Fatigue in people with localized colorectal cancer who do and do not receive chemotherapy: a longitudinal prospective study

J L Vardy; H M Dhillon; G R Pond; C Renton; A Dodd; H Zhang; S J Clarke; I F Tannock

doi:10.1093/annonc/mdw252

Fatigue in people with localized colorectal cancer who do and do not receive chemotherapy: a longitudinal prospective study

Ann Oncol. 2016 Sep;27(9):1761-7. doi: 10.1093/annonc/mdw252. Epub 2016 Jul 20.

Authors

J L Vardy¹, H M Dhillon², G R Pond³, C Renton², A Dodd⁴, H Zhang⁵, S J Clarke², I F Tannock⁴

Affiliations

¹ Sydney Medical School, University of Sydney, Sydney, Australia Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada Concord Cancer Centre, Concord Hospital, Concord, Australia janette.vardy@sydney.edu.au.
² Sydney Medical School, University of Sydney, Sydney, Australia.
³ Department of Oncology, McMaster University, Hamilton.
⁴ Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada.
⁵ St Michael's Hospital, University of Toronto, Toronto, Canada.

Abstract

Background: Fatigue is associated with cancer and chemotherapy and may be sustained. Here, we describe a prospective longitudinal study evaluating fatigue and putative mechanisms in people with colorectal cancer (CRC).

Patients and methods: People with localized CRC completed the Functional Assessment of Cancer Treatment-Fatigue (FACT-F) questionnaire at baseline (before chemotherapy, if given), 6, 12, and 24 months. Healthy controls (HCs) were assessed at the first three time points. Fatigue was defined by standardized FACT-F scores ≤68/100. Quality-of-life (QoL, assessed by the FACT-G questionnaire), affective, and cognitive symptoms were evaluated. Associations were sought between fatigue, baseline factors, and blood tests (including hemoglobin, cytokines, and sex hormones). Regression analyses, Fisher's exact tests, and Wilcoxon rank-sum tests assessed levels of fatigue at each time point and change in fatigue from baseline. A repeated-measures analysis investigated prognostic factors of fatigue across all time points.

Results: A total of 289 subjects with localized CRC (173 received chemotherapy) and 72 HCs were assessed. More CRC patients had fatigue than HCs at baseline (52% versus 26%, P < 0.001). Fatigue was increased in the chemotherapy (CTh) group at 6 months [CTh+ 70% versus CTh- 31% (P < 0.001), HCs 22%] and remained more common at 12 [CTh+ 44% versus CTh- 31% (P = 0.079)] and 24 months [CTh+ 39% versus CTh- 24% (P = 0.047)]. There was no significant difference between those not receiving chemotherapy and HCs at follow-up assessments. Fatigue was associated with poor QoL, affective and cognitive symptoms, but not consistently with cytokine levels. Predictors for sustained fatigue were baseline fatigue, treatment group, cognitive and affective symptoms, poorer QoL, and comorbidities.

Conclusions: CRC patients have more fatigue than HCs at baseline. Fatigue peaks immediately after adjuvant chemotherapy, but remains common for 2 years in those who receive chemotherapy. Cognitive and affective symptoms, QoL, comorbidities, chemotherapy, and baseline fatigue predict for longer term fatigue.

Trial registration: ClinicalTrials.gov NCT00188331.

Keywords: cancer-related fatigue; chemotherapy; colorectal cancer; quality of life.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Antineoplastic Combined Chemotherapy Protocols / administration & dosage
Antineoplastic Combined Chemotherapy Protocols / adverse effects
Chemotherapy, Adjuvant / adverse effects*
Colorectal Neoplasms / complications
Colorectal Neoplasms / drug therapy*
Colorectal Neoplasms / epidemiology
Colorectal Neoplasms / pathology
Fatigue / chemically induced
Fatigue / epidemiology
Fatigue / pathology*
Female
Healthy Volunteers
Humans
Longitudinal Studies
Male
Middle Aged
Quality of Life
Surveys and Questionnaires

Associated data

ClinicalTrials.gov/NCT00188331