A longitudinal analysis of fatigue in colorectal cancer patients during chemotherapy

Abstract

Purpose The aim of this longitudinal study was to analyze trends in fatigue among colorectal cancer patients during chemotherapy and examine the predictors of multidimensional fatigue. Methods A mixed sample of colorectal cancer patients who were receiving chemotherapy (N = 200) was recruited in China. The patients completed the Cancer Fatigue Scale (CFS) at baseline (before chemotherapy) and after 3 and 6 months of chemotherapy. Repeated measures ANOVAs were conducted to evaluate the effect of time on the CFS score. The data on violations of the statistical assumptions (independence, normality, and sphericity) from the repeated measures ANOVAs were examined. Stepwise regression analyses were conducted to evaluate the associations of the potential predictor variables at baseline on the total fatigue score and subscale scores at follow-up. Results As chemotherapy progressed, significant increases in the three subscale scores and total scores were observed. Physical fatigue and total fatigue scores increased continuously during chemotherapy (P < 0.001). However, affective fatigue and cognitive fatigue scores increased significantly in the first 3 months (P < 0.001) and basically remained stable thereafter (P > 0.05). Multiple stepwise regression was used to analyze the predictors. The results showed that the baseline fatigue subscale score was the strongest predictor of each dimension of fatigue. In addition, age affected physical fatigue, and monthly income and education affected cognitive fatigue. Conclusion Fatigue increased during chemotherapy. Early assessment and intervention may be better for controlling fatigue, especially in patients with higher baseline fatigue level, older age, and lower economic and educational levels.

Trajectories and risk factors of fatigue following colorectal cancer diagnosis

“…Early implementation of evidence‐based fatigue management strategies and care options will benefit patients during and after cancer therapy [47–50]. Our findings, along with the existing evidence [8, 37, 51], are in accordance with guidelines from the National Comprehensive Cancer Network that call for initiating early screening for fatigue and continual monitoring of fatigue until treatment completion.…”

“…Compared to other cancer-related symptoms such as pain and nausea, fatigue has a greater negative impact on daily activities and QoL [4][5][6]. Fatigue can persist for months or years following cancer diagnosis [7,8]; late-onset fatigue has also been documented among post-treatment cancer survivors [9][10][11].…”

“…A recent meta-analysis of symptomatology among CRC patients reported that fatigue was the most severe symptom following CRC treatment [1]. However, few longitudinal studies have examined changes in fatigue among CRC patients from diagnosis through treatment and survivorship [8,[15][16][17]. Previous studies with limited samples suggested that the prevalence and severity of fatigue increased immediately after treatment until 6 months [2], and then decreased thereafter; at 24 months, fatigue recovered toward the pretreatment levels [15].…”

Determinants of quality of life of cancer patients at a tertiary care medical city in Riyadh, Saudi Arabia

“…In this study, patients with poor QoL suffered from increased fatigue. Fatigue is the most commonly experienced side effect of cancer and cancer treatment ( 13 , 49 , 50 ). In addition, it is more common in older patients and among those with a lower socioeconomic status ( 50 ).…”

“…Fatigue is the most commonly experienced side effect of cancer and cancer treatment ( 13 , 49 , 50 ). In addition, it is more common in older patients and among those with a lower socioeconomic status ( 50 ). It has been demonstrated that increased levels of fatigue are not only associated with ongoing chemotherapy sessions but can also last for several years after the completion of chemotherapy ( 13 , 49 , 51 ).…”