Associations among musculoskeletal impairments, depression, body image and fatigue in breast cancer survivors within the first year after treatment

The aim of the current study was to investigate the relationship between pressure pain thresholds, shoulder movement, mood state, pain perception, muscle endurance, quality of life and fatigue in breast cancer survivors (BCS). Fifty-nine BCS reporting fatigue were examined at 6 months post-treatment. Women completed the Piper Fatigue Scale, the Breast Cancer-Specific Quality of Life Questionnaire, the Profile of Mood State, and neck-shoulder visual analogue scale. Additionally, shoulder flexion range of motion, the McQuade test (trunk flexor endurance) and pressure pain thresholds over the C5-C6 joint, the deltoid muscle, the second metacarpal and tibialis anterior muscle were assessed. Fatigue was greater in those patients with higher depression (r = 0.45, P < 0.05), higher shoulder pain (r = 0.39, P < 0.05), higher neck pain (r = 0.46, P < 0.01), lower body image (r = -0.34, P < 0.05) and reduced shoulder movement (r = -0.32, P < 0.05). Regression analyses demonstrated that depression, cervical pain intensity, body image and shoulder mobility were associated with fatigue (r = 0.55, P < 0.001). A psychological state characterised with higher depression and reduced body image and a physical impairment with higher cervical pain intensity and reduced shoulder mobility confirm multidimensional character of fatigue in BCS.