Associations of Molecular-Genetic Bioenergetics and Chemotherapy-Induced Fatigue Symptoms in Patients with Breast Cancer: A proposal development

Introduction: Cancer-related fatigue (CRF) occurs in 82%-96% of cancer patients receiving chemotherapy (CT). CT-induced CRF is a distressing, persistent sense of exhaustion related to the disease or its treatment, and negatively impacts health outcomes. CRF is one of the most prevalent side effects of CT in patients with breast cancer. Despite various attempts to investigate the etiology of CRF, the biochemical mechanisms remain elusive. Objectives: The study aims to explore the molecular-genetic pathway of mitochondrial bioenergetics and its association with CT-induced CRF. We hypothesized that the chemotherapeutic agent containing anthracycline targets cell cycle progression, which triggers genetic and cellular instability, altering expression of mitochondrial genes and proteins, inducing reduced electron transport chain enzymatic activity and impaired oxidative phosphorylation, resulting in adenosine triphosphate (ATP) depletion and excessive reactive oxygen species (ROS) generation, leading to the development and intensification of CRF. Methods: This is a prospective, hypothesis-testing, and longitudinal study design. A total of 60 patients with breast cancer undergoing CT will be enrolled. Validated instruments will be used to measure CRF, depression, sleep disturbance, and physical activity. Whole blood sample will be collected before, during, and at the completion of CT to determine profiles of mitochondrial bioenergetics. A linear mixed model repeated measures analysis will be used to examine associations between changes in study variables. Anticipated Results: Increased scores of CRF will be associated with altered mitochondria-related genes and mitochondrial bioenergetics (e.g., ↓oxidative phosphorylation, ↓electron transport chain complexes activity, ↓ATP content, and ↑ROS production) in patients receiving CT-containing anthracyclines. Conclusion: The results will enable us to discover biomarkers, support the design of nonpharmacological interventions, and initiate precision symptom management to improve CRF.