Toward unraveling the correlates of fatigue in glioma

Abstract

Background: Even though fatigue is one of the most prevalent and burdensome symptoms in patients with glioma, its etiology and determinants are still poorly understood. We aimed to identify which demographic, tumor- and treatment-related characteristics and patient-reported outcome measures (PROMs) are associated with fatigue in glioma, and aimed to find predictors of postoperative fatigue. Methods: In this retrospective cohort study, we collected data from patients with diffuse glioma who had performed preoperative and postoperative assessments consisting of PROMs on fatigue, depression, cognitive deficits, and health-related quality of life (HRQoL). Linear mixed models were used to identify which clinical factors and PROMs were associated with fatigue and linear multiple regression was used to find predictors of postoperative fatigue. Results: In this study, 222 glioma patients were included, who had performed 333 assessments (193 preoperative and 116 postoperative). Of all assessments, 39% were indicative of severe fatigue. Several HRQoL domains, depression, and having a right-sided tumor were significantly associated with fatigue (marginal R2 = 0.63). Contrary to common expectations, tumor type, treatment-related factors, the timing of the assessment, and disease status, were not associated with fatigue. In a subgroup of 70 patients with complete follow-up assessments, preoperative fatigue and self-reported physical functioning were predictors of postoperative fatigue (adjusted R2 = 0.31). Conclusion: Fatigue is a complex symptom, which should not solely be attributed to the tumor or its treatment, but is instead related to different aspects of mood and HRQoL. These insights are of importance in understanding fatigue and could guide symptom management.