Cancer-related fatigue may impact balance after breast cancer treatment
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Cancer-related fatigue appeared associated with greater postural sway among a cohort of breast cancer survivors, according to study results published in Rehabilitation Oncology.
The findings showed the association even after controlling for symptoms of chemotherapy-induced peripheral neuropathy (CIPN), age and weekly exercise.
Methods
Cancer-related fatigue is one of the most prevalent adverse effects of cancer and its treatments, Stephen Wechsler, PT, DPT, PhD, researcher in the PhD program in rehabilitation sciences at Massachusetts General Hospital Institute of Health Professions, told Healio.
“Evidence has mounted that cancer-related fatigue affects physical function, including a recent study by our team that showed survivors of breast cancer with persistent cancer-related fatigue demonstrated increased fatigability — a variable associated with imbalance, gait dysfunction and falls among older adults — in response to exercise,” Wechsler said. “Although cancer-related fatigue has been linked to self-reported falls, the direct relationship between cancer-related fatigue and balance has not been quantified. In fact, our 2021 scoping review showed that of the 30 studies since 2006 investigating imbalance, gait dysfunction and falls after chemotherapy, while 20 studies investigated CIPN, no studies considered cancer-related fatigue as a potential contributing factor.”
For the secondary analysis of data that examined functional differences between women with breast cancer with and without persistent cancer-related fatigue, researchers assessed the contributions of cancer-related fatigue and CIPN to static and dynamic balance before and after fatiguing exercise among 43 women (mean age, 57.2 years) with a history of breast cancer and a mean time since treatment of 3.5 years. All women had undergone chemotherapy, 69.8% also received radiation therapy and 53.5% remained on antiestrogen therapy at the time of study entry.
Researchers additionally performed regression analyses to determine how cancer-related fatigue and severity of CIPN predicted sway and how much variance they could attribute to each.
Findings
Researchers found an association of greater cancer-related fatigue with greater preexertional (P = .04) and postexertional static sway (P = .02) during the anterior-posterior plane in static standing, even after adjusting for symptoms of CIPN, age and weekly exercise.
Results also showed an association of cancer-related fatigue with 10.5% of the variance in preexertional sway and 9.5% in postexertional sway compared with 0.9% and 1.4% accounted for by CIPN.
Moreover, researchers found breast cancer survivors with greater cancer-related fatigue experienced changes in sit-to-stand strategy after a short period of moderate-intensity exercise that focused on leg muscles compared with those who had less severe cancer-related fatigue.
“Breast cancer survivors with greater cancer-related fatigue also demonstrated a more conservative weight shift during a sit-to-stand transfer, known as a ‘stabilization strategy,’ which has also been observed among elderly fallers and populations with known balance impairments,” Wechsler said.
Of note, cancer-related fatigue appeared associated with 6.6% of the variance in anteroposterior weight shifting during the postexertional sit-to-stand transfer vs. only 3% accounted for by CIPN.
Implications
The postexertional change in sit-to-stand strategy among participants with greater cancer-related fatigue suggests a lower extremity-fatiguing task may cause or exacerbate impairments in dynamic balance, Wechsler said.
“In everyday life, women with breast cancer and cancer-related fatigue may encounter such fatiguing tasks through performing activities of daily living, negotiating stairs or the community, or participating in a recommended exercise program,” he continued. “The vast majority of falls occur during dynamic tasks and transitional movements. Therefore, potential changes in the ability of individuals with cancer-related fatigue to perform these dynamic tasks following activity must be taken seriously.
“Rehabilitation clinicians and exercise specialists must consider the potential implications of balance impairments among individuals with cancer-related fatigue, especially when prescribing exercise,” Wechsler added. “Although CIPN remains a risk factor for imbalance in this population, cancer-related fatigue warrants consideration in clinical practice and research as a mechanism of postural instability.”
Future studies should assess multimodal exercise and balance training, effective for individuals with CIPN, among patients experiencing cancer-related fatigue-related imbalance, Wechsler said.
“A greater understanding of how postexertional changes in balance are experienced in the context of daily life may enhance our ability to provide individualized activity recommendations for individuals with cancer-related fatigue following cancer treatment,” he said. “Finally, future longitudinal studies should explore the temporal relationship between cancer-related fatigue and balance with assessments before, during and after cancer treatment. A greater understanding of the temporal relationship between cancer-related fatigue and balance would improve our ability to monitor for and address changes in balance throughout the continuum of care.”
References:
- Cancer-related fatigue linked to balance problems after chemotherapy for breast cancer. Available at: . Published Aug. 15, 2022. Accessed Sept. 7, 2022.
- Wechsler S, et al. Rehab Oncol. 2022;doi:10.1097/01.REO.0000000000000308.
- Wood Magee LJ, et al. Rehab Oncol. 2022;doi:10.1097/01.REO.0000000000000305.
For more information :
Stephen Wechsler, PT, DPT, PhD, can be reached at sbwechsler1@gmail.com.
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