Body composition and its association with fatigue in the first 2 years after colorectal cancer diagnosis

Abstract

Purpose Persistent fatigue among colorectal cancer (CRC) patients might be associated with unfavorable body composition, but data are sparse and inconsistent. We studied how skeletal muscle index (SMI), skeletal muscle radiodensity (SMR), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) at diagnosis are associated with fatigue up to 24 months post-diagnosis in stage I–III CRC patients. Methods SMI, SMR, VAT, and SAT were assessed among 646 CRC patients using pre-treatment computed tomography images. Fatigue at diagnosis, at 6, and 24 months post-diagnosis was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. The association of SMI, SMR, VAT, and SAT with fatigue (yes/no) was assessed using confounder-adjusted restricted cubic spline analyses. Results Prevalence of fatigue at diagnosis was 18%, at 6 months 25%, and at 24 months 12%. At diagnosis, a significant (p = 0.01) non-linear association of higher levels of SAT with higher prevalence of fatigue was observed. Lower levels of SMR were linearly associated with higher prevalence of fatigue at 6 months post-diagnosis (overall association p = 0.02). None of the body composition parameters were significantly associated with fatigue at 24 months. Conclusion Having more SAT was associated with more fatigue at diagnosis, while low levels of SMR were associated with more fatigue at 6 months post-diagnosis. Implications for Cancer Survivors Our results suggest that it may be interesting to investigate whether interventions that aim to increase SMR around the time of diagnosis may help to lower fatigue. However, more knowledge is needed to understand the mechanisms behind the association of SMR with fatigue.

Multidimensional Predictors of Cancer-Related Fatigue Based on the Predisposing, Precipitating, and Perpetuating (3P) Model: A Systematic Review

“…We found that predisposing factors (baseline fatigue, demographic characteristics, clinical characteristics, psychosocial traits, physical symptoms), precipitating factors (radiotherapy and chemotherapy, inflammatory factors, laboratory indicators, and metabolites), and perpetuating factors (physical activity levels, nutritional status) predicted the development of CRF to varying degrees. We found that the demographic characteristics of high age, BMI ≥25, and female are predictors of CRF in patients, consistent with previous findings [50,54,60,61]. However, one study found lower BMI to be a predictor of general fatigue [44], implying that low BMI represents the poorer nutritional status of the patient.…”

Longitudinal Associations between Inflammatory Markers and Fatigue up to Two Years after Colorectal Cancer Treatment

“…Fatigue is a common and debilitating symptom experienced by colorectal cancer survivors during and posttreatment (5,6). Reported rates of fatigue among colorectal cancer survivors range from 12% to 69.7% depending on the measurement instrument used and time elapsed since treatment (6)(7)(8)(9)(10). Results from prospective studies, including ours, and a systematic review showed that fatigue peaked between 6 weeks and 6 months posttreatment but persisted up to 2 years posttreatment (9,11,12).…”

“…The validated Checklist Individual Strength (CIS) and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) fatigue subscale were used to measure fatigue at 6 weeks, 6, 12, and 24 months posttreatment. The CIS is a 20-item questionnaire composed of 4 subscalessubjective fatigue , motivation (4-28), physical activity (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), and concentration (5-35; ref. 37).…”

Could nutrition status predict fatigue one week before in patients with nasopharynx cancer undergoing radiotherapy?

“…Van Baar investigated the relationship between baseline skeletal muscle/fat‐related indices and fatigue in 646 patients with colon cancer during the first 2 years after diagnosis. The results showed that patients with high subcutaneous fat had stronger fatigue at diagnosis, while those with low skeletal muscle radiation density had stronger fatigue 6 months after diagnosis 15 . Another secondary analysis of a longitudinal, nationwide study of 565 breast cancer patients revealed that post‐chemotherapy fatigue scores remained substantially higher for obese patients than normal‐weight patients 16 .…”