Background: Cancer-related fatigue is a common and disabling symptom among women receiving chemotherapy for breast cancer, yet its early trajectory and associated factors remain insufficiently characterised in African settings. This study examined longitudinal changes in fatigue and baseline factors associated with fatigue deterioration among women with breast cancer receiving chemotherapy at a Nigerian tertiary oncology centre.
Methods: This prospective cohort study included 79 chemotherapy-naïve women with histologically confirmed breast cancer who were assessed before chemotherapy and after completion of the third cycle. Fatigue was measured using the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue) scale. The primary outcome was the within-participant change in FACIT-Fatigue score, calculated as the cycle 3 score minus the baseline score. Baseline demographic, clinical, socioeconomic, haematological and study-specific patient-reported variables were evaluated as potential predictors of fatigue deterioration.
Results: At baseline, the mean FACIT-Fatigue score was 34.0 ± 8.4, and 36 participants (45.6%) had clinically significant fatigue. By cycle 3, the mean score had declined to 24.8 ± 11.7, representing significant fatigue deterioration (mean change −9.23 points; 95% CI −11.82 to −6.64; p < 0.001; Cohen’s dz = 0.80). Seventy participants (88.6%) experienced a clinically meaningful decline of at least three FACIT-Fatigue points. Surgical status was associated with fatigue change in the bivariate analysis, while age and appetite demonstrated weak or borderline associations. However, none of the evaluated baseline factors were independently associated with fatigue deterioration in the multivariable analysis. The adjusted model had virtually no explanatory value (adjusted R² = 0.001).
Conclusion: Women with breast cancer began chemotherapy with a substantial burden of fatigue, which worsened markedly during the first three treatment cycles. Although no evaluated baseline factor independently predicted this deterioration, the prospective within-participant findings demonstrate a substantial early symptom burden. These findings support fatigue assessment before chemotherapy and repeated monitoring during treatment, together with timely, guideline-directed supportive care when clinically indicated.
