Fadiga Oncológica no Pós-Operatório de Câncer de Mama: Influência de Variáveis Clínicas e Funcionais

Aline Ferreira Cavalcante Souza; Thaís da Silva Neri; Fernanda da Rocha Medeiros; Luciana de Lima Sousa

doi:10.32635/2176-9745.RBC.2026v72n4.5828

Authors

Aline Ferreira Cavalcante Souza Instituto de Gestão Estratégica de Saúde do Distrito Federal - IGESDF / Programa de Residência Multiprofissional em Oncologia. https://orcid.org/0000-0002-5493-0153
Thaís da Silva Neri Instituto de Gestão Estratégica de Saúde do Distrito Federal (IGES DF), Programa de Residência Multiprofissional em Oncologia. Brasília (DF), Brasil. https://orcid.org/0000-0002-7680-0106
Fernanda da Rocha Medeiros Instituto de Gestão Estratégica de Saúde do Distrito Federal (IGES DF), Programa de Residência Multiprofissional em Oncologia. Brasília (DF), Brasil. https://orcid.org/0000-0003-4298-4733
Luciana de Lima Sousa Instituto de Gestão Estratégica de Saúde do Distrito Federal (IGES DF), Programa de Residência Multiprofissional em Urgência e Emergência. Brasília (DF), Brasil. https://orcid.org/0000-0002-9270-7390

DOI:

https://doi.org/10.32635/2176-9745.RBC.2026v72n4.5828

Keywords:

Muscle Fatigue, Breast Neoplasms, Muscle Strength

Abstract

Introduction: Individuals with breast cancer often experience adverse effects associated with both cancer treatment and disease progression, with cancer-related fatigue being a prominent issue. Objective: To determine the prevalence of fatigue among postoperative breast cancer patients treated at an oncology physical therapy clinic, as well as the influence of clinical and functional factors. Method: An observational, cross-sectional study on cancer-related fatigue and analysis of functional aspects. Fatigue was assessed using the Piper Fatigue Scale – Revised, classified as mild (score <4), moderate (score ≥ 4 and <6), and severe (score ≥ 6). Functional aspects included assessment of Hand Grip Strength (HGS), Calf Circumference (CC), and the Timed Up and Go (TUG) test. All variables, sociodemographic, clinical, and functional, were organized and compared across groups of individuals with mild, moderate, and severe fatigue. Results: The sample consisted of 84 patients, with a predominance of females (98.8%). Cancer-related fatigue was highly prevalent across all dimensions (behavioral, affective, sensory/psychological). Most patients had normal scores on the HGS (85.2%) and CC (95.1%) assessments, and no risk of falling based on TUG scores (85.7%). Conclusion: Fatigue was present in all evaluated patients, with a predominance of severe fatigue. No statistically significant associations were observed between fatigue and the clinical and functional variables analyzed.

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References

Arnold M, Morgan E, Rumgay H, et al. Current and future burden of breast cancer: global statistics for 2020 and 2040. Breast. 2022;66:15-23. doi: https://doi.org/10.1016/j.breast.2022.08.010 DOI: https://doi.org/10.1016/j.breast.2022.08.010

Instituto Nacional de Câncer. Estimativa 2026: incidência de câncer no Brasil [Internet]. Rio de Janeiro: INCA; 2026 [acesso 2026 ago 31]. Disponível em: https://ninho.inca.gov.br/jspui/bitstream/123456789/17914/1/Estima2026_completo%20%281%29.pdf

Martins LFL, Chaves GV, Oliveira JFP, et al. Perfil epidemiológico da incidência de câncer no Brasil e regiões: estimativas para o triênio 2026-2028. Rev Bras Cancerol. 2026;72(2):e-025587. doi: https://doi.org/10.32635/2176-9745.RBC.2026v72n2.5587 DOI: https://doi.org/10.32635/2176-9745.RBC.2026v72n2.5587

Smolarz B, Nowak AZ, Romanowicz H. Breast cancer - epidemiology, classification, pathogenesis and treatment (review of literature). Cancers. 2022;14(10):2569. doi: https://doi.org/10.3390/cancers14102569 DOI: https://doi.org/10.3390/cancers14102569

Menon G, Alkabban FM, Ferguson T. Breast cancer. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [acesso 2025 nov 11]. Disponível em: https://pubmed.ncbi.nlm.nih.gov/29493913/

Tabrizi FM, Alizadeh S. Cancer Related Fatigue in Breast Cancer Survivors: in Correlation to Demographic Factors. Maedica (Bucur). 2017[acesso 2025 out 14];12(2):106-11. Disponível em: https://pmc.ncbi.nlm.nih.gov/articles/PMC5649030/

Lima FD, Bottaro M, Oliveira Valeriano R, et al. Cancer-related fatigue and muscle quality in Hodgkin's lymphoma survivors. Integr Cancer Ther. 2018;17(2):299-305. doi: https://doi.org/10.1177/1534735417712009 DOI: https://doi.org/10.1177/1534735417712009

Fabi A, Bhargava R, Fatigoni S, et al. Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Ann Oncol. 2020;31(6):713-23. doi: https://doi.org/10.1016/j.annonc.2020.02.016 DOI: https://doi.org/10.1016/j.annonc.2020.02.016

Neefjes ECW, van den Hurk RM, Blauwhoff-Buskermolen S, et al. Muscle mass as a target to reduce fatigue in patients with advanced cancer. J Cachexia Sarcopenia Muscle. 2017;8:623-32. Disponível em: https://doi.org/10.1002/jcsm.12199 DOI: https://doi.org/10.1002/jcsm.12199

Wang R, Nakshatri H. Systemic Actions of Breast Cancer Facilitate Functional Limitations. Cancers. 2020; 12(1):194. doi: https://doi.org/10.3390/cancers12010194 DOI: https://doi.org/10.3390/cancers12010194

Campos MDSB, Feitosa RHF, Mizzaci CC, et al. The Benefits of Exercise in Breast Cancer. Arq Bras Cardiol. 2022;119(6):981-90. doi: https://doi.org/10.36660/abc.20220086 DOI: https://doi.org/10.36660/abc.20220086

Li CC, Chou YJ, Shun SC. The relationship between muscle strength and body composition measures and cancer-related fatigue: a systematic review and meta-analysis. Oncol Nurs Forum. 2021;48(5):558-76. doi: https://doi.org/10.1188/21.ONF.558-576 DOI: https://doi.org/10.1188/21.ONF.558-576

World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO; 2000.

Mota DDCF, Pimenta CAM, Piper BF. Fatigue in Brazilian cancer patients, caregivers and nursing students: a psychometric validation study of the Piper Fatigue Scale-Revised. Support Care Cancer. 2009;17(6):645-52. doi: https://doi.org/10.1007/s00520-008-0518-x DOI: https://doi.org/10.1007/s00520-008-0518-x

Isaac AFB, Miranda LF, Gonçalves MCG, et al. Assessment of fatigue, anxiety, depression and quality of life of women during radiotherapy. Res Soc Dev. 2022;11(8):e18611830606. doi: https://doi.org/10.33448/rsd-v11i8.30606 DOI: https://doi.org/10.33448/rsd-v11i8.30606

Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011;40(4):423-9. doi: https://doi.org/10.1093/ageing/afr051 DOI: https://doi.org/10.1093/ageing/afr051

Duarte ACF, Silva BA, Avelino PR, et al. Força de preensão, capacidade funcional e qualidade de vida de indivíduos com câncer. Fisioter Pesqui. 2020;27(4):e19039127042020. doi: https://doi.org/10.1590/1809-2950/19039127042020 DOI: https://doi.org/10.1590/1809-2950/19039127042020

Lupton-Smith A, Fourie K, Mazinyo A, et al. Measurement of hand grip strength: a cross-sectional study of two dynamometry devices. S Afr J Physiother. 2022;78(1):a1768. doi: https://doi.org/10.4102/sajp.v78i1.1768 DOI: https://doi.org/10.4102/sajp.v78i1.1768

Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Writing Group for the European Working Group on Sarcopenia in Older People 2 (EWGSOP2); Extended Group for EWGSOP2. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. doi: https://doi.org/10.1093/ageing/afy169 DOI: https://doi.org/10.1093/ageing/afy169

Jeong E, Kim M, Won CW. Effects of posture, side and dominant hand on calf circumference measurement in community-dwelling older adults. Geriatr Gerontol Int. 2020;20(9):822-7. doi: https://doi.org/10.1111/ggi.13983 DOI: https://doi.org/10.1111/ggi.13983

Pagotto V, Santos KF, Malaquias SG, et al. Calf circumference: clinical validation for evaluation of muscle mass in the elderly. Rev Bras Enferm. 2018;71(2):322-8. doi: https://doi.org/10.1590/0034-7167-2017-0121 DOI: https://doi.org/10.1590/0034-7167-2017-0121

Pérez-Santiago L, Garzón-Hernández LP, Martín-Arévalo J, et al. Accuracy of the Timed Up and Go test for predicting low muscle mass in a preoperative prehabilitation program for colorectal cancer. J Clin Med. 2025;14(6):2088. doi: https://doi.org/10.3390/jcm14062088 DOI: https://doi.org/10.3390/jcm14062088

Alexandre TS, Meira DM, Rico NC, et al. Accuracy of Timed Up and Go test for screening risk of falls among community-dwelling elderly. Rev Bras Fisioter. 2012;16(5):381-8. doi: https://doi.org/10.1590/S1413-35552012005000041 DOI: https://doi.org/10.1590/S1413-35552012005000041

Sullivan KM, Dean A, Soe MM. OpenEpi: a web-based epidemiologic and statistical calculator for public health. Public Health Rep. 2009;124(3):471-4. DOI: https://doi.org/10.1177/003335490912400320

Bahia JC, Lima CM, Oliveira MM, et al. Fadiga em mulheres com câncer de mama submetidas à radioterapia. Rev Bras Cancerol. 2019;65(2):e-09089. doi: https://doi.org/10.32635/2176-9745.RBC.2019v65n2.89 DOI: https://doi.org/10.32635/2176-9745.RBC.2019v65n2.89

SPSS®: Statistical Package for Social Science (SPSS) [Internet]. Versão 29.0. [Nova York]. International Business Machines Corporation. [acesso 2024 mar 9]. Disponível em: https://www.ibm.com/br-pt/spss?utm_content=SRCWW&p1=Search&p4=43700077515785492&p5=p&gclid=CjwKCAjwgZCoBhBnEiwAz35Rwiltb7s14pOSLocnooMOQh9qAL59IHVc9WP4ixhNTVMjenRp3-aEgxoCubsQAvD_BwE&gclsrc=aw.ds

Conselho Nacional de Saúde (BR). Resolução no 466, de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos [Internet]. 2013 jun 13 [acesso 2025 jun 25]; Edição 112; Seção I:59-62. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/cns/2013/res0466_12_12_2012.html

Antonini M, Mattar A, Pannain G, et al. Male and female disparities in breast cancer epidemiology: a comparative cross-sectional analysis of a Brazilian cohort (2017-2021). Heliyon. 2024;10(19):e38183. doi: https://doi.org/10.1016/j.heliyon.2024.e38183 DOI: https://doi.org/10.1016/j.heliyon.2024.e38183

Thong MS, van Noorden CJF, Steindorf K, et al. Cancer-related fatigue: causes and current treatment options. Curr Treat Options Oncol. 2020;21(2):17. doi: https://doi.org/10.1007/s11864-020-0707-5 DOI: https://doi.org/10.1007/s11864-020-0707-5

Bower JE. The role of neuro-immune interactions in cancer-related fatigue: Biobehavioral risk factors and mechanisms. Cancer, 2019;125(3):353-64. doi: https://doi.org/10.1002/cncr.31790 DOI: https://doi.org/10.1002/cncr.31790

Iyizoba-Ebozue Z, Nicklin E, Currie S, et al. Multidimensional fatigue and its impact on work productivity, mood and quality of life in long-term survivors following definitive intensity-modulated radiotherapy for oropharyngeal cancer: a cross-sectional study. J Cancer Surviv. 2025;19(6):2718-31. doi: https://doi.org/10.1007/s11764-024-01735-8 DOI: https://doi.org/10.1007/s11764-024-01735-8

Fisher MI, Cohn JC, Harrington SE, et al. Screening and assessment of cancer-related fatigue: a clinical practice guideline for health care providers. Phys Ther. 2022;102(9):pzac120. doi: https://doi.org/10.1093/ptj/pzac120 DOI: https://doi.org/10.1093/ptj/pzac120

Matoso LBBM, Boing L, Korpalski T, et al. Relationship of fatigue with depressive symptoms and level of physical activity in women with breast cancer diagnosis. Rev Bras Cineantropom Desempenho Hum. 2020;22:e59189. doi: https://doi.org/10.1590/1980-0037.2020v22e59189 DOI: https://doi.org/10.1590/1980-0037.2020v22e59189

Bower JE, Asher A, Garet D, et al. Testing a biobehavioral model of fatigue before adjuvant therapy in women with breast cancer. Cancer. 2019;125(4):633-41. doi: https://doi.org/10.1002/cncr.31827 DOI: https://doi.org/10.1002/cncr.31827

Parveen, Kumar N, Sinha AP, et al. Fatigue and functional ability in patients undergoing upfront surgical treatment for solid malignancies. Indian J Surg Oncol. 2019;10(3):441-5. doi: https://doi.org/10.1007/s13193-019-00918-5 DOI: https://doi.org/10.1007/s13193-019-00918-5

Vaz-Luis I, Di Meglio A, Havas J, et al. Long-term longitudinal patterns of patient-reported fatigue after breast cancer: a group-based trajectory analysis. J Clin Oncol. 2022;40(19):2148-62. doi: https://doi.org/10.1200/JCO.21.01958 DOI: https://doi.org/10.1200/JCO.21.01958

Thong MSY, Doege D, Koch-Gallenkamp L, et al. Fatigue in long-term cancer survivors: prevalence, associated factors, and mortality: a prospective population-based study. Br J Cancer. 2025;133(7):831-43. doi: https://doi.org/10.1038/s41416-025-03116-z DOI: https://doi.org/10.1038/s41416-025-03116-z

Bøhn SH, Thorsen L, Kiserud CE, et al. Chronic fatigue and associated factors among long-term survivors of cancers in young adulthood. Acta Oncol. 2019;58(5):753-62. doi: https://doi.org/10.1080/0284186X.2018.1557344 DOI: https://doi.org/10.1080/0284186X.2018.1557344

Bower JE, Ganz PA, Irwin MR, et al. Do all patients with cancer experience fatigue? A longitudinal study of fatigue trajectories in women with breast cancer. Cancer. 2021;127(8):1334-44. doi: https://doi.org/10.1002/cncr.33327 DOI: https://doi.org/10.1002/cncr.33327

Pepe I, Petrelli A, Fischetti F, et al. Nonregular physical activity and handgrip strength as indicators of fatigue and psychological distress in cancer survivors. Curr Oncol. 2025;32(5):289. doi: https://doi.org/10.3390/curroncol32050289 DOI: https://doi.org/10.3390/curroncol32050289

Tanigaiselvane DJ, Ravi RS, Singh AK. Cancer-related fatigue across sensory, behavioral, cognitive, affective domains and HRV metrics: a prevalence study. J Adv Sci Technol. 2024;21(1):473-84. doi: https://doi.org/10.29070/sd9zwm05 DOI: https://doi.org/10.29070/sd9zwm05

Kim H, Yoo S, Kim H, et al. Cancer survivors with low hand grip strength have decreased quality of life compared with healthy controls: the Korea National Health and Nutrition Examination Survey 2014-2017. Korean J Fam Med. 2021;42(3):204-11. doi: https://doi.org/10.4082/kjfm.20.0060 DOI: https://doi.org/10.4082/kjfm.20.0060

Inglis JE, Janelsins MC, Culakova E, et al. Longitudinal assessment of the impact of higher body mass index on cancer-related fatigue in patients with breast cancer receiving chemotherapy. Support Care Cancer. 2020;28(3):1411-8. doi: https://doi.org/10.1007/s00520-019-04953-4 DOI: https://doi.org/10.1007/s00520-019-04953-4

Wu T, Yan F, Wei Y, et al. Effect of exercise therapy on cancer-related fatigue in patients with breast cancer: a systematic review and network meta-analysis. Am J Phys Med Rehabil. 2023;102(12):1055-62. doi: https://doi.org/10.1097/PHM.0000000000002277 DOI: https://doi.org/10.1097/PHM.0000000000002277