The Pink October Series, Episode 2: Fatigue After Breast Cancer



Yep, you guessed it. Here I go again, talking about fatigue.

I’m featuring fatigue in The Pink October Series because it’s such a pervasive issue for breast cancer survivors; approximately 30 percent of breast cancer survivors experience moderate to severe fatigue after completion of initial treatment. Persistent fatigue in breast cancer survivors has been shown to persist up to ten years post diagnosis. It goes without saying - but it must be said - the negative impact of this fatigue on your quality of life can be severe.

Additionally, this kind of persistent, severe fatigue is correlated with a decrease in physical activity. As we’ve explored on this blog in previous posts (here and here), physical activity actually helps fatigue, so a decrease in activity due to persistent fatigue causes a vicious cycle that perpetuates more fatigue, depression, and decreased quality of life.

Causes of cancer related fatigue were discussed in the post 5 Causes of Hard-To-Beat Post Cancer Fatigue. Today, I’d like to view fatigue from a wellness-focused, breast cancer survivor’s perspective. In reviewing the medical literature on the topic, I found two studies I think you’ll be interested in. I’ve summarized the findings of these studies below, so read on, Survivors.

What a cluster.

A 2015 study in The Journal of Symptom Management examined a cluster of symptoms in breast cancer patients - pain, depression, and sleep problems - over a one year period. Their aim was to demonstrate that these three symptoms occur together over the course of treatment (in a cluster) and that the severity of one symptom predicts the severity the same and other symptoms in the cluster at a later time point.

The researchers found that:

  1. Fatigue, depression, and sleep disturbance DO appear together as a symptom cluster in pre and post menopausal women with breast cancer.

  2. Fatigue was very strongly correlated with fatigue and depression at later time points for pre menopausal women, but not for post menopausal women.

So why does this matter to you?

Hopefully you appreciate the opportunity to look at fatigue in breast cancer patients with a microscope here. The implication of this study for you as a breast cancer survivor is this:

If you are a pre menopausal survivor of breast cancer with fatigue, this study says you are at greater risk for more fatigue AND potentially depression later. This is helpful because it argues for earlier treatment of your fatigue - and you can do something about that today. Exercise, meditate, nourish your body. More of the good stuff will protect you from future distress.

For post menopausal breast cancer survivors, having fatigue earlier in your breast cancer survivor journey is not as strongly predictive of the same issues later in your journey. This is something to know, and perhaps something to give comfort.

For medical providers, studies like this can help us design treatment programs aimed at helping your earlier in your course. If we focus on reducing the severity of a symptom like fatigue when it’s first recognized, women with breast cancer will do better in the long run.

We have that goal in common because it’s important, and it’s what wellness is all about - prevention of disease and suffering.

Predicting long term fatigue in breast cancer survivors - who’s at risk?

A 2016 study in The Annals of Oncology did an extensive meta analysis (a study pooling and analyzing data from many other studies giving a HUGE and more reliable sample size) on risk factors, prevalence, and course of severe fatigue after breast cancer treatment.

The researchers determined that:

  1. Approximately 25% of breast cancer survivors experience severe fatigue.

  2. Risk factors for severe fatigue were a) higher disease stage (example: stage 3 puts you at higher risk than stage 1), b) chemotherapy as treatment, and 3) receiving combination treatment (surgery, radiation, and chemotherapy, both with and without hormone therapy).

  3. Having a partner, receiving only surgery, and surgery plus radiation decreased the risk of severe fatigue.

So what does this matter to you?

For me, the results of this study make logical sense the results are what we might have hypothesized, right? If you have a higher stage of breast cancer you likely received more intensive treatment which would clearly put you at greater risk of persistent fatigue. And chemo is known to cause changes in your body that put you at risk for persistent fatigue so the effect of chemo on fatigue in breast cancer patients would be no different. But you know what really stuck out for me in this study?

The part about having a partner decreasing your risk.

Reading all this science and information about treatment and data and staging - having social support is powerful - just as powerful and influential as the effect of the type of treatment you had.

From a wellness perspective, this gives me heart. Brio is all about creating a space for and supporting survivors who want to focus on conquering fatigue with self care. It’s about creating a community that’s accepting, non-judgmental, and aware of a cancer survivor’s needs as they step forward in their lives. To know that having a partner in that journey decreases your risk of fatigue - that puts me smack dab in the center of my happy place.

And if sometimes you don’t feel like you have that partner in your life to support you through this - please know that you do. Right here.

A word about interpreting medical research.

It’s a rare medical study that’s convincing enough to cause a paradigm shift in medicine all on its own. In fact, you should be skeptical when anyone uses an individual study to stubbornly validate actions that are not accepted by by guiding bodies in medicine.

It might be noted: both studies summarized above align well with what is widely accepted in current supportive oncology care.

Oncology treatment guidelines are crafted by expert medical scientists who get together annually to carefully consider all the newest and most reliable medical research. The results of these meetings are then disseminated to providers in the greater oncology community to apply on a daily basis.

Once in a while, there will be a very large study designed by authoritative groups of medical scientists who’ve identified an important treatment question that needs to be settled. These types of studies can change practice more quickly than small studies that are on the edge of accepted norms.

I want to be clear that this is the way you want things to move - carefully and scientifically. While we’re anxious for cures in oncology, reacting quickly to new, invalidated information can cause harm to human beings regardless of how hopeful the results may seem.


My goodness. I’ll get off my soap box now and finish up. I hope you learned something new with this perspective on fatigue in breast cancer survivors. There are a million online “listicles” about fatigue after breast cancer and a lot of very general advice about how to fix it. I didn’t want to write one of those because I know you want to hear something different.

Breast cancer survivors are some of the most sophisticated medical consumers on the planet, so I know you can handle something a little heavier that might give you some real insight.

One more thing - I have to mention Brio’s FREE Morning Checklist - A 7 Point Solution to Cancer Survivor Fatigue. If persistent fatigue after breast cancer is something you’re struggling with, download and use the checklist. It’s full of information to help you find the vitality you deserve. Click on the button below and I’ll email it right away.

Take care, partner.