Cancer-Related Fatigue Linked to Balance Problems After Breast Cancer Treatment

Cancer-related fatigue can persist as a long-term adverse effect after breast cancer treatment, and it has been associated with balance problems.

New research by Stephen Wechsler and colleagues in Rehabilitation Oncology on 28 June 2022 measured the effects of cancer-related fatigue on balance. It was the first study to compare these with chemotherapy-induced peripheral neuropathy, or nerve damage in the hands and feet. The researchers stated, "Cancer-related fatigue may substantially affect balance even several years after chemotherapy, independently of a patient’s chemotherapy-induced peripheral neuropathy status."

Cancer-Related Fatigue Predicts Balance Problems

After breast cancer treatment, many patients experience physical and functional limitations, including balance problems and greater fall risk. These were generally attributed to chemotherapy-related nerve damage in the hands and feet. Recent studies, however, suggest that cancer-related fatigue, another common effect of cancer and its treatment, may also contribute.

To examine fatigue and postural instability, Dr Wechsler and colleagues analysed 43 women who had received chemotherapy for breast cancer. They were assessed an average of 3.5 years after treatment. Mean fatigue score was 43 on a scale from 0 to 100, where higher scores meant more fatigue. More than half (54%) had at least mild chemotherapy-induced peripheral neuropathy.

Participants underwent standardised balance assessments. On a static balance test, women with higher fatigue scores had greater anteroposterior, or front-to-back, postural sway. Cancer-related fatigue accounted for 1% of peripheral neuropathy and 10% of postural sway.

Women with more severe fatigue also showed increased sway after brief exercise. In both tests, sway was not significantly associated with the severity of chemotherapy-induced peripheral neuropathy.

A standard sit-to-stand test measures physical function and indicates fall risk. Researchers used it to assess fatigue’s effect on dynamic balance. After strenuous leg exercise, cancer-related fatigue accounted for 3% of chemotherapy-associated peripheral neuropathy and approximately 7% of postural sway.

After exercise, participants with greater fatigue showed forward balance disturbances during sit-to-stand. This matched the "stabilisation strategy" commonly seen in people with balance problems. The researchers said it suggested impaired postural control because it relies more on lower-leg strength than the "momentum transfer" strategy used by people with better balance.

Effects of Cancer-Related Fatigue

The researchers discussed several clinical implications. Most importantly, a tiring task involving the legs may cause or worsen dynamic balance problems. Cancer survivors may encounter such tasks during daily activities or while following a recommended exercise programme.

The report adds to evidence that fatigue after chemotherapy and other treatments may increase balance problems and falls in breast cancer survivors. The authors stated, "Although chemotherapy-induced peripheral neuropathy remains a risk factor for imbalance in this population, cancer-related fatigue should receive greater attention as a mechanism of postural instability in clinical practice and research."

Exercise programmes designed by oncology rehabilitation professionals may help cancer survivors reduce fall risk and improve dynamic balance. The researchers added that patients with post-treatment fatigue may particularly benefit from education about safety, coping and compensatory strategies—different ways of performing the same task.

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