Novel and Clinically Relevant Measure of Perceived Fatigability Reveals Benefit of Exercise in Breast Cancer Survivors

Conference Correspondent  - ASCO 2021 - Breast Cancer

Fatigue after treatment is a common symptom among breast cancer survivors and is associated with lower quality of life. The most commonly used tool to measure cancer-related fatigue is a 1-item nonspecific evaluation of global fatigue, Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES). Exercise is recommended to manage fatigue but often only results in minimal improvement. The extent of the positive effects of exercise on fatigue may appear limited because of the current method of assessment. Researchers assessed a novel assessment that measures perceived fatigability using the 10-item Pittsburgh Fatigability Scale.

Forty-one participants enrolled in a single-center pilot study between 2015 and 2017 were randomly distributed to control (n = 19) or exercise (n = 22) groups. The patients were primarily white women (80%) with an average age of 54.9 years. Exercise consisted of a home-based program designed by a personal trainer to accumulate a minimum of 150 minutes of moderate to vigorous activity each week during weeks 6 to 14. The control group was not instructed to exercise during the trial. Both groups used the FACT-ES (1 question rated on 0- to 4-point scale) and the Pittsburgh Fatigability Scale (10 questions for a total of 0-50, where a higher score corresponds to greater fatigability) rating scales to report global and perceived fatigue, respectively, at the first and the last visits.

Changes in scores from the first to the final visits on both measurement tools were used to determine the ability of exercise to reduce fatigue compared with control and evaluate the sensitivity of the assessment tool itself. The results suggest perceived fatigability is a more precise measure than global fatigability, as demonstrated by a greater change in score using the Pittsburgh Fatigability Scale in the exercise group compared with the control group (–4.4 vs 0.2; P = .022). The FACT-ES showed minimal change between the 2 groups (–0.64 exercise group and 0.00 in the control group; P = .054).

The investigators suggest that exercise reduces cancer-related fatigue at a higher level when assessed using a perceived fatigability rating as opposed to minimal improvement shown by the global fatigability scale. The Pittsburgh Fatigability Scale may be a more reliable tool to measure fatigability in breast cancer survivors.

Source: Qiao Y, Van Londen GJ, Brufsky J, et al. Perceived physical fatigability improves after an exercise intervention among breast cancer survivors: a pilot randomized clinical trial. American Society of Clinical Oncology Virtual Meeting; June 4-8, 2021. Abstract 12050.

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