysakier, A.L. Martin, Everhard, Laas, Chopin, Vanlemmens, Jouannaud, Levy, Rigal, Fournier, Soulie, Scotte, Pistilli, Dumas, Menvielle, André, Michiels, Dauchy, Vaz-Luis. Visualization: Di Meglio, Vaz-Luis. Writing – original draft: Di Meglio, Vaz-Luis. Writing – review and editing: Di Meglio, Vaz-Luis.
Disclosures: Dr. Michiels has disclosed serving on a data safety monitoring board for Sensorion, Biophytis, Servier, and Yuhan, and serving as a consultant for IDDI, Amaris, and Roche. Dr. Vaz-Luis has disclosed receiving honoraria for education purposes (institutional) from AstraZeneca and Pfizer/Edimark. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Funding: This work was supported by funding from a Career Pathway Grant in Symptom Management from Conquer Cancer, ASCO, and Rising Tide Foundation for Clinical Cancer Research (A. Di Meglio), Susan G. Komen (CCR17483507 to I. Vaz-Luis), Odyssea (I. Vaz-Luis), the French Foundation for Cancer Research (I. Vaz-Luis), Fondation Gustave Roussy (I. Vaz-Luis), and Breast Cancer Research Foundation. The CANTO study is supported by the French Government under the “Investment for the Future” program, managed by the National Research Agency (ANR), grant N. ANR-10-COHO-0004.
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