JCT  Vol.3 No.5 A , October 2012
Metabolic, Health and Lifestyle Profiling of Breast Cancer Radiotherapy Patients and the Risk of Developing Fatigue
Abstract: Background: Fatigue is commonly reported by cancer patients. In some instances it can persist after treatment is completed. In order to develop effective treatment strategies it is important to understand the mechanisms underlying the development of fatigue and to be able to predict those that may be at greatest risk of experiencing fatigue during and following treatment. The current paper examines predisposing factors for fatigue including altered fatty acid homeostasis in a cohort of breast cancer radiotherapy patients. Methodology: Patients had undergone breast-conserving surgery and adjuvant breast irradiation. Prior to radiotherapy the patients were free from significant fatigue. Levels of fatigue were determined prior to and following radiotherapy using the Functional Assessment of Cancer Therapy fatigue subscale. Plasma fatty acid levels, urinary and plasma amino acid levels, blood biochemistry factors and general health and lifestyle characteristics were assessed. Results: Following radiotherapy, significant fatigue affected approximately one third of the 26 patients and these subjects were then assigned to the fatigued cohort. Univariate analysis revealed that higher levels of the fatty acids myristic acid and eicosadienoic acid were present for the fatigued cohort prior to radiotherapy. Multivariate analysis also revealed that fatty acid homeostasis was altered between the fatigued and non-fatigued groups at baseline. Orthogonal partial least squares discriminant analysis of the general health, lifestyle and metabolic data revealed that the fatigued and non-fatigued patients could be clustered into two clearly separate groups. Conclusions: The results supported the proposition that the fatigued patients had an underlying metabolic homeostasis which may predispose them to the development of fatigue. Biochemical and general health profiling of breast cancer patients has the potential to identify those at most risk of developing significant fatigue following radiotherapy.
Cite this paper: R. Hugh Dunstan, D. L. Sparkes, C. Wratten, J. W. Denham, J. Gottfries, T. K. Roberts and M. M. Macdonald, "Metabolic, Health and Lifestyle Profiling of Breast Cancer Radiotherapy Patients and the Risk of Developing Fatigue," Journal of Cancer Therapy, Vol. 3 No. 5A, 2012, pp. 731-740. doi: 10.4236/jct.2012.325092.

[1]   A. Maxmen, “The Hard Facts,” Nature, Vol. 485, No. 7400, 2012, pp. S50-S51. doi:10.1038/485S50a

[2]   P. Stone, A. Richardson, E. Ream, et al., “Cancer-Related Fatigue: Inevitable, Unimportant and Untreatable? Results of a Multi-Centre Patient Survey,” Annals of Oncology, Vol 11, No. 8, 2000, pp. 971-975. doi:10.1023/A:1008318932641

[3]   P. Servaes, M. F. M. Gielissen, S. Verhagen, et al., “The Course of Severe Fatigue in Disease-Free Breast Cancer Patients: A Longitudinal Study,” Psycho-Oncology, Vol 16, No. 9, 2007, pp. 787-795. doi:10.1002/pon.1120

[4]   A. C. G. Cavalli Kluthcovsky, A. A. Urbanetz, D. S. de Carvalho, et al., “Fatigue after Treatment in Breast Cancer Survivors: Prevalence, Determinants and Impact on Health-Related Quality of Life,” Support Care Cancer, Vol. 20, No. 8, 2012, pp. 1901-1909. doi:10.1007/s00520-011-1293-7

[5]   V. Mock, C. Frangakis, N. E. Davidson, et al., “Exercise Manages Fatigue during Breast Cancer Treatment: A Randomized Controlled Trial,” Psycho-Oncology, Vol. 14, No. 6, 2005, pp. 464-477. doi:10.1002/pon.863

[6]   K. M. Mustian, G. R. Morrow, J. K. Carroll, et al., “Integrative Nonpharmacologic Behavioral Interventions for the Management of Cancer-Related Fatigue,” Oncologist, Vol 12, Suppl. 1, 2007, pp. 52-67. doi:10.1634/theoncologist.12-S1-52

[7]   S. B. Yellen, D. F. Cella, K. Webster, et al., “Measuring Fatigue and Other Anemia-Related Symptoms with the Functional Assessment of Cancer Therapy (FACT) Measurement System,” Journal of Pain and Symptom Management, Vol 13, No. 2, 1997, pp. 63-74. doi:10.1016/S0885-3924(96)00274-6

[8]   R. H. Dunstan, D. L. Sparkes, M. M. Macdonald, et al., “Altered Amino Acid Homeostasis and the Development of Fatigue by Breast Cancer Radiotherapy Patients: A Pilot Study,” Clinical Biochemistry, Vol. 44, No. 2-3, 2011, pp. 208-215. doi:10.1016/j.clinbiochem.2010.10.002

[9]   G. Lepage and C. C. Roy, “Direct Transesterification of All Classes of Lipids in a One-Step Reaction,” The Journal of Lipid Research, Vol. 27, 1, 1986, pp. 114-120.

[10]   J. Trygg and S. Wold, “Orthogonal Projections to Latent Structures (O-PLS),” Journal of Chemometrics, Vol. 16, No. 3, 2002, pp. 119-128. doi:10.1002/cem.695

[11]   J. E. Jackson, “A User’s Guide to Principal Components,” Wiley, New York, 1991. doi:10.1002/0471725331

[12]   S. Wold, “Cross-Validatory Estimation of the Number of Components in Factor and Principal Components Models,” Technometrics, Vol. 20, No. 4, 1978. pp. 397-405. doi:10.1080/00401706.1978.10489693

[13]   C. Cleeland and S. Wang, “Measuring and Understanding Fatigue,” Oncology, Vol. 13, No. 11A, 1999, pp. 91-97.

[14]   C. Wratten, J. Kilmurray, S. Nash, et al., “Fatigue during Breast Radiotherapy and Its Relationship to Biological Factors,” International Journal of Radiation Oncology, Biology and Physics, Vol. 59, No. 1, 2004, pp. 160-167.doi:10.1016/j.ijrobp.2003.10.008

[15]   E. M. A. Smets, M. R. M. Visser, A. F. M. N. Willems-Groot, et al., “Fatigue and Radiotherapy: (A) Experience in Patients Undergoing Treatment,” British Journal of Cancer, Vol. 78, No. 7, 1998, pp. 899-906. doi:10.1038/bjc.1998.599

[16]   H. Geinitz, F. B. Zimmermann, R. Thamm, et al., “Fatigue in Patients with Adjuvant Radiation Therapy for Breast Cancer: Long-Term Follow-Up,” Journal of Cancer Research and Clinical Oncology, Vol. 130, No. 6, 2004, pp. 327-333. doi:10.1007/s00432-003-0540-9

[17]   R. Morant, “Asthenia: An Important Symptom in Cancer Patients,” Cancer Treatment Reviews, Vol. 22, Suppl. A, 1996, pp. 117-122. doi:10.1016/S0305-7372(96)90073-0

[18]   J. E. Bower, P. A. Ganz, K. A. Desmond, et al., “Fatigue in Breast Cancer Survivors: Occurrence, Correlates, and Impact on Quality of Life,” Journal of Clinical Oncology, Vol. 18, No. 4, 2000, pp. 743-753.

[19]   S. Haghighat, M. E. Akbari, K. Holakouei, et al., “Factors Predicting Fatigue in Breast Cancer Patients,” Support Care Cancer, Vol. 11, No. 8, 2003. pp. 533-538. doi:10.1007/s00520-003-0473-5

[20]   R. Haque, M. U. Yood, A. M. Geiger, et al., “Long-Term Safety of Radiotherapy and Breast Cancer Laterality in Older Survivors,” Cancer Epidemiology, Biomarkers & Prevention, Vol. 20, No. 10, 2011, pp. 2120-2126.doi:10.1158/1055-9965.EPI-11-0348