The trajectory of fatigue over time in breast cancer patients treated with chemotherapy: exploring the effect of anthracycline-based chemotherapy

Anneke Kastelein; Laura Kervezee; Dieuwke R Mink van der Molen; Daniel J Evers; Carmen C van der Pol; Annemiek Doeksen; N H Chavannes; Hans Gelderblom; Jacques Neefjes; Helena M Verkooijen; Anne M May

doi:10.1016/j.breast.2026.104700

The trajectory of fatigue over time in breast cancer patients treated with chemotherapy: exploring the effect of anthracycline-based chemotherapy

Anneke Kastelein
, Laura Kervezee
, Dieuwke R Mink van der Molen
, Daniel J Evers
, Carmen C van der Pol
, Annemiek Doeksen
, N H Chavannes
, Hans Gelderblom
, Jacques Neefjes
, Helena M Verkooijen
, Anne M May^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Cancer-related fatigue is a common and profound side effect of cancer treatment. The specific impacts of different classes of chemotherapy remains understudied. This study aimed to compare the trajectory of fatigue between breast cancer patients treated with anthracycline-based versus non-anthracycline-based regimens over a period of 4 years.

METHODS: Data were obtained from the Dutch UMBRELLA cohort. Included were breast cancer patients treated with (neo)adjuvant chemotherapy, categorized as anthracycline-containing vs. non-anthracycline-containing. Fatigue was measured using the Multidimensional Fatigue Inventory-20 and the fatigue scale of the EORTC QLQ-C30. A total of 1155 patients were included: 971 received anthracycline-based chemotherapy, and 184 received non-anthracycline-based chemotherapy. Linear mixed-effects models were employed to analyse time-by-treatment interactions for different dimensions of fatigue.

RESULTS: The fatigue trajectories differed significantly between treatment groups for general and physical fatigue. Pairwise comparisons indicate that anthracycline-treated patients reported higher levels of general fatigue and physical fatigue as well as reduced activity in the first six months after start of treatment. Notably, patients treated with non-anthracycline-based regimens reported better recovery over time, with significantly lower fatigue levels at 42-48 months compared to anthracyclines-treated patients, as measured by both the MFI-20 and the fatigue scale of the EORTC QLQ-C30.

CONCLUSION: These observations suggest that (neo)adjuvant anthracycline-based chemotherapy in breast cancer patients is associated with higher levels of fatigue during treatment as well as a prolonged burden of fatigue. Treatment tailored fatigue management strategies may be particularly useful for patients undergoing anthracycline-based chemotherapy.

Original language	English
Article number	104700
Number of pages	7
Journal	The Breast
Volume	85
Early online date	14 Jan 2026
DOIs	https://doi.org/10.1016/j.breast.2026.104700
Publication status	Published - Feb 2026

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The trajectory of fatigue over time in breast cancer patients treated with chemotherapy: exploring the effect of anthracycline-based chemotherapyFinal published version, 1.97 MBLicence: CC BY

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Kastelein, A., Kervezee, L., Mink van der Molen, D. R., Evers, D. J., van der Pol, C. C., Doeksen, A., Chavannes, N. H., Gelderblom, H., Neefjes, J., Verkooijen, H. M., & May, A. M. (2026). The trajectory of fatigue over time in breast cancer patients treated with chemotherapy: exploring the effect of anthracycline-based chemotherapy. The Breast, 85, Article 104700. https://doi.org/10.1016/j.breast.2026.104700

@article{1fd8719e816c4575a3cbce476e0647ae,

title = "The trajectory of fatigue over time in breast cancer patients treated with chemotherapy: exploring the effect of anthracycline-based chemotherapy",

abstract = "BACKGROUND: Cancer-related fatigue is a common and profound side effect of cancer treatment. The specific impacts of different classes of chemotherapy remains understudied. This study aimed to compare the trajectory of fatigue between breast cancer patients treated with anthracycline-based versus non-anthracycline-based regimens over a period of 4 years.METHODS: Data were obtained from the Dutch UMBRELLA cohort. Included were breast cancer patients treated with (neo)adjuvant chemotherapy, categorized as anthracycline-containing vs. non-anthracycline-containing. Fatigue was measured using the Multidimensional Fatigue Inventory-20 and the fatigue scale of the EORTC QLQ-C30. A total of 1155 patients were included: 971 received anthracycline-based chemotherapy, and 184 received non-anthracycline-based chemotherapy. Linear mixed-effects models were employed to analyse time-by-treatment interactions for different dimensions of fatigue.RESULTS: The fatigue trajectories differed significantly between treatment groups for general and physical fatigue. Pairwise comparisons indicate that anthracycline-treated patients reported higher levels of general fatigue and physical fatigue as well as reduced activity in the first six months after start of treatment. Notably, patients treated with non-anthracycline-based regimens reported better recovery over time, with significantly lower fatigue levels at 42-48 months compared to anthracyclines-treated patients, as measured by both the MFI-20 and the fatigue scale of the EORTC QLQ-C30.CONCLUSION: These observations suggest that (neo)adjuvant anthracycline-based chemotherapy in breast cancer patients is associated with higher levels of fatigue during treatment as well as a prolonged burden of fatigue. Treatment tailored fatigue management strategies may be particularly useful for patients undergoing anthracycline-based chemotherapy.",

author = "Anneke Kastelein and Laura Kervezee and \{Mink van der Molen\}, \{Dieuwke R\} and Evers, \{Daniel J\} and \{van der Pol\}, \{Carmen C\} and Annemiek Doeksen and Chavannes, \{N H\} and Hans Gelderblom and Jacques Neefjes and Verkooijen, \{Helena M\} and May, \{Anne M\}",

note = "Publisher Copyright: {\textcopyright} 2026 The Authors",

year = "2026",

month = feb,

doi = "10.1016/j.breast.2026.104700",

language = "English",

volume = "85",

journal = "The Breast",

issn = "0960-9776",

publisher = "Churchill Livingstone",

}

Kastelein, A, Kervezee, L, Mink van der Molen, DR, Evers, DJ, van der Pol, CC, Doeksen, A, Chavannes, NH, Gelderblom, H, Neefjes, J, Verkooijen, HM & May, AM 2026, 'The trajectory of fatigue over time in breast cancer patients treated with chemotherapy: exploring the effect of anthracycline-based chemotherapy', The Breast, vol. 85, 104700. https://doi.org/10.1016/j.breast.2026.104700

TY - JOUR

T1 - The trajectory of fatigue over time in breast cancer patients treated with chemotherapy

T2 - exploring the effect of anthracycline-based chemotherapy

AU - Kastelein, Anneke

AU - Kervezee, Laura

AU - Mink van der Molen, Dieuwke R

AU - Evers, Daniel J

AU - van der Pol, Carmen C

AU - Doeksen, Annemiek

AU - Chavannes, N H

AU - Gelderblom, Hans

AU - Neefjes, Jacques

AU - Verkooijen, Helena M

AU - May, Anne M

PY - 2026/2

Y1 - 2026/2

N2 - BACKGROUND: Cancer-related fatigue is a common and profound side effect of cancer treatment. The specific impacts of different classes of chemotherapy remains understudied. This study aimed to compare the trajectory of fatigue between breast cancer patients treated with anthracycline-based versus non-anthracycline-based regimens over a period of 4 years.METHODS: Data were obtained from the Dutch UMBRELLA cohort. Included were breast cancer patients treated with (neo)adjuvant chemotherapy, categorized as anthracycline-containing vs. non-anthracycline-containing. Fatigue was measured using the Multidimensional Fatigue Inventory-20 and the fatigue scale of the EORTC QLQ-C30. A total of 1155 patients were included: 971 received anthracycline-based chemotherapy, and 184 received non-anthracycline-based chemotherapy. Linear mixed-effects models were employed to analyse time-by-treatment interactions for different dimensions of fatigue.RESULTS: The fatigue trajectories differed significantly between treatment groups for general and physical fatigue. Pairwise comparisons indicate that anthracycline-treated patients reported higher levels of general fatigue and physical fatigue as well as reduced activity in the first six months after start of treatment. Notably, patients treated with non-anthracycline-based regimens reported better recovery over time, with significantly lower fatigue levels at 42-48 months compared to anthracyclines-treated patients, as measured by both the MFI-20 and the fatigue scale of the EORTC QLQ-C30.CONCLUSION: These observations suggest that (neo)adjuvant anthracycline-based chemotherapy in breast cancer patients is associated with higher levels of fatigue during treatment as well as a prolonged burden of fatigue. Treatment tailored fatigue management strategies may be particularly useful for patients undergoing anthracycline-based chemotherapy.

AB - BACKGROUND: Cancer-related fatigue is a common and profound side effect of cancer treatment. The specific impacts of different classes of chemotherapy remains understudied. This study aimed to compare the trajectory of fatigue between breast cancer patients treated with anthracycline-based versus non-anthracycline-based regimens over a period of 4 years.METHODS: Data were obtained from the Dutch UMBRELLA cohort. Included were breast cancer patients treated with (neo)adjuvant chemotherapy, categorized as anthracycline-containing vs. non-anthracycline-containing. Fatigue was measured using the Multidimensional Fatigue Inventory-20 and the fatigue scale of the EORTC QLQ-C30. A total of 1155 patients were included: 971 received anthracycline-based chemotherapy, and 184 received non-anthracycline-based chemotherapy. Linear mixed-effects models were employed to analyse time-by-treatment interactions for different dimensions of fatigue.RESULTS: The fatigue trajectories differed significantly between treatment groups for general and physical fatigue. Pairwise comparisons indicate that anthracycline-treated patients reported higher levels of general fatigue and physical fatigue as well as reduced activity in the first six months after start of treatment. Notably, patients treated with non-anthracycline-based regimens reported better recovery over time, with significantly lower fatigue levels at 42-48 months compared to anthracyclines-treated patients, as measured by both the MFI-20 and the fatigue scale of the EORTC QLQ-C30.CONCLUSION: These observations suggest that (neo)adjuvant anthracycline-based chemotherapy in breast cancer patients is associated with higher levels of fatigue during treatment as well as a prolonged burden of fatigue. Treatment tailored fatigue management strategies may be particularly useful for patients undergoing anthracycline-based chemotherapy.

U2 - 10.1016/j.breast.2026.104700

DO - 10.1016/j.breast.2026.104700

M3 - Article

C2 - 41558212

SN - 0960-9776

VL - 85

JO - The Breast

JF - The Breast

M1 - 104700

ER -

The trajectory of fatigue over time in breast cancer patients treated with chemotherapy: exploring the effect of anthracycline-based chemotherapy

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