Fatigue Associated with Radiation Treatment for Breast Cancer

  • Canhua Xiao
  • Mylin Ann TorresEmail author


Fatigue is one of the most prevalent and debilitating symptoms that breast cancer patients experience. Cancer-related fatigue (CRF) can persist for many years after treatment has ended, and it is not relieved by either rest or sleep. Fatigue negatively affects quality of life and physical function and may result in decreased adherence to medical treatment. Increasing evidence shows that fatigue is prognostic of survival. In this chapter, we discuss the prevalence, biological mechanisms, and predictors of fatigue in women with breast cancer who receive radiotherapy. The impact of radiation dose and modality on the development of fatigue, as well as interventions for fatigue, are also reviewed.


Breast cancer Radiotherapy Fatigue Inflammation Radiation Cancer-related fatigue 


  1. 1.
    Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, Cleeland C, Dotan E, Eisenberger MA, Escalante CP, Jacobsen PB, Jankowski C, LeBlanc T, Ligibel JA, Loggers ET, Mandrell B, Murphy BA, Palesh O, Pirl WF, Plaxe SC, Riba MB, Rugo HS, Salvador C, Wagner LI, Wagner-Johnston ND, Zachariah FJ, Bergman MA, Smith C. Cancer-related fatigue, version 2.2015. J Natl Compr Canc Netw (JNCCN). 2015;13(8):1012–39.CrossRefGoogle Scholar
  2. 2.
    Cella D, Davis K, Breitbart W, Curt G. Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol. 2001;19(14):3385–91.PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer. 2006;106(4):751–8.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Servaes P, Gielissen MF, Verhagen S, Bleijenberg G. The course of severe fatigue in disease-free breast cancer patients: a longitudinal study. Psychooncology. 2007;16(9):787–95.PubMedCrossRefGoogle Scholar
  5. 5.
    Cavalli Kluthcovsky AC, Urbanetz AA, de Carvalho DS, Pereira Maluf EM, Schlickmann Sylvestre GC, Bonatto Hatschbach SB. Fatigue after treatment in breast cancer survivors: prevalence, determinants and impact on health-related quality of life. Support Care Cancer. 2012;20(8):1901–9.CrossRefGoogle Scholar
  6. 6.
    Noal S, Levy C, Hardouin A, Rieux C, Heutte N, Segura C, Collet F, Allouache D, Switsers O, Delcambre C, Delozier T, Henry-Amar M, Joly F. One-year longitudinal study of fatigue, cognitive functions, and quality of life after adjuvant radiotherapy for breast cancer. Int J Radiat Oncol Biol Phys. 2011;81(3):795–803.PubMedCrossRefGoogle Scholar
  7. 7.
    Morrow GR, Shelke AR, Roscoe JA, Hickok JT, Mustian K. Management of cancer-related fatigue. Cancer Investig. 2005;23(3):229–39.CrossRefGoogle Scholar
  8. 8.
    Schmidt ME, Chang-Claude J, Vrieling A, Heinz J, Flesch-Janys D, Steindorf K. Fatigue and quality of life in breast cancer survivors: temporal courses and long-term pattern. J Cancer Surviv. 2012;6(1):11–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Solberg Nes L, Ehlers SL, Patten CA, Gastineau DA. Self-regulatory fatigue in hematologic malignancies: impact on quality of life, coping, and adherence to medical recommendations. Int J Behav Med. 2013;20(1):13–21.PubMedPubMedCentralCrossRefGoogle Scholar
  10. 10.
    Vogelzang NJ, Breitbart W, Cella D, Curt GA, Groopman JE, Horning SJ, Itri LM, Johnson DH, Scherr SL, Portenoy RK. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol. 1997;34(3 Suppl 2):4–12.PubMedGoogle Scholar
  11. 11.
    Ramalingam S, Belani CP. Meaningful survival in lung cancer patients. Semin Oncol. 2002;29(1 Suppl 4):125–31.PubMedCrossRefGoogle Scholar
  12. 12.
    Montazeri A. Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health Qual Life Outcomes. 2009;7:102.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Groenvold M, Petersen MA, Idler E, Bjorner JB, Fayers PM, Mouridsen HT. Psychological distress and fatigue predicted recurrence and survival in primary breast cancer patients. Breast Cancer Res Treat. 2007;105(2):209–19.PubMedCrossRefGoogle Scholar
  14. 14.
    Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Godwin J, Gray R, Pierce L, Whelan T, Wang Y, Peto R. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet (London, England). 2011;378(9804):1707–16.CrossRefGoogle Scholar
  15. 15.
    Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, Kamby C, Kjaer M, Gadeberg CC, Rasmussen BB, Blichert-Toft M, Mouridsen HT. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet (London, England). 1999;353(9165):1641–8.CrossRefGoogle Scholar
  16. 16.
    Overgaard M, Hansen PS, Overgaard J, Rose C, Andersson M, Bach F, Kjaer M, Gadeberg CC, Mouridsen HT, Jensen MB, Zedeler K. Postoperative radiotherapy in high-risk premenopausal women with breast cancer who receive adjuvant chemotherapy. Danish Breast Cancer Cooperative Group 82b Trial. N Engl J Med. 1997;337(14):949–55.PubMedCrossRefGoogle Scholar
  17. 17.
    Manir KS, Bhadra K, Kumar G, Manna A, Patra NB, Sarkar SK. Fatigue in breast cancer patients on adjuvant treatment: course and prevalence. Indian J Palliat Care. 2012;18(2):109–16.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Garrett K, Dhruva A, Koetters T, West C, Paul SM, Dunn LB, Aouizerat BE, Cooper BA, Dodd M, Lee K, Wara W, Swift P, Miaskowski C. Differences in sleep disturbance and fatigue between patients with breast and prostate cancer at the initiation of radiation therapy. J Pain Symptom Manag. 2011;42(2):239–50.CrossRefGoogle Scholar
  19. 19.
    Miaskowski C, Lee K, Dunn L, Dodd M, Aouizerat BE, West C, Paul SM, Cooper B, Wara W, Swift P. Sleep-wake circadian activity rhythm parameters and fatigue in oncology patients before the initiation of radiation therapy. Cancer Nurs. 2011;34(4):255–68.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Knobf MT, Sun Y. A longitudinal study of symptoms and self-care activities in women treated with primary radiotherapy for breast cancer. Cancer Nurs. 2005;28(3):210–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Sundaresan P, Sullivan L, Pendlebury S, Kirby A, Rodger A, Joseph D, Campbell I, Dhillon HM, Stockler MR. Patients’ perceptions of health-related quality of life during and after adjuvant radiotherapy for T1N0M0 breast cancer. Clin Oncol (R Coll Radiol). 2015;27(1):9–15.CrossRefGoogle Scholar
  22. 22.
    Wratten C, Kilmurray J, Nash S, Seldon M, Hamilton CS, O’Brien PC, Denham JW. Fatigue during breast radiotherapy and its relationship to biological factors. Int J Radiat Oncol Biol Phys. 2004;59(1):160–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Xiao C, Miller AH, Felger J, Mister D, Liu T, Torres MA. Depressive symptoms and inflammation are independent risk factors of fatigue in breast cancer survivors. Psychol Med. 2017;47(10):1733–43.PubMedCrossRefGoogle Scholar
  24. 24.
    Hsu T, Ennis M, Hood N, Graham M, Goodwin PJ. Quality of life in long-term breast cancer survivors. J Clin Oncol Off J Am Soc Clin Oncol. 2013;31(28):3540–8.CrossRefGoogle Scholar
  25. 25.
    Bantema-Joppe EJ, de Bock GH, Woltman-van Iersel M, Busz DM, Ranchor AV, Langendijk JA, Maduro JH, van den Heuvel ER. The impact of age on changes in quality of life among breast cancer survivors treated with breast-conserving surgery and radiotherapy. Br J Cancer. 2015;112(4):636–43.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Goldstein D, Bennett BK, Webber K, Boyle F, de Souza PL, Wilcken NR, Scott EM, Toppler R, Murie P, O’Malley L, McCourt J, Friedlander M, Hickie IB, Lloyd AR. Cancer-related fatigue in women with breast cancer: outcomes of a 5-year prospective cohort study. J Clin Oncol Off J Am Soc Clin Oncol. 2012;30(15):1805–12.CrossRefGoogle Scholar
  27. 27.
    De Sanctis V, Agolli L, Visco V, Monaco F, Muni R, Spagnoli A, Campanella B, Valeriani M, Minniti G, Osti MF, Amanti C, Pellegrini P, Brunetti S, Costantini A, Alfo M, Torrisi MR, Marchetti P, Enrici RM. Cytokines, fatigue, and cutaneous erythema in early stage breast cancer patients receiving adjuvant radiation therapy. Biomed Res Int. 2014;2014:523568.PubMedPubMedCentralCrossRefGoogle Scholar
  28. 28.
    Andrykowski MA, Schmidt JE, Salsman JM, Beacham AO, Jacobsen PB. Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2005;23(27):6613–22.CrossRefGoogle Scholar
  29. 29.
    Standish LJ, Torkelson C, Hamill FA, Yim D, Hill-Force A, Fitzpatrick A, Olsen M, Schildt S, Sweet E, Wenner CA, Martzen MR. Immune defects in breast cancer patients after radiotherapy. J Soc Integr Oncol. 2008;6(3):110–21.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Greenberg DB, Sawicka J, Eisenthal S, Ross D. Fatigue syndrome due to localized radiation. J Pain Symptom Manag. 1992;7(1):38–45.CrossRefGoogle Scholar
  31. 31.
    Browall M, Ahlberg K, Karlsson P, Danielson E, Persson LO, Gaston-Johansson F. Health-related quality of life during adjuvant treatment for breast cancer among postmenopausal women. Eur J Oncol Nurs Off J Eur Oncol Nurs Soc. 2008;12(3):180–9.CrossRefGoogle Scholar
  32. 32.
    Franco P, Zeverino M, Migliaccio F, Cante D, Sciacero P, Casanova Borca V, Torielli P, Arrichiello C, Girelli G, La Porta MR, Tofani S, Numico G, Ricardi U. Intensity-modulated and hypofractionated simultaneous integrated boost adjuvant breast radiation employing statics ports of tomotherapy (TomoDirect): a prospective phase II trial. J Cancer Res Clin Oncol. 2014;140(1):167–77.PubMedCrossRefGoogle Scholar
  33. 33.
    Furst CJ, Ahsberg E. Dimensions of fatigue during radiotherapy. An application of the Multidimensional Fatigue Inventory. Support Care Cancer. 2001;9(5):355–60.PubMedCrossRefGoogle Scholar
  34. 34.
    Garsa AA, Ferraro DJ, DeWees TA, Deshields TL, Margenthaler JA, Cyr AE, Naughton M, Aft R, Gillanders WE, Eberlein T, Matesa MA, Ochoa LL, Zoberi I. A prospective longitudinal clinical trial evaluating quality of life after breast-conserving surgery and high-dose-rate interstitial brachytherapy for early-stage breast cancer. Int J Radiat Oncol Biol Phys. 2013;87(5):1043–50.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Irvine DM, Vincent L, Graydon JE, Bubela N. Fatigue in women with breast cancer receiving radiation therapy. Cancer Nurs. 1998;21(2):127–35.PubMedCrossRefGoogle Scholar
  36. 36.
    Kishan AU, Wang PC, Sharif J, Kupelian PA, Steinberg ML, McCloskey SA. Clinical indicators of psychosocial distress predict for acute radiation-induced fatigue in patients receiving adjuvant radiation therapy for breast cancer: an analysis of patient-reported outcomes. Int J Radiat Oncol Biol Phys. 2016;95(3):946–55.PubMedCrossRefGoogle Scholar
  37. 37.
    Poirier P. The relationship of sick leave benefits, employment patterns, and individual characteristics to radiation therapy-related fatigue. Oncol Nurs Forum. 2006;33(3):593–601.PubMedCrossRefGoogle Scholar
  38. 38.
    Dhruva A, Dodd M, Paul SM, Cooper BA, Lee K, West C, Aouizerat BE, Swift PS, Wara W, Miaskowski C. Trajectories of fatigue in patients with breast cancer before, during, and after radiation therapy. Cancer Nurs. 2010;33(3):201–12.PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Geinitz H, Zimmermann FB, Thamm R, Keller M, Busch R, Molls M. Fatigue in patients with adjuvant radiation therapy for breast cancer: long-term follow-up. J Cancer Res Clin Oncol. 2004;130(6):327–33.PubMedCrossRefGoogle Scholar
  40. 40.
    Han TJ, Felger JC, Lee A, Mister D, Miller AH, Torres MA. Association of childhood trauma with fatigue, depression, stress, and inflammation in breast cancer patients undergoing radiotherapy. Psychooncology. 2016;25(2):187–93.PubMedCrossRefGoogle Scholar
  41. 41.
    Torres MA, Pace TW, Liu T, Felger JC, Mister D, Doho GH, Kohn JN, Barsevick AM, Long Q, Miller AH. Predictors of depression in breast cancer patients treated with radiation: role of prior chemotherapy and nuclear factor kappa B. Cancer. 2013;119(11):1951–9.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Reidunsdatter RJ, Rannestad T, Frengen J, Frykholm G, Lundgren S. Early effects of contemporary breast radiation on health-related quality of life – predictors of radiotherapy-related fatigue. Acta Oncol (Stockholm, Sweden). 2011;50(8):1175–82.CrossRefGoogle Scholar
  43. 43.
    Woo B, Dibble SL, Piper BF, Keating SB, Weiss MC. Differences in fatigue by treatment methods in women with breast cancer. Oncol Nurs Forum. 1998;25(5):915–20.PubMedGoogle Scholar
  44. 44.
    Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol Off J Am Soc Clin Oncol. 2000;18(4):743–53.CrossRefGoogle Scholar
  45. 45.
    Graydon JE. Women with breast cancer: their quality of life following a course of radiation therapy. J Adv Nurs. 1994;19(4):617–22.PubMedCrossRefGoogle Scholar
  46. 46.
    Dragun AE, Ajkay NJ, Riley EC, Roberts TL, Pan J, Rai SN, Jain D, Quillo AR, Scoggins CR, McMasters KM, Woo SY. First results of a phase 2 trial of once-Weekly Hypofractionated Breast Irradiation (WHBI) for early-stage breast cancer. Int J Radiat Oncol Biol Phys. 2017;98(3):595–602.PubMedCrossRefGoogle Scholar
  47. 47.
    Constantine C, Parhar P, Lymberis S, Fenton-Kerimian M, Han SC, Rosenstein BS, Formenti SC. Feasibility of accelerated whole-breast radiation in the treatment of patients with ductal carcinoma in situ of the breast. Clin Breast Cancer. 2008;8(3):269–74.PubMedCrossRefGoogle Scholar
  48. 48.
    Trotti A, Colevas AD, Setser A, Basch E. Patient-reported outcomes and the evolution of adverse event reporting in oncology. J Clin Oncol Off J Am Soc Clin Oncol. 2007;25(32):5121–7.Google Scholar
  49. 49.
    Atkinson TM, Ryan SJ, Bennett AV, Stover AM, Saracino RM, Rogak LJ, Jewell ST, Matsoukas K, Li Y, Basch E. The association between clinician-based common terminology criteria for adverse events (CTCAE) and patient-reported outcomes (PRO): a systematic review. Support Care Cancer. 2016;24(8):3669–76.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Bower JE. Cancer-related fatigue – mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11(10):597–609.PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Ryan JL, Carroll JK, Ryan EP, Mustian KM, Fiscella K, Morrow GR. Mechanisms of cancer-related fatigue. Oncologist. 2007;12(Suppl 1):22–34.PubMedCrossRefGoogle Scholar
  52. 52.
    Barsevick A, Frost M, Zwinderman A, Hall P, Halyard M. I’m so tired: biological and genetic mechanisms of cancer-related fatigue. Qual Life Res Int J Qual Life Asp Treat Care Rehab. 2010;19(10):1419–27.Google Scholar
  53. 53.
    Bourhis J, Calais G, Lapeyre M, Tortochaux J, Alfonsi M, Sire C, Bardet E, Rives M, Bergerot P, Rhein B, Desprez B. Concomitant radiochemotherapy or accelerated radiotherapy: analysis of two randomized trials of the French Head and Neck Cancer Group (GORTEC). Semin Oncol. 2004;31(6):822–6.PubMedCrossRefGoogle Scholar
  54. 54.
    Hart BL. The behavior of sick animals. Vet Clin North Am Small Anim Pract. 1991;21(2):225–37.PubMedCrossRefGoogle Scholar
  55. 55.
    Pyter LM. Behavioral consequences of peripheral tumors: neuroimmune mechanisms. Chicago: American Association for Cancer Research; 2012.Google Scholar
  56. 56.
    Capuron L, Pagnoni G, Drake DF, Woolwine BJ, Spivey JR, Crowe RJ, Votaw JR, Goodman MM, Miller AH. Dopaminergic mechanisms of reduced basal ganglia responses to hedonic reward during interferon-alpha administration. Arch Gen Psychiatry. 2012;69(10):1044–53.Google Scholar
  57. 57.
    Bower JE, Ganz PA, Aziz N, Fahey JL. Fatigue and proinflammatory cytokine activity in breast cancer survivors. Psychosom Med. 2002;64(4):604–11.PubMedCrossRefGoogle Scholar
  58. 58.
    Collado-Hidalgo A, Bower JE, Ganz PA, Cole SW, Irwin MR. Inflammatory biomarkers for persistent fatigue in breast cancer survivors. Clin Cancer Res. 2006;12(9):2759–66.PubMedCrossRefGoogle Scholar
  59. 59.
    Schmidt ME, Meynkohn A, Habermann N, Wiskemann J, Oelmann J, Hof H, Wessels S, Klassen O, Debus J, Potthoff K, Steindorf K, Ulrich CM. Resistance exercise and inflammation in breast cancer patients undergoing adjuvant radiation therapy: mediation analysis from a randomized, controlled intervention trial. Int J Radiat Oncol Biol Phys. 2016;94(2):329–37.PubMedCrossRefGoogle Scholar
  60. 60.
    Bower JE, Ganz PA, Irwin MR, Kwan L, Breen EC, Cole SW. Inflammation and behavioral symptoms after breast cancer treatment: do fatigue, depression, and sleep disturbance share a common underlying mechanism. J Clin Oncol Off J Am Soc Clin Oncol. 2011;29(26):3517–22.CrossRefGoogle Scholar
  61. 61.
    Orre IJ, Reinertsen KV, Aukrust P, Dahl AA, Fossa SD, Ueland T, Murison R. Higher levels of fatigue are associated with higher CRP levels in disease-free breast cancer survivors. J Psychosom Res. 2011;71(3):136–41.PubMedCrossRefGoogle Scholar
  62. 62.
    Cameron BA, Bennett B, Li H, Boyle F, Desouza P, Wilcken N, Friedlander M, Goldstein D, Lloyd AR. Post-cancer fatigue is not associated with immune activation or altered cytokine production. Ann Oncol. 2012;69(10):1044–53.Google Scholar
  63. 63.
    Geinitz H, Zimmermann FB, Stoll P, Thamm R, Kaffenberger W, Ansorg K, Keller M, Busch R, van Beuningen D, Molls M. Fatigue, serum cytokine levels, and blood cell counts during radiotherapy of patients with breast cancer. Int J Radiat Oncol Biol Phys. 2001;51(3):691–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Karin M, Greten FR. NF-kappaB: linking inflammation and immunity to cancer development and progression. Nat Rev Immunol. 2005;5(10):749–59.PubMedCrossRefGoogle Scholar
  65. 65.
    Gupta SC, Kim JH, Kannappan R, Reuter S, Dougherty PM, Aggarwal BB. Role of nuclear factor kappaB-mediated inflammatory pathways in cancer-related symptoms and their regulation by nutritional agents. Exp Biol Med (Maywood). 2011;236(6):658–71.CrossRefGoogle Scholar
  66. 66.
    Merriman JD, Jansen C, Koetters T, West C, Dodd M, Lee K, Paul SM, Aouizerat BE, Cooper BA, Swift PS, Wara W, Miaskowski C. Predictors of the trajectories of self-reported attentional fatigue in women with breast cancer undergoing radiation therapy. Oncol Nurs Forum. 2010;37(4):423–32.PubMedPubMedCentralCrossRefGoogle Scholar
  67. 67.
    Jagsi R, Griffith KA, Boike TP, et al. Differences in the acute toxic effects of breast radiotherapy by fractionation schedule: comparative analysis of physician-assessed and patient-reported outcomes in a large multicenter cohort. JAMA Oncol. 2015;1(7):918–30.PubMedCrossRefGoogle Scholar
  68. 68.
    Shaitelman SF, Schlembach PJ, Arzu I, et al. Acute and short-term toxic effects of conventionally fractionated vs hypofractionated whole-breast irradiation: a randomized clinical trial. JAMA Oncol. 2015;1(7):931–41.PubMedPubMedCentralCrossRefGoogle Scholar
  69. 69.
    Taunk NK, Haffty BG, Chen S, Khan AJ, Nelson C, Pierce D, Goyal S. Comparison of radiation-induced fatigue across 3 different radiotherapeutic methods for early stage breast cancer. Cancer. 2011;117(18):4116–24.PubMedCrossRefGoogle Scholar
  70. 70.
    Albuquerque K, Tell D, Lobo P, Millbrandt L, Mathews HL, Janusek LW. Impact of partial versus whole breast radiation therapy on fatigue, perceived stress, quality of life and natural killer cell activity in women with breast cancer. BMC Cancer. 2012;12:251.PubMedPubMedCentralCrossRefGoogle Scholar
  71. 71.
    Dash C, Randolph-Jackson PD, Isaacs C, Mills M, Makambi K, Watkins VV, Adams-Campbell LL. An exercise trial to reduce cancer related fatigue in African American breast cancer patients undergoing radiation therapy: design, rationale, and methods. Contemp Clin Trials. 2016;47:153–7.PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Mock V, Dow KH, Meares CJ, Grimm PM, Dienemann JA, Haisfield-Wolfe ME, Quitasol W, Mitchell S, Chakravarthy A, Gage I. Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncol Nurs Forum. 1997;24(6):991–1000.PubMedGoogle Scholar
  73. 73.
    Reis D, Walsh ME, Young-McCaughan S, Jones T. Effects of Nia exercise in women receiving radiation therapy for breast cancer. Oncol Nurs Forum. 2013;40(5):E374–81.PubMedCrossRefGoogle Scholar
  74. 74.
    Sprod LK, Palesh OG, Janelsins MC, Peppone LJ, Heckler CE, Adams MJ, Morrow GR, Mustian KM. Exercise, sleep quality, and mediators of sleep in breast and prostate cancer patients receiving radiation therapy. Commun Oncol. 2010;7(10):463–71.CrossRefGoogle Scholar
  75. 75.
    Yang TY, Chen ML, Li CC. Effects of an aerobic exercise programme on fatigue for patients with breast cancer undergoing radiotherapy. J Clin Nurs. 2015;24(1–2):202–11.PubMedCrossRefGoogle Scholar
  76. 76.
    Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev. 2016;9:Cd005001.PubMedGoogle Scholar
  77. 77.
    Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012;11:Cd006145.PubMedGoogle Scholar
  78. 78.
    Cheng KKF, Lim YTE, Koh ZM, Tam WWS. Home-based multidimensional survivorship programmes for breast cancer survivors. Cochrane Database Syst Rev. 2017;8:Cd011152.PubMedGoogle Scholar
  79. 79.
    Lipsett A, Barrett S, Haruna F, Mustian K, O'Donovan A. The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: a systematic review and meta-analysis. Breast (Edinburgh, Scotland). 2017;32:144–55.CrossRefGoogle Scholar
  80. 80.
    Lee H, Lim Y, Yoo MS, Kim Y. Effects of a nurse-led cognitive-behavior therapy on fatigue and quality of life of patients with breast cancer undergoing radiotherapy: an exploratory study. Cancer Nurs. 2011;34(6):E22–30.PubMedCrossRefGoogle Scholar
  81. 81.
    Montgomery GH, David D, Kangas M, Green S, Sucala M, Bovbjerg DH, Hallquist MN, Schnur JB. Randomized controlled trial of a cognitive-behavioral therapy plus hypnosis intervention to control fatigue in patients undergoing radiotherapy for breast cancer. J Clin Oncol Off J Am Soc Clin Oncol. 2014;32(6):557–63.CrossRefGoogle Scholar
  82. 82.
    Montgomery GH, Kangas M, David D, Hallquist MN, Green S, Bovbjerg DH, Schnur JB. Fatigue during breast cancer radiotherapy: an initial randomized study of cognitive-behavioral therapy plus hypnosis. Health Psychol Off J Div Health Psychol Am Psychol Assoc. 2009;28(3):317–22.Google Scholar
  83. 83.
    FitzHenry F, Wells N, Slater V, Dietrich MS, Wisawatapnimit P, Chakravarthy AB. A randomized placebo-controlled pilot study of the impact of healing touch on fatigue in breast cancer patients undergoing radiation therapy. Integr Cancer Ther. 2014;13(2):105–13.PubMedCrossRefGoogle Scholar
  84. 84.
    Kim YH, Kim HJ, Ahn SD, Seo YJ, Kim SH. Effects of meditation on anxiety, depression, fatigue, and quality of life of women undergoing radiation therapy for breast cancer. Complement Ther Med. 2013;21(4):379–87.PubMedCrossRefGoogle Scholar
  85. 85.
    da Costa Miranda V, Trufelli DC, Santos J, Campos MP, Nobuo M, da Costa Miranda M, Schlinder F, Riechelmann R, del Giglio A. Effectiveness of guarana (Paullinia cupana) for postradiation fatigue and depression: results of a pilot double-blind randomized study. J Altern Complement Med (New York, NY). 2009;15(4):431–3.CrossRefGoogle Scholar
  86. 86.
    Mustian KM, Roscoe JA, Palesh OG, Sprod LK, Heckler CE, Peppone LJ, Usuki KY, Ling MN, Brasacchio RA, Morrow GR. Polarity therapy for cancer-related fatigue in patients with breast cancer receiving radiation therapy: a randomized controlled pilot study. Integr Cancer Ther. 2011;10(1):27–37.PubMedPubMedCentralCrossRefGoogle Scholar
  87. 87.
    Roscoe JA, Matteson SE, Mustian KM, Padmanaban D, Morrow GR. Treatment of radiotherapy-induced fatigue through a nonpharmacological approach. Integr Cancer Ther. 2005;4(1):8–13.PubMedCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Radiation OncologyWinship Cancer Institute, Emory University School of MedicineAtlantaUSA

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