Persistent fatigue, characterized by overwhelming and sustained exhaustion, is a common and often debilitating side-effect of breast cancer treatment. Risk factors for cancer-related fatigue remain largely unknown, however, even though there are approximately 13.7 million cancer survivors living in the United States today.
In a new study, published in Clinical Psychological Science, Dr. Julienne Bower and Dr. George Slavich examined the role lifetime stress exposure plays in cancer-related fatigue. Results revealed that women with persistent fatigue have significantly higher levels of stress, in both childhood and adulthood, than non-fatigued control participants. The data thus suggest that stress occurring over the life course may play an important role in promoting symptoms of fatigue in the context of cancer.
To investigate how stress impacts fatigue, Drs. Bower and Slavich examined the life histories of 50 breast cancer survivors using an online stress assessment system that Dr. Slavich developed, called the Stress and Adversity Inventory, or STRAIN. The STRAIN is based on state-of-the-art methods for assessing life stress and measures individuals’ lifetime exposure to 96 types of acute and chronic stressors that may have implications for health. Fatigue status, in turn, was assessed by asking individuals standardized, clinically relevant questions regarding the extent to which they “felt full of pep,” “felt worn out,” “felt tired,” and “had a lot of energy” during the past four weeks.
“Women with breast cancer can experience high levels of stress, but the effects these experiences have on clinical outcomes in cancer are rarely assessed,” said Slavich. “In this study, therefore, we aimed to understand all of the major stressors that each patient experienced over their lifetime and how those experiences in turn impacted their health and well-being.”
The data collected revealed that fatigued breast cancer survivors reported significantly higher levels of stress in both childhood and adulthood compared to their non-fatigued counterparts. Prior research on this topic has shown that traumatic life events impact clinical functioning in cancer. In the paper, Drs. Bower and Slavich note that the present study extends this prior research by showing that more common, non-traumatic stressors occurring over the lifespan can also influence clinical outcomes in the context of cancer.
“Although these results do not highlight the specific mechanisms that might link stress and fatigue in breast cancer,” Slavich said, “they do suggest that life stress is a risk factor for cancer-related fatigue that should be routinely assessed in the course of all cancer treatment.”
The study was supported by the University of California Cancer Research Coordinating Committee, the Breast Cancer Research Foundation, National Institutes of Health (NIH)/National Cancer Institute Grant R01-CA160427 awarded to Dr. Bower, NIH/National Institute of General Medical Sciences Grant T32-GM084903 awarded to study co-author Alexandra Dupont, and by a Society in Science–Branco Weiss Fellowship awarded to Dr. Slavich.
Dr. Julienne Bower is an associate professor in the Department of Psychology at UCLA and a Research Scientist at the UCLA Cousins Center for Psychoneuroimmunology.
Dr. George Slavich is an assistant professor and Society in Science – Branco Weiss Fellow in the Department of Psychiatry and Biobehavioral Sciences at UCLA. He is also a Research Scientist at the UCLA Cousins Center for Psychoneuroimmunology, where he directs the Laboratory for Stress Assessment and Research.
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Childhood Adversity and Cumulative Life Stress: Risk Factors for Cancer-Related Fatigue
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