A longitudinal analysis of fatigue in colorectal cancer patients during chemotherapy

The aim of this longitudinal study was to analyze trends in fatigue among colorectal cancer patients during chemotherapy and examine the predictors of multidimensional fatigue.

A mixed sample of colorectal cancer patients who were receiving chemotherapy (N = 200) was recruited in China. The patients completed the Cancer Fatigue Scale (CFS) at baseline (before chemotherapy) and after 3 and 6 months of chemotherapy. Repeated measures ANOVAs were conducted to evaluate the effect of time on the CFS score. The data on violations of the statistical assumptions (independence, normality, and sphericity) from the repeated measures ANOVAs were examined. Stepwise regression analyses were conducted to evaluate the associations of the potential predictor variables at baseline on the total fatigue score and subscale scores at follow-up.

As chemotherapy progressed, significant increases in the three subscale scores and total scores were observed. Physical fatigue and total fatigue scores increased continuously during chemotherapy (P < 0.001). However, affective fatigue and cognitive fatigue scores increased significantly in the first 3 months (P < 0.001) and basically remained stable thereafter (P > 0.05). Multiple stepwise regression was used to analyze the predictors. The results showed that the baseline fatigue subscale score was the strongest predictor of each dimension of fatigue. In addition, age affected physical fatigue, and monthly income and education affected cognitive fatigue.

Fatigue increased during chemotherapy. Early assessment and intervention may be better for controlling fatigue, especially in patients with higher baseline fatigue level, older age, and lower economic and educational levels.