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

Masa Auprih
Masa Auprih
, 
Tina Zagar
Tina Zagar
, 
Nina Kovacevic
Nina Kovacevic
, 
Andreja Cirila Skufca Smrdel
Andreja Cirila Skufca Smrdel
, 
Nikola Besic
Nikola Besic
 and 
Vesna Homar
Vesna Homar
   | Mar 07, 2024
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Article Category: Research Article
Published Online: Mar 07, 2024
Page range: 243 - 257
Received: Jun 05, 2023
Accepted: Dec 09, 2023
DOI: https://doi.org/10.2478/raon-2024-0016
Keywords
© 2024 Masa Auprih et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

A flowchart of patients’ inclusion in our study.
A flowchart of patients’ inclusion in our study.

FIGURE 2.

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 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.

FIGURE 3.

Data and statistical analysis from EORTC BR23 questionnaires.
Data and statistical analysis from EORTC BR23 questionnaires.

FIGURE 4.

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

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
Yes 299 147 152
Neoadjuvant chemotherapy and/or anti-HER-2 therapy No 465 227 237 0.241
Yes 135 74 61
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
Yes 451 218 233
Chemotherapy No 280 137 143 0.623
Yes 320 164 156
Anti-HER2 therapy No 522 264 258 0.629
Yes 78 37 41
Hormone therapy No 132 69 63 0.623
Yes 468 232 236

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
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