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The association between cancer-related fatigue and diabetes from pre-chemotherapy to 6 months post-chemotherapy

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Abstract 

Purpose

To quantify the relationship between diabetes and fatigue from pre-chemotherapy to 6 months post-chemotherapy for women with breast cancer compared to women without a history of cancer (controls).

Methods

This was a secondary analysis from a nationwide prospective longitudinal study of female patients with breast cancer undergoing chemotherapy and controls. Diabetes diagnosis (yes/no) was obtained at baseline, and cancer-related fatigue was measured using the Multidimensional Fatigue Symptom Inventory (MFSI) pre-, post-, and 6 months post-chemotherapy in patients; controls were assessed at equivalent time points. Repeated measures mixed effects models estimated the association between fatigue and diabetes controlling for cancer (yes/no), body mass index, exercise and smoking habits, baseline anxiety and depressive symptoms, menopausal status, marital status, race, and education.

Results

Among 439 patients and 235 controls (52.8 ± 10.5 years old), diabetes was twice as prevalent among patients as controls (11.6% vs. 6.8%). At baseline, diabetes was associated with worse fatigue (4.1 ± 1.7 points, p = 0.017). Also, diabetes was associated with clinically meaningful worse fatigue throughout the study period among all participants (5.2 ± 1.9 points, p = 0.008) and patients alone (4.5 ± 2.0, p = 0.023). For the MFSI subdomains among patients, diabetes was associated with worse general (p = 0.005) and mental fatigue (p = 0.026).

Conclusions

Diabetes was twice as prevalent in women with breast cancer compared to controls, and diabetes was associated with more severe cancer-related fatigue in patients before and after chemotherapy and at 6 months post-chemotherapy. Interventions that address diabetes management may also help address cancer-related fatigue during chemotherapy treatment.

Trial registration

ClinicalTrials.gov identifier: NCT01382082, first posted June 27, 2011.

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Data availability

The datasets and statistical code generated during and analyzed during the current study are available from the corresponding and last author on reasonable request.

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Acknowledgements

We would like to thank the following National Cancer Institute (NCI) Community Oncology Research Program (NCORP) affiliate sites who participated in this study: Central Illinois, Columbus, Cancer Research Consortium of West Michigan, Dayton, Delaware, Grand Rapids, Greenville, Hematology-Oncology Associates of Central New York, Kalamazoo, Kansas City, Marshfield, Metro Minnesota, Nevada, North Shore, Pacific Cancer Research Consortium, Southeast Cancer Control Consortium, Southeast Clinical Oncology Research Consortium, Upstate Carolina, Virginia Mason, Wichita, Wisconsin NCORP, and Western Oncology Research Consortium.

Funding

This research was supported by the National Institutes of Health (NIH) NCI grants UG1CA189961 to KMM and Gary Morrow, T32CA102618 to MCJ and Gary Morrow, R01CA231014 to MCJ, and K07CA221931 to IRK. This publication was supported by funds through the Maryland Department of Health’s Cigarette Restitution Fund Program.

Author information

Authors and Affiliations

  1. Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, 655 W. Lombard Ave., 7th floor, Baltimore, MD, 21201, USA

    Amber S. Kleckner & Ian R. Kleckner

  2. Division of Supportive Care in Cancer, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA

    Eva Culakova, Abdi T. Gudina, Karen M. Mustian, Luke J. Peppone & Michelle C. Janelsins

  3. Department of Medicine, University of Rochester Medical Center, 265 Crittenden Blvd. CU 420658, Rochester, NY, 14642, USA

    Michelle Shayne

  4. Department of Psychological Science, Hobart and William Smith Colleges, Geneva, NY, USA

    Elizabeth K. Belcher

  5. Department of Epidemiology & Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN, USA

    AnnaLynn M. Williams

  6. Wisconsin NCORP, Marshfield Medical Center, Weston, WI, USA

    Adedayo A. Onitilo

  7. Southeast Clinical Oncology Research (SCOR) Consortium, Winston-Salem, Weston, NC, USA

    Judith O. Hopkins

  8. Dayton Clinical Oncology Program, Dayton, OH, USA

    Howard Gross

Authors
  1. Amber S. Kleckner
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Contributions

MCJ led the parent study. KMM, LJP, AAO, JOH, and HG contributed to the design of the parent study. ASK conceived the idea for this analysis. ASK, IRK, EC, and MCJ designed and conducted the analysis. EC and ASK performed the statistical analysis. ASK wrote the initial draft of the manuscript. All authors edited the manuscript and read and approved the final version of the manuscript.

Corresponding authors

Correspondence to Amber S. Kleckner or Michelle C. Janelsins.

Ethics declarations

Ethics approval

Ethical approval was obtained from Institutional Review Boards at University of Rochester Cancer Center and each of the 22 recruitment sites prior to enrollment. This trial was performed in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All individual participants included in the study provided informed consent.

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The authors declare no competing interests.

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The results of this study were presented as an oral presentation at the 2021 Multinational Association of Supportive Care in Cancer Annual meeting, with a Young Investigator Award to AK.

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Kleckner, A.S., Kleckner, I.R., Culakova, E. et al. The association between cancer-related fatigue and diabetes from pre-chemotherapy to 6 months post-chemotherapy. Support Care Cancer 30, 7655–7663 (2022). https://doi.org/10.1007/s00520-022-07189-x

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