Advertisement

Predictors of fatigue in cancer patients: a longitudinal study

  • Kuhnt SusanneEmail author
  • Friedrich Michael
  • Schulte Thomas
  • Esser Peter
  • Hinz Andreas
Original Article
  • 66 Downloads

Abstract

Introduction

Having a better understanding of predictors of cancer-related fatigue makes it easier to early identify patients at risk of suffering from long-term fatigue. The aim of this longitudinal study was to identify factors that predict long-term fatigue 6 months after discharge from a rehabilitation clinic using a multidimensional conceptualization.

Method

A mixed sample of cancer survivors (N = 948) were recruited while in-patient at a rehabilitation clinic. The follow-up survey was administered 6 months after they were discharged from the clinic. Fatigue was assessed with the EORTC QLQ-FA12. Predictive values were estimated using hierarchical multiple linear regression analyses.

Results

Mean fatigue scores were 20.7 (cognitive fatigue), 30.9 (emotional fatigue), and 53.2 (physical fatigue) at baseline and significantly lower at follow-up (Cohen’s d 0.12–0.31). Baseline levels of fatigue and depression were identified as important predictors of all dimensions of fatigue. Partnership and time since diagnosis predicted only the levels of physical fatigue. The regression models explained between 36% and 45% of variance in fatigue.

Conclusion

Levels of fatigue in early stages as well as psychosocial issues could enable clinicians to identify patients with elevated long-term fatigue and thus to provide optimal care for improving patients’ quality of life. Findings of different associates of individual dimensions of fatigue support the multidimensional concept of fatigue.

Keywords

Cancer Oncology Fatigue Predictors Depression Longitudinal design 

Notes

Funding

This study was supported by the German Cancer Aid under Grant (No: 7011 2267).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Berger AM, Mooney K, Alvarez-Perez A, Breitbart WS, Carpenter KM, Cella D, Cleeland C, Dotan E, Eisenberger MA, Escalante CP, Jacobsen PB, Jankowski C, LeBlanc T, Ligibel JA, Loggers ET, Mandrell B, Murphy BA, Palesh O, Pirl WF, Plaxe SC, Riba MB, Rugo HS, Salvador C, Wagner LI, Wagner-Johnston ND, Zachariah FJ, Bergman MA, Smith C, National comprehensive cancer network (2015) Cancer-related fatigue, version 2.2015. J Natl Compr Cancer Netw 13:1012–1039CrossRefGoogle Scholar
  2. 2.
    Wang XS, Zhao F, Fisch MJ, O’Mara AM, Cella D, Mendoza TR, Cleeland CS (2014) Prevalence and characteristics of moderate to severe fatigue: a multicenter study in cancer patients and survivors. Cancer 120:425–432.  https://doi.org/10.1002/cncr.28434 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Shi Q, Smith TG, Michonski JD, Stein KD, Kaw C, Cleeland CS (2011) Symptom burden in cancer survivors 1 year after diagnosis: a report from the American Cancer Society’s studies of cancer survivors. Cancer 117:2779–2790.  https://doi.org/10.1002/cncr.26146. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Abrahams HJG, Gielissen MFM, Schmits IC, Verhagen CAH, Rovers MM, Knoop H (2016) Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12 327 breast cancer survivors. Ann Oncol 27:965–974.  https://doi.org/10.1093/annonc/mdw099 CrossRefPubMedGoogle Scholar
  5. 5.
    Jones JM, Olson K, Catton P, Catton CN, Fleshner NE, Krzyzanowska MK, McCready DR, Wong RKS, Jiang H, Howell D (2016) Cancer-related fatigue and associated disability in post-treatment cancer survivors. J Cancer Surviv 10:51–61.  https://doi.org/10.1007/s11764-015-0450-2 CrossRefPubMedGoogle Scholar
  6. 6.
    Kim YA, Yun YH, Chang YJ, Lee J, Kim MS, Lee H-S, Zo JI, Kim J, Choi YS, Shim YM, Yoon SJ (2014) Employment status and work-related difficulties in lung cancer survivors compared with the general population. Ann Surg 259:569–575.  https://doi.org/10.1097/SLA.0b013e318291db9d CrossRefPubMedGoogle Scholar
  7. 7.
    Islam T, Dahlui M, Majid HA, Nahar AM, Mohd Taib NA, Su TT (2014) Factors associated with return to work of breast cancer survivors: a systematic review. BMC Public Health 14(Suppl 3):S8.  https://doi.org/10.1186/1471-2458-14-S3-S8 CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Morrow GR, Andrews PLR, Hickok JT, Roscoe JA, Matteson S (2002) Fatigue associated with cancer and its treatment. Support Care Cancer 10:389–398.  https://doi.org/10.1007/s005200100293 CrossRefPubMedGoogle Scholar
  9. 9.
    Berger AM, Gerber LH, Mayer DK (2012) Cancer-related fatigue: implications for breast cancer survivors. Cancer 118:2261–2269.  https://doi.org/10.1002/cncr.27475 CrossRefPubMedGoogle Scholar
  10. 10.
    Piper BF, Lindsey AM, Dodd MJ (1987) Fatigue mechanisms in cancer patients: developing nursing theory. Oncol Nurs Forum 14:17–23PubMedGoogle Scholar
  11. 11.
    Glaus A, Crow R, Hammond S (1996) A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals. Support Care Cancer 4:82–96CrossRefGoogle Scholar
  12. 12.
    Purcell A, Fleming J, Haines T, Bennett S (2009) Cancer-related fatigue: a review and a conceptual framework to guide therapists’ understanding. Br J Occup Ther 72:79–86.  https://doi.org/10.1177/030802260907200205 CrossRefGoogle Scholar
  13. 13.
    van Muijen P, Duijts SFA, Bonefaas-Groenewoud K, van der Beek AJ, Anema JR (2017) Predictors of fatigue and work ability in cancer survivors. Occup Med (Lond) 67:703–711.  https://doi.org/10.1093/occmed/kqx165 CrossRefGoogle Scholar
  14. 14.
    Kreissl S, Mueller H, Goergen H, Mayer A, Brillant C, Behringer K, Halbsguth TV, Hitz F, Soekler M, Shonukan O, Rueffer JU, Flechtner HH, Fuchs M, Diehl V, Engert A, Borchmann P (2016) Cancer-related fatigue in patients with and survivors of Hodgkin’s lymphoma: a longitudinal study of the German Hodgkin study group. Lancet Oncol 17:1453–1462.  https://doi.org/10.1016/S1470-2045(16)30093-6 CrossRefPubMedGoogle Scholar
  15. 15.
    Fisch MJ, Zhao F, O’Mara AM, Wang XS, Cella D, Cleeland CS (2014) Predictors of significant worsening of patient-reported fatigue over a 1-month timeframe in ambulatory patients with common solid tumors. Cancer 120:442–450.  https://doi.org/10.1002/cncr.28437 CrossRefPubMedGoogle Scholar
  16. 16.
    Vardy JL, Dhillon HM, Pond GR, Renton C, Dodd A, Zhang H, Clarke SJ, Tannock IF (2016) Fatigue in people with localized colorectal cancer who do and do not receive chemotherapy: a longitudinal prospective study. Ann Oncol 27:1761–1767.  https://doi.org/10.1093/annonc/mdw252 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Servaes P, Gielissen MFM, Verhagen S, Bleijenberg G (2007) The course of severe fatigue in disease-free breast cancer patients: a longitudinal study. Psychooncology 16:787–795.  https://doi.org/10.1002/pon.1120 CrossRefPubMedGoogle Scholar
  18. 18.
    Husson O, Mols F, van de Poll-Franse, de Lonneke VJ, Schep G, Thong MSY (2015) Variation in fatigue among 6011 (long-term) cancer survivors and a normative population: a study from the population-based PROFILES registry. Support Care Cancer 23:2165–2174.  https://doi.org/10.1007/s00520-014-2577-5 CrossRefPubMedGoogle Scholar
  19. 19.
    Goldstein D, Bennett BK, Webber K, Boyle F, Souza d, Paul L, Wilcken NRC et al (2012) Cancer-related fatigue in women with breast cancer: outcomes of a 5-year prospective cohort study. J Clin Oncol 30:1805–1812.  https://doi.org/10.1200/JCO.2011.34.6148 CrossRefPubMedGoogle Scholar
  20. 20.
    Goedendorp MM, Gielissen MFM, Bleijenberg G, Verhagen, Constans A H H V M (2013) Development of fatigue in cancer survivors: a prospective follow-up study from diagnosis into the year after treatment. J Pain Symptom Manag 45:213–222.  https://doi.org/10.1016/j.jpainsymman.2012.02.009 CrossRefGoogle Scholar
  21. 21.
    Pertl MM, Hevey D, Collier S, Lambe K, O’Dwyer A-M (2014) Predictors of fatigue in cancer patients before and after chemotherapy. J Health Psychol 19:699–710.  https://doi.org/10.1177/1359105313477675 CrossRefPubMedGoogle Scholar
  22. 22.
    Goedendorp MM, Gielissen, Marieke F M, Bleijenberg G, Verhagen, Constantijn A H H V M. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev 2009:CD006953. doi: https://doi.org/10.1002/14651858.CD006953.pub2.
  23. 23.
    Weis J, Tomaszewski KA, Hammerlid E, Ignacio Arraras J, Conroy T, Lanceley A, Schmidt H, Wirtz M, Singer S, Pinto M, Alm el-Din M, Compter I, Holzner B, Hofmeister D, Chie WC, Czeladzki M, Harle A, Jones L, Ritter S, Flechtner HH, Bottomley A, on Behalf of the EORTC Quality of Life Group (2017) International psychometric validation of an EORTC quality of life module measuring cancer related fatigue (EORTC QLQ-FA12). J Natl Cancer Inst 109 (5).  https://doi.org/10.1093/jnci/djw273
  24. 24.
    Kecke S, Ernst J, Einenkel J, Singer S, Hinz A (2017) Psychometric properties of the fatigue questionnaire EORTC QLQ-FA12 in a sample of female cancer patients. J Pain Symptom Manag 54:922–928.  https://doi.org/10.1016/j.jpainsymman.2017.08.007 CrossRefGoogle Scholar
  25. 25.
    Löwe B, Gräfe K, Zipfel S, Witte S, Loerch B, Herzog W (2004) Diagnosing ICD-10 depressive episodes: superior criterion validity of the patient health questionnaire. Psychother Psychosom 73:386–390.  https://doi.org/10.1159/000080393 CrossRefPubMedGoogle Scholar
  26. 26.
    Hinz A, Mehnert A, Kocalevent R-D, Brähler E, Forkmann T, Singer S, Schulte T (2016) Assessment of depression severity with the PHQ-9 in cancer patients and in the general population. BMC Psychiatry 16:22.  https://doi.org/10.1186/s12888-016-0728-6 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Löwe B, Wahl I, Rose M, Spitzer C, Glaesmer H, Wingenfeld K, Schneider A, Brähler E (2010) A 4-item measure of depression and anxiety: validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord 122:86–95.  https://doi.org/10.1016/j.jad.2009.06.019 CrossRefPubMedGoogle Scholar
  28. 28.
    Plummer F, Manea L, Trepel D, McMillan D (2016) Screening for anxiety disorders with the GAD-7 and GAD-2: a systematic review and diagnostic metaanalysis. Gen Hosp Psychiatry 39:24–31.  https://doi.org/10.1016/j.genhosppsych.2015.11.005 CrossRefPubMedGoogle Scholar
  29. 29.
    Jenkins CD, Stanton BA, Niemcryk SJ, Rose RM (1988) A scale for the estimation of sleep problems in clinical research. J Clin Epidemiol 41:313–321CrossRefGoogle Scholar
  30. 30.
    Kudielka BM, von Känel R, Gander M-L, Fischer JE (2004) Effort-reward imbalance, overcommitment and sleep in a working population. Work Stress 18:167–178.  https://doi.org/10.1080/02678370410001731785 CrossRefGoogle Scholar
  31. 31.
    Schwarzer RJM (1995) Generalized self-efficacy scale. In: Weinman J, Wright S, Johnston M (eds) Measures in health psychology: a user’s portfolio. NFER-Nelson, Windsor, pp 35–37Google Scholar
  32. 32.
    Thieme M, Einenkel J, Zenger M, Hinz A (2017) Optimism, pessimism and self-efficacy in female cancer patients. Jpn J Clin Oncol 47:849–855.  https://doi.org/10.1093/jjco/hyx079 CrossRefPubMedGoogle Scholar
  33. 33.
    Hinz A, Schumacher J, Albani C, Schmid G, Brähler E. Bevölkerungsrepräsentative Normierung der Skala zur Allgemeinen Selbstwirksamkeitserwartung. Diagnostica 2006;52:26–32. doi: https://doi.org/10.1026/0012-1924.52.1.26.
  34. 34.
    Hinz A, Weis J, Brähler E, Mehnert A (2018) Fatigue in the general population: German normative values of the EORTC QLQ-FA12. Qual Life Res 27:2681–2689.  https://doi.org/10.1007/s11136-018-1918-0 CrossRefGoogle Scholar
  35. 35.
    Arndt V, Stegmaier C, Ziegler H, Brenner H (2006) A population-based study of the impact of specific symptoms on quality of life in women with breast cancer 1 year after diagnosis. Cancer 107:2496–2503.  https://doi.org/10.1002/cncr.22274 CrossRefPubMedGoogle Scholar
  36. 36.
    Schultz SL, Dalton SO, Christensen J, Carlsen K, Ross L, Johansen C (2011) Factors correlated with fatigue in breast cancer survivors undergoing a rehabilitation course, Denmark, 2002-2005. Psychooncology 20:352–360.  https://doi.org/10.1002/pon.1739 CrossRefPubMedGoogle Scholar
  37. 37.
    Peoples AR, Roscoe JA, Block RC, Heckler CE, Ryan JL, Mustian KM, Janelsins MC, Peppone LJ, Moore DF, Coles C, Hoelzer KL, Morrow GR, Dozier AM (2017) Nausea and disturbed sleep as predictors of cancer-related fatigue in breast cancer patients: a multicenter NCORP study. Support Care Cancer 25:1271–1278.  https://doi.org/10.1007/s00520-016-3520-8 CrossRefPubMedGoogle Scholar
  38. 38.
    Kuhnt S, Ernst J, Singer S, Rüffer JU, Kortmann R-D, Stolzenburg J-U, Schwarz R (2009) Fatigue in cancer survivors-prevalence and correlates. Onkologie 32:312–317.  https://doi.org/10.1159/000215943 CrossRefPubMedGoogle Scholar
  39. 39.
    Hinz A, Weis J, Faller H, Brähler E, Härter M, Keller M, Schulz H, Wegscheider K, Koch U, Geue K, Götze H, Mehnert A (2018) Quality of life in cancer patients-a comparison of inpatient, outpatient, and rehabilitation settings. Support Care Cancer 26:3533–3541.  https://doi.org/10.1007/s00520-018-4211-4 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Medical Psychology and Medical SociologyUniversity Medical Center LeipzigLeipzigGermany
  2. 2.Rehabilitation Clinic Bad OexenBad OeynhausenGermany

Personalised recommendations