A prospective study was conducted to determine whether any relationship exists between skin erythema, fatigue and biological factors during and after adjuvant radiotherapy for early breast cancer. Breast erythema was assessed objectively using reflectance spectrophotometry. Fatigue was recorded utilising the functional assessment of cancer therapy fatigue subscale. A number of potential systemic indicators (biological factors) of the effects of radiotherapy was measured, including circulating cytokines, coagulation factors, peripheral blood indices and biochemistry. Measurements for erythema, fatigue and biological factors were taken at baseline and intervals during and following completion of radiotherapy. A total of 52 eligible patients was included in the analysis. Breast erythema was shown to progressively increase during treatment, peaking on day 36 and returning to baseline by 4 months postirradiation. Fatigue also progressively increased during treatment, reaching a plateau between day 22 and 2 weeks post-radiotherapy. A statistically significant association was demonstrated between total breast erythema and fatigue at days 4, 8, 22 and 29 of irradiation and 2 and 6 weeks post-radiotherapy. When only the increase in erythema attributable to radiotherapy was considered, statistically significant associations remained for day 4 of irradiation and 2 and 6 weeks post-radiotherapy. When multiple time points were considered together, an association between increased erythema and fatigue was present only postradiotherapy. No relationship was demonstrated between the biological factors and erythema or fatigue during radiotherapy. This study demonstrates a significant and consistent relationship between radiotherapy-induced breast erythema and fatigue, particularly in the period immediately following breast irradiation.
Asia-Pacific Journal of Clinical Oncology Vol. 5, Issue 4, p. 257-263