Development of fatigue in cancer survivors: a prospective follow-up study from diagnosis into the year after treatment

J Pain Symptom Manage. 2013 Feb;45(2):213-22. doi: 10.1016/j.jpainsymman.2012.02.009. Epub 2012 Aug 25.


Context: There is a lack of longitudinal studies investigating fatigue from before cancer treatment to long after successful cancer treatment.

Objectives: This prospective follow-up study aimed to determine the prevalence and predictors of persistent fatigue in cancer survivors in the first year after completion of cancer treatment.

Methods: Sixty patients with various malignancies were assessed before (T1), shortly after curative cancer treatment (T2), and one year after T2 (T3). Fatigue was assessed monthly between T2 and T3. Fatigue severity was measured using the subscale of the Checklist Individual Strength. Questionnaires were used to measure impaired sleep and rest, physical activity, social support, fatigue catastrophizing, and somatic-related attributions regarding fatigue. Linear regression analyses were performed to identify predictors of persistent fatigue.

Results: In total, 22% of survivors had severe persistent fatigue over the last six months in the first year after cancer treatment. Fatigue at T1, T2, and negative interactions predicted the severity of persistent fatigue. Analyses without fatigue showed that more negative interactions, impaired sleep and rest, fatigue catastrophizing, and lower self-reported physical activity at T2 were associated with the severity of persistent fatigue.

Conclusion: Twenty-two percent of the survivors had severe persistent fatigue in the year after cancer treatment. Fatigue and cognitive behavioral factors predicted persistent fatigue in the year after cancer treatment. Diagnosis or cancer treatment did not predict persistent fatigue. The implication is that cognitive behavioral therapy for postcancer fatigue, aimed at the fatigue-perpetuating factors, could be offered from two months after successful cancer treatment.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Causality
  • Comorbidity
  • Fatigue / diagnosis
  • Fatigue / epidemiology*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / diagnosis
  • Neoplasms / epidemiology*
  • Neoplasms / therapy*
  • Netherlands / epidemiology
  • Prevalence
  • Prospective Studies
  • Risk Assessment
  • Sleep Wake Disorders / diagnosis
  • Sleep Wake Disorders / epidemiology*
  • Survivors / statistics & numerical data*
  • Treatment Outcome