Following exposure to breast cancer chemotherapy, cancer-related fatigue contributes to balance issues.


Following exposure to breast cancer chemotherapy, cancer-related fatigue contributes to balance issues.

Cancer-related fatigue (CRF) is a common side effect of chemotherapy for breast cancer patients and is linked to continued balance issues, according to a study published in Rehabilitation Oncology, the official journal of APTA Oncology, an academy of the American Physical Therapy Association (APTA). Wolters Kluwer publishes the journal under the Lippincott imprint.

The MGH Institute of Health Professions, Boston, and colleagues' recent study is the first to quantify and contrast the relative contributions of chemotherapy-induced peripheral neuropathy and CRF to postural instability (CIPN).

The researchers conclude that their findings "suggest that CRF, even years after exposure to chemotherapy, may distinctly impact balance regardless of a patient's CIPN status."

Greater postural sway and modifications to "sit-to-stand" function are predicted by CRF.

Many breast cancer patients develop physical or functional restrictions after treatment, including balance issues and a higher risk of falling. These balance issues are commonly related to CIPN, a common side effect of cancer chemotherapy that causes nerve damage. Recent research, however, indicates that CRF, another typical side effect of cancer and its treatment, might also be related to balance issues.

Data on 43 women who had received chemotherapy for breast cancer were examined by Dr. Wechsler and colleagues to determine the connection between CRF and postural instability. A median of 3.5 years had passed since cancer treatment when patients were evaluated. The average score for fatigue was 43 on a 0-to-100 scale, with higher scores indicating more fatigue, which is consistent with the high reported frequency of CRF. The majority of the women (53.5%) experienced some degree of CIPN symptoms.

A series of standardised evaluations of balance function were performed on the participants. Women with higher CRF scores showed more anteroposterior (front to back) postural sway during a static (still) balance test. After adjusting for other variables, the CRF score explained 10% more variation in postural sway than the CIPN, which only explained 1%.

Following a brief activity assignment, postural sway was also more pronounced in those with more severe CRF. Postural sway did not substantially correlate with the severity of CIPN in either test.

Additional studies looked at how CRF affected dynamic balance during a sit-to-stand test, a crucial indicator of physical health and a predictor of the likelihood of falling. In this test, CRF accounted for over 7% of the variance in postural sway compared to 3% for CIPN following an exhausting workout that targeted the muscles of the lower extremities.

During the sit-to-stand test after exercise, persons with higher CRF displayed "smaller, more conservative" forward transfers in body weight. That pattern fits with a "stabilisation technique" frequently observed in people with balance issues. According to Dr. Wechsler and colleagues, the stabilisation method, which depends more on lower leg strength than the "momentum transfer" strategy seen in persons with higher balance function, is symptomatic of inadequate postural control.

Cancer-related Fatigue's Effects

The most important clinical relevance of the study's findings is that lower-extremity-fatiguing tasks may contribute to or exacerbate dynamic balance abnormalities in CRF survivors. Performing routines of daily living, navigating stairwells or the neighborhood, or taking part in a suggested exercise regimen can all present survivors with such taxing challenges.

The study supports recent research that suggests CRF following chemotherapy and other therapies may increase breast cancer survivors' risk of falling and balance issues. While CIPN continues to be a risk factor for imbalance in this population, Dr. Wechsler and co-authors suggest that CRF should be taken into account in clinical practice and research as a mechanism of postural instability.

The results could have an impact on how rehabilitation specialists recommend exercise to cancer survivors, especially in terms of increasing dynamic balance to lower the chance of falling. The researchers note that individuals with CRF who have had cancer treatment "may benefit from balance-related instruction regarding safety and coping or compensatory measures."

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