Brain Changes Linked to Fatigue Emerge Early During Chemotherapy

A research team led by Professor LI Hai from the Hefei Institutes of Physical Science of the Chinese Academy of Sciences has identified early brain changes associated with cancer-related fatigue (CRF) in breast cancer patients undergoing chemotherapy.

The findings were recently published in Cancer.

CRF is one of the most common and debilitating symptoms experienced by breast cancer patients during chemotherapy. It can interfere with daily activities and significantly affect quality of life. However, how the brain changes as fatigue develops during treatment remains unclear.

In this study, the team followed 61 women with breast cancer and 41 healthy women. The participants underwent 3T brain magnetic resonance imaging and clinical assessments before chemotherapy and after two treatment cycles. The researchers examined both cortical microstructure and cortical structure, using cortical mean diffusivity (cMD), and conventional measures such as cortical thickness.

After two cycles of chemotherapy, the proportion of patients with clinically significant fatigue rose from 29.5% to 70.5%. At the same time, changes were observed in the microstructure and thickness of several cortical regions.

One of the most notable changes occurred in the left isthmus cingulate cortex, where cMD decreased more markedly in breast cancer patients than in healthy controls. Patients with greater decreases in this region also tended to experience greater worsening of fatigue and emotional well-being. The analysis further indicated that changes in emotional well-being may partly connect the brain changes with the development of fatigue.

The findings show that brain changes linked to cancer-related fatigue can emerge early in chemotherapy, with the left isthmus cingulate cortex potentially involved in fatigue and emotional well-being.

Study design, imaging processing, and statistical workflow. (Image by ZHOU Yanfei)