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Anemia and fatigue during adjuvant chemotherapy for breast cancer: Patterns and impact on quality of life.

8060 Background: Research has failed to delineate a consistent pattern of fatigue and anemia & their impact on quality of life (QOL) during adjuvant breast cancer (BrCA) chemotherapy.


METHODS
Aims: To define the incidence and patterns of anemia and fatigue during and after adjuvant BrCA chemotherapy, & to determine relationships between anemia, fatigue, and QOL. We enrolled 110 patients with Stage I-III BrCA receiving either 4 cycles of Adriamycin & Cytoxan (AC) or AC followed by a taxane for 4 cycles (AC-T). Hemoglobin (Hb) values were obtained on day 1 of each cycle, as well as 6 weeks & 3 months after completion of chemotherapy. Piper Fatigue Scale total scores (PFS) and Linear Analog Scale Assessment (LASA) QOL scores were obtained on day 1 and 8 of cycles 1, 4, 5, and 8 as well as 6 weeks and 3 months following chemotherapy.


RESULTS
Mean Hb at baseline was 12.9 g/dL, decreased (p= 0.00) to 11.7 by Cycle 4 in all patients and Cycle 8 in individuals receiving AC-T. By 3 months post-chemotherapy, Hb recovered to baseline. Fatigue was generally mild (0 - 3) to moderate (4-6). Mean PFS scores increased from cycle 1 [(Cycle 1 day 1 = 2.63) and (Cycle 1 day 8 = 3.97) to cycle 4 [(day 1 = 3.87 and (day 8 = 5.10)] in all subjects, and from cycle 1 to cycle 8 ([Cycle 8 day 1 = 4.75], and [Cycle 8 day 8 = 5.15]) in AC-T. Fatigue was worse one week following chemotherapy. All results were significant at p<0.001. Finally, the impact of anemia on fatigue and QOL was explored by categorizing Hb at Cycle 4 into values < 11.5 and ≥ 11.5 g/dl. Although these groups did not significantly differ (p = 0.14) on PFS scores, 81% of patients with a Hb < 11.5 had moderate to severe fatigue, as compared to only 44% of those with Hb≥ 11.5 g/dl. Additionally, individuals with Hb < 11.5 had significantly lower QOL on the LASA (p = 0.008).


CONCLUSIONS
Both anemia and fatigue increase over time across adjuvant BrCA chemotherapy, & fatigue worsens during the week following chemotherapy. In addition, preliminary evidence exists to validate Crawford's (2002) incremental analysis data demonstrating that the most significant increase in quality of life related to hemoglobin occurs between the values of 11 to 12 g/dl. [Table: see text].