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Cancer Survivorship and Care / Chemotherapy-induced Cardiotoxicity and Mitigation / Cancer Related Cognitive Impairment Studies · Journal article
JAMA Network Open · August 18, 2026
Well-designed and adequately powered for the question it asks.
This prospective cohort study of 236 breast cancer patients and 145 noncancer comparators followed for 24 months demonstrates that 34.6% of chemotherapy-treated patients experience clinically relevant fatigue increase post-treatment, mediated primarily by depressive symptoms and perceived stress rather than cardiac dysfunction. The finding is independent of left ventricular ejection fraction change, suggesting psychological rather than cardiotoxic mechanisms drive long-term fatigue in this population.
Prospective multicenter cohort study with noncancer comparators. Participants with stage I to III breast cancer receiving potentially cardiotoxic chemotherapy or aromatase inhibitors, and noncancer comparators; mean age 54 years; enrolled across multiple community hospital-based cancer centers.. Intervention: Potentially cardiotoxic chemotherapy or aromatase inhibitors for breast cancer treatment. Compared with: Noncancer comparators and aromatase inhibitor-treated patients (for chemotherapy-exposed group). n = 381. Multiple community hospital-based cancer centers (specific sites not detailed in abstract).
33 patients (18.2%) receiving potentially cardiotoxic chemotherapy experienced clinically relevant fatigue at 24 months (χ² P <0.001 vs aromatase inhibitors or controls) 62 patients (34.6%) experienced significant increase in fatigue relative to baseline (χ² P <0.001 vs aromatase inhibitors and controls) Depressive symptoms associated with 24-month fatigue (estimate −0.77; 95% CI −0.83 to −0.71; P <0.001)
Safety was not reported in the material analysed. Check the source before drawing any conclusion about harm.
Clinicians should recognize that post-treatment fatigue in breast cancer survivors is driven primarily by treatable psychological factors (depression and perceived stress) rather than cardiac dysfunction, suggesting that mental health screening and intervention should be prioritized in fatigue management regardless of cardiovascular risk profiles or changes in cardiac function.
A well-designed prospective cohort study with 24-month follow-up and multivariate analysis identifies modifiable psychological mediators of post-treatment fatigue in breast cancer survivors, with clear effect sizes and controlled comparators.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should recognize that post-treatment fatigue in breast cancer survivors is driven primarily by treatable psychological factors (depression and perceived stress) rather than cardiac dysfunction, suggesting that mental health screening and intervention should be prioritized in fatigue management regardless of cardiovascular risk profiles or changes in cardiac function.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Importance Patients with breast cancer (BC) may have long-term fatigue after treatment, which is associated with reduced quality of life. Objective To identify cardiac, psychological, and cancer treatment factors associated with fatigue before and 24 months after BC treatment. Design, Setting, and Participants This cohort study was conducted across multiple community hospital-based cancer centers among participants with stage I to III BC receiving potentially cardiotoxic chemotherapy or aromatase inhibitors and noncancer comparators. Participants were enrolled from May 2017 to July 2021 and followed up for 24 months. Data were analyzed between July 2023 and July 2026. Exposures Fatigue was assessed by the Functional Assessment of Chronic Illness Therapy Fatigue scale. Main Outcomes and Measures It was hypothesized that chemotherapy-associated changes in left ventricular function were associated with and mediated 2-year post-BC treatment fatigue. Outcome measures included fatigue, sociodemographic variables, hematocrit, left ventricular ejection fraction and circumferential strain, cardiovascular comorbidities, 6-minute walk distance, perceived stress, and depressive symptoms. Results From a total of 381 patients, patients with BC (236) and noncancer comparators (145) had a mean (SD) age of 54 (12) years. Two years after BC treatment, 33 (18.2%) receiving potentially cardiotoxic chemotherapy experienced clinically relevant fatigue (χ 2 test P lt;.001 relative to aromatase inhibitors or controls), and 62 (34.6%) experienced a significant increase in fatigue relative to their precancer treatment fatigue level (χ 2 test P lt;.001, relative to aromatase inhibitors and controls). Independent of pretreatment and posttreatment left ventricular ejection fraction, diabetes status, hypertension, tobacco use, age, body mass index, hematocrit, receipt of potentially cardioprotective medications, and chemotherapy regimens, only depressive symptoms (estimate, −0.77; 95% CI, −0.83 to −0.71; P lt;.001) and perceived stress (−0.32; 95% CI, −0.41 to −0.24; P lt;.001) were associated with and mediated 24-month post-BC treatment fatigue measures. Baseline adjusted changes in 6-minute walk distance, left ventricular ejection fraction, and left ventricular strain were not associated with 24-month post-BC treatment fatigue levels. Conclusions and Relevance In this cohort study of patients with BC, clinically relevant fatigue increased in 34% of patients 2 years after initiating cancer treatment mediated partly by depressive symptoms and perceived stress regardless of cardiovascular risk factors, age, or change in left ventricular ejection fraction and/or strain. Trial Registration ClinicalTrials.gov Identifier: NCT02791581
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