Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Melinda L. Irwin


Purpose: Cancer-related fatigue negatively impacts quality of life and possible recurrence and overall mortality in breast cancer survivors. This study aimed to investigate the associations between inflammation and cancer-related fatigue in breast cancer survivors using methods of systematic review and quantitative assessment of the Hormones and Physical Exercise (HOPE) Study in a high-risk population.

Methods: A PubMed search was conducted to identify peer-reviewed studies that assessed the associations among inflammatory markers, CRP, IL-6, and TNF-α, and cancer-related fatigue in breast cancer survivors. The HOPE Study was a randomized control trial in 121 postmenopausal Stage I-IIIC breast cancer survivors, who were taking Aromatase Inhibitors (AIs) and experiencing arthralgia. This study investigated the associations of baseline (N = 69) pro-inflammatory markers CRP, IL-6, and TNF-α and self-reported fatigue.

Results: Fifteen studies with more than 1,900 participants were included in the systematic review. The literature inconclusively supports a positive association between CRP and cancer-related fatigue. TNF-α and IL-6 were not associated with cancer-related fatigue. In the HOPE Study, CRP, IL-6, and TNF-α, fatigue, and sleep duration were not significantly associated. There was the suggestion of a positive trending association between CRP and cancer-related fatigue among women with higher stage of disease. BMI status and joint pain intensity were significant risk factors of cancer-related fatigue.

Conclusion: A growing body of literature inconclusively supports the link between downstream inflammatory activity and cancer-related fatigue. There may be subgroups of women, e.g. those with higher stage of disease, for whom this may be particularly important. A further understanding of cancer-related fatigue mechanisms and the development of effective interventions are necessary to improve the quality and duration of life in the increasing population of cancer survivors.


This is an Open Access Thesis.

Open Access

This Article is Open Access