Article

Strength, Physical Activity, and Age Predict Fatigue in Older Breast Cancer Survivors

Kerri Winters-Stone

Jill A. Bennett

Lillian M. Nail

Anna L. Schwartz

physical activity, age, at-risk populations
ONF 2008, 35(5), 815-821. DOI: 10.1188/08.ONF.815-821

Purpose/Objectives: To determine whether clinical characteristics, physical fitness, or physical activity predict fatigue in older, long-term breast cancer survivors.

Design: Cross sectional.

Setting: National Cancer Institute-designated cancer center in Portland, OR.

Sample: 47 women (X age = 69 years) who were at least one year beyond treatment completion, including surgery, radiation, chemotherapy, or hormone therapy, for early-stage breast cancer.

Methods: Participants completed one two-hour testing session to determine fatigue ratings, clinical information, submaximal aerobic fitness, lower-extremity muscle strength, body composition, and physical activity levels.

Main Research Variables: Self-reported fatigue assessed by the Schwartz Cancer Fatigue Scale, cancer and treatment history obtained by self-report, submaximal aerobic fitness assessed by 12-minute walk distance, lower-extremity muscle strength assessed by number of chair stands completed in 30 seconds, body composition assessed as percentage of body fat, and physical activity levels assessed by self-reported hours per week.

Findings: Fatigue was significantly correlated with all independent variables, with the exception of aerobic fitness. Fatigue was higher with lower age, greater percentage of body fat, fewer years after diagnosis, more adjuvant treatments, poorer lower-extremity muscle strength, and less physical activity. In regression analyses, lower-extremity muscular strength, physical activity levels, and age each were significant independent predictors of fatigue. Lower-extremity muscle strength, physical activity, and age all were inversely related to fatigue and accounted for 15%, 7%, and 15% of the variance in fatigue scores, respectively.

Conclusions: In this sample of older breast cancer survivors, fatigue was linked to physical activity and muscle strength; women with better lower-extremity muscle strength, higher physical activity levels, and advanced age reported less fatigue.

Implications for Nursing: A physical activity program aimed at improving lower body strength could mitigate persistent fatigue in older, long-term breast cancer survivors.

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    References

    Demark-Wahnefried, W., Clipp, E. C., Morey, M. C., Pieper, C. F., Sloane, R., Snyder, D. C., et al. (2004). Physical function and associations with diet and exercise: Results of a cross-sectional survey among elders with breast or prostate cancer. International Journal of Behavioral Nutrition and Physical Activity, 1(1), 16.
    Dimeo, F., Stieglitz, R. D., Novelli-Fischer, U., Fetscher, S., Mertelsmann, R., & Keul, J. (1997). Correlation between physical performance and fatigue in cancer patients. Annals of Oncology, 8(12), 1251-1255.
    Dorval, M., Maunsell, E., Deschenes, L., & Brisson, J. (1998). Type of mastectomy and quality of life for long term breast carcinoma survivors. Cancer, 83(10), 2130-2138.
    Deimling, G. T., Sterns, S., Bowman, K. F., & Kahana, B. (2005). The health of older-adult, long-term cancer survivors. Cancer Nursing, 28(6), 415-424.
    Deimling, G. T., Sterns, S., Bowman, K. F., & Kahana, B. (2007). Functioning and activity participation restrictions among older adult, long-term cancer survivors. Cancer Investigations, 25(2), 106-116.
    Deimling, G. T., Wagner, L. J., Bowman, K. F., Sterns, S., Kercher, K., & Kahana, B. (2006). Coping among older-adult, long-term cancer survivors. Psycho-Oncology, 15(2), 143-159.
    Ganz, P. A., Greendale, G. A., Kahn, B., O'Leary, J. F., & Desmond, K. A. (1999). Are older breast carcinoma survivors willing to take hormone replacement therapy? Cancer, 86(5), 814-820.
    Geinitz, H., Zimmermann, F. B., Stoll, P., Thamm, R., Kaffenberger, W., Ansorg, K., et al. (2001). Fatigue, serum cytokine levels, and blood cell counts during radiotherapy of patients with breast cancer. International Journal of Radiation Oncology, Biology Physics, 51(3), 691-698.
    Servaes, P., Verhagen, S., & Bleijenberg, G. (2002a). Determinants of chronic fatigue in disease-free breast cancer patients: A cross-sectional study. Annals of Oncology 13(4), 589-598.
    Servaes, P., Verhagen, C. A., & Bleijenberg, G. (2002b). Relations between fatigue, neuropsychological functioning, and physical activity after treatment for breast carcinoma: Daily self-report and objective behavior. Cancer, 95(9), 2017-2026.
    Smets, E. M., Garssen, B., Schuster-Uitterhoeve, A. L., & de Haes, J. C. (1993). Fatigue in cancer patients. British Journal of Cancer, 68(2), 220-224.
    Sparks, L., & Mittapalli, K. (2004). To know or not to know: The case of communication by and with older adult Russians diagnosed with cancer. Journal of Cross Cultural Gerontology, 19(4), 383-403.
    American Cancer Society. (2008). Cancer facts and figures 2008. Atlanta, GA: Author.
    American College of Sports Medicine. (1998). Exercise and physical activity for older adults. Medicine and Science in Sports and Exercise, 30(6), 992-1008.
    Bernstein, M. L., Despars, J. A., Singh, N. P., Avalos, K., Stansbury, D. W., & Light, R. W. (1994). Reanalysis of the 12-minute walk in patients with chronic obstructive pulmonary disease. Chest, 105(1), 163-167.
    Blesch, K. S., Paice, J. A., Wickham, R., Harte, N., Schnoor, D. K., Purl, S., et al. (1991). Correlates of fatigue in people with breast or lung cancer. Oncology Nursing Forum, 18(1), 81-87.
    Bower, J. E., Ganz, P. A., Desmond, K. A., Bernaards, C., Rowland, J. H., Meyerowitz, B. E., et al. (2006). Fatigue in long-term breast carcinoma survivors: A longitudinal investigation. Cancer, 106(4), 751-758.
    Bower, J. E., Ganz, P. A., Desmond, K. A., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18(4), 743-753.
    Broeckel, J. A., Jacobsen, P. B., Horton, J., Balducci, L., & Lyman, G. H. (1998). Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 16(5), 1689-1696.
    Deimling, G. T., Bowman, K. F., Sterns, S., Wagner, L. J., & Kahana, B. (2006). Cancer-related health worries and psychological distress among older adult, long-term cancer survivors. Psycho-Oncology, 15(4), 306-320.
    Girinsky, T. A., Pallardy, M., Comoy, E., Benassi, T., Roger, R., Ganem, G., et al. (1994). Peripheral blood corticotropin-releasing factor, adrenocorticotropic hormone and cytokine (interleukin beta, interleukin 6, tumor necrosis factor alpha) levels after high- and low-dose total-body irradiation in humans. Radiation Research, 139(3), 360-363.
    Glaus, A., Boehme, C., Thurlimann, B., Ruhstaller, T., Hsu Schmitz, S. F., Morant, R., et al. (2006). Fatigue and menopausal symptoms in women with breast cancer undergoing hormonal cancer treatment. Annals of Oncology, 17(5), 801-806.
    Haghighat, S., Akbari, M. E., Holakouei, K., Rahimi, A., & Montazeri, A. (2003). Factors predicting fatigue in breast cancer patients. Supportive Care in Cancer, 11(8), 533-538.
    Heidrich, S. M., Egan, J. J., Hengudomsub, P., & Randolph, S. M. (2006). Symptoms, symptom beliefs, and quality of life of older breast cancer survivors: A comparative study. Oncology Nursing Forum, 33(2), 315-322.
    Hildegunn, L., Jones, K., Grenstad, T., Dreyer, V., Farbu, E., & Rekand, T. (2007). Perceived disability, fatigue, pain and measured isometric muscle strength in patients with post-polio symptoms. Physiotherapy Research International, 12(1), 39-49.
    Jacobsen, P. B., Hann, D. M., Azzarello, L. M., Horton, J., Balducci, L., & Lyman, G. H. (1999). Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. Journal of Pain and Symptom Management, 18(4), 233-242.
    Jacobsen, P. B., & Stein, K. (1999). Is fatigue a long-term side effect of breast cancer treatment? Cancer Control, 6(3), 256-263.
    Jones, C. J., Rikli, R. E., & Beam, W. C. (1999). A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly in Exercise and Sport, 70(2), 113-119.
    Keating, N. L., Norredam, M., Landrum, M. B., Huskamp, H. A., & Meara, E. (2005). Physical and mental health status of older long-term cancer survivors. Journal of the American Geriatric Society, 53(12), 2145-2152.
    Kosak, M., & Smith, T. (2005). Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke. Journal of Rehabilitation Research and Development, 42(1), 103-107.
    Markes, M., Brockow, T., & Resch, K. L. (2006). Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Systematic Reviews, 4, CD005001.
    Mast, M. E. (1998). Correlates of fatigue in survivors of breast cancer. Cancer Nursing, 21(2), 136-142.
    McNeely, M. L., Campbell, K. L., Rowe, B. H., Klassen, T. P., Mackey, J. R., & Courneya, K. S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. Canadian Medical Association Journal, 175(1), 34-41.
    Mock, V. (2004). Evidence-based treatment for cancer-related fatigue. Journal of the National Cancer Institute. Monographs, 32, 112-118.
    Mutrie, N., Campbell, A. M., Whyte, F., McConnachie, A., Emslie, C., Lee, L., et al. (2007). Benefits of supervised group exercise programme for women being treated for early stage breast cancer: Pragmatic randomised controlled trial. BMJ, 334(7592), 517-524.
    Panagiotakos, D. B., Pitsavos, C., Yannakoulia, M., Chrysohoou, C., & Stefanadis, C. (2005). The implication of obesity and central fat on markers of chronic inflammation: The ATTICA study. Atherosclerosis, 183(2), 308-315.
    Pusztai, L., Mendoza, T. R., Reuben, J. M., Martinez, M. M., Willey, J. S., Lara, J., et al. (2004). Changes in plasma levels of inflammatory cytokines in response to paclitaxel chemotherapy. Cytokine, 25(3), 94-102.
    Rikli, R., & Jones, J. (2001). Senior fitness testing manual. Champaign, IL: Human Kinetics.
    Robb, C., Haley, W. E., Balducci, L., Extermann, M., Perkins, E. A., Small, B. J., et al. (2007). Impact of breast cancer survivorship on quality of life in older women. Critical Reviews in Oncology/Hematology, 62(1), 84-91.
    Schlicht, J. (2000). Strength training for older adults: Prescription guidelines for nurses in advanced practice. Journal of Gerontological Nursing, 26(8), 25-32.
    Schmitz, K. H., Holtzman, J., Courneya, K. S., Masse, L. C., Duval, S., & Kane, R. (2005). Controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Cancer Epidemiology Biomarkers Prevention, 14(7), 1588-1595.
    Schneider, C. M., Hsieh, C. C., Sprod, L. K., Carter, S. D., & Hayward, R. (2007). Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment. Cancer, 110(4), 918-925.
    Schwartz, A. L. (1998). The Schwartz Cancer Fatigue Scale: Testing reliability and validity. Oncology Nursing Forum, 25(4), 711-717.
    Schwartz, A. L., Mori, M., Gao, R., Nail, L. M., & King, M. E. (2001). Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Medicine and Science in Sports and Exercise, 33(5), 718-723.
    Stewart, A. L., Mills, K. M., King, A. C., Haskell, W. L., Gillis, D., & Ritter, P. L. (2001). CHAMPS physical activity questionnaire for older adults: Outcomes for interventions. Medicine and Science in Sports and Exercise, 33(7), 1126-1141.
    Stone, P., Richards, M., A'Hern, R., & Hardy, J. (2000). A study to investigate the prevalence, severity and correlates of fatigue among patients with cancer in comparison with a control group of volunteers without cancer. Annals of Oncology, 11(5), 561-567.
    Stricker, C. T., Drake, D., Hoyer, K. A., & Mock, V. (2004). Evidence-based practice for fatigue management in adults with cancer: Exercise as an intervention. Oncology Nursing Forum, 31(5), 963-976.
    Tchen, N., Juffs, H. G., Downie, F. P., Yi, Q. L., Hu, H., Chemerynsky, I., et al. (2003). Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 21(22), 4175-4183.
    Winters, K. M., & Snow, C. M. (2000). Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women. Journal of Bone and Mineral Research, 15(12), 2495-2503.
    Wood, L. J., Nail, L. M., Gilster, A., Winters, K. A., & Elsea, C. R. (2006). Cancer chemotherapy-related symptoms: Evidence to suggest a role of proinflammatory cytokines. Oncology Nursing Forum, 33(3), 535-542.
    Wratten, C., Kilmurray, J., Nash, S., Seldon, M., Hamilton, C. S., O'Brien, P. C., et al. (2004). Fatigue during breast radiotherapy and its relationship to biological factors. International Journal of Radiation Oncology, Biology, Physics, 59(1), 160-167.
    Bautmans, I., Gorus, E., Njemini, R., & Mets, T. (2007). Handgrip performance in relation to self-perceived fatigue, physical functioning and circulating IL-6 in elderly persons without inflammation. BMC Geriatrics, 7(1), 5.
    Beaumont, A., Cockcroft, A., & Guz, A. (1985). A self-paced treadmill walking test for breathless patients. Thorax, 40(6), 459-464.
    Berger, A. M., & Higginbotham, P. (2000). Correlates of fatigue during and following adjuvant breast cancer chemotherapy: A pilot study. Oncology Nursing Forum, 27(9), 1443-1448.
    Berglund, G., Bolund, C., Fornander, T., Rutqvist, L. E., & Sjoden, P. O. (1991). Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients. European Journal of Cancer, 27(9), 1075-1081.
    Larson, J. L., Covey, M. K., Vitalo, C. A., Alex, C. G., Patel, M., & Kim, M. J. (1996). Reliability and validity of the 12-minute distance walk in patients with chronic obstructive pulmonary disease. Nursing Research, 45(4), 203-210.
    Lim, W., Hong, S., Nelesen, R., & Dimsdale, J. E. (2005). The association of obesity, cytokine levels, and depressive symptoms with diverse measures of fatigue in healthy subjects. Archives of Internal Medicine, 165(8), 910-915.