Association between fatigue and sarcopenia in middle-aged Korean cancer survivors: A cross-sectional study

Abstract

Background Fatigue is a common and distressing symptom of cancer survivors, negatively affecting health-related quality of life. We evaluated the relation between fatigue and low relative skeletal muscle mass in middle-aged cancer survivors. Methods Study participants were 693 Korean cancer survivors aged 40-64 years, who was recruited between September 2014-February 2017 from a cancer survivorship clinic of a university-affiliated hospital. We measured appendicular skeletal muscle mass of study participants with bioelectrical impedance analysis and collected selected variables through a self-administered questionnaire and medical record review. Fatigue was evaluated by a 9-item fatigue severity scale (FSS) which was validated in previous studies. Sarcopenia was defined by appendicular skeletal muscle index cut-off values stratified by sex (< 7.0kg/m2 for males, <5.7kg/m2 for females). Severe fatigue was defined as high FSS score (≥36). The association between sarcopenia and fatigue was assessed using multiple logistic regression analysis. Results Overall, 18.6% of study participants were sarcopenic, 15.0% for males and 20.3% for females. Total scores of FSS (29.3 vs, 23.5, P = 0.034) and prevalence of severe fatigue (FSS≥36) (39.4% vs. 19.3%, P = 0.012) were higher in the sarcopenia group compared with the non-sarcopenia group, distinctively in male cancer survivors. Even after adjusting for selected covariates including cancer related factors and lifestyle factors, sarcopenia was significantly associated with severe fatigue in male survivors (Odd ratio [OR]: 5.36, 95% CI: 1.47, 19.54) and pre-menopausal females (OR: 2.33, 95% CI: 1.06, 5.13). However, the significant association was not found for post-menopausal females (OR: 2.28, 95% CI: 0.77, 6.79). resConclusion Sarcopenia was positively associated with severe fatigue of middle-aged cancer survivors, independent of cancer related factors and lifestyle factors.