Factors associated with cancer-related fatigue in breast cancer patients: a systematic review and meta-analysis

Background Cancer-related fatigue (CRF) remains one of the most common and persistent complications among breast cancer survivors, profoundly impairing their psychosocial well-being. Although various predictors have been proposed, existing evidence yields inconsistent findings. This study aimed to systematically synthesize multidimensional factors associated with CRF in this population, providing an evidence-based framework for identifying the individuals and tailoring early interventions. Methods A systematic search was conducted in PubMed, Embase, Cochrane Library and Web of Science databases for studies investigating factors associated with fatigue in breast cancer patients, The search covered the period from database inception to May 3, 2026. Two researchers independently performed study screening, quality assessment, and data extraction, and statistical analyses were performed using Stata 19.0. Results 16 studies involving a total of 11,984 patients were included. Some potentially relevant factors were identified: pain (OR 1.78, 95% CI 1.29–2.45), dyspnea (OR 2.01, 95% CI 1.10–3.66), anxiety (OR 1.44, 95% CI 1.12–1.86), depression (OR 1.97, 95% CI 1.49–2.60), sleep disturbances (OR 2.02, 95% CI 1.05–3.87) and BMI ≥ 30 kg/m 2 (OR 1.36, 95% CI 1.05–1.75). Conclusion The patients with cancer- related fatigue in breast cancer, pain, dyspnea, anxiety, depression, sleep disturbances (OR 2.02, 95% CI 1.05–3.87) and BMI ≥ 30 kg/m 2 may be associated with fatigue and should be considered as potential related factors. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261432176.