Cancer-related fatigue (CRF) is one of the most common and debilitating symptoms experienced by breast cancer patients during chemotherapy. It interferes with daily activities and significantly affects the quality of life. During the treatment, how the brain changes as fatigue develops remains unclear.

In a study published in Cancer, a research team led by Prof. LI Hai from the Hefei Institutes of Physical Science of the Chinese Academy of Sciences identified early brain changes associated with CRF in breast cancer patients undergoing chemotherapy.

Researchers followed 61 women with breast cancer and 41 healthy women, who underwent 3T brain magnetic resonance imaging and clinical assessments before chemotherapy and after two treatment cycles. By using cortical mean diffusivity (cMD) and conventional measures such as cortical thickness, they examined both cortical microstructure and cortical structure

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

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

This study shows 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.