Fatigue Syndrome in Patients with Bone and Soft Tissue Sarcomas: An Observational Study

The aim of the present study is to describe the course of fatigue syndrome in patients with musculoskeletal tumors starting from chemotherapy and to compare it with that of other cancer populations. The second objective is to identify the risk factors for a higher level of fatigue.

A prospective prognostic observational cohort study was carried out. All patients diagnosed with musculoskeletal tumors who started chemotherapy treatment over 12 years of age were identified and enrolled consecutively from July 2019 to April 2021 in the osteo-oncology department. Patients' fatigue was measured using the Brief Fatigue Inventory at four different time points: at the beginning of treatment and then subsequently at 6, 12 and 24 months from the time of enrollment.

The mean fatigue value was 3.3 (SD = 2.4) at the start of antiblastic treatment, which progressively decreased over time until it reached a mean score of 2.1 (SD = 1.5). At 24 months; 17% of patients had moderate/severe fatigue. Presence of metastases at the onset of the disease, location of the tumor in the upper limb, a shorter oncological treatment-free gap and surgical treatment were independent predictive factors of BFI score.

In patients with musculoskeletal tumors, fatigue is a complication of the disease itself and does not occur only after chemotherapy treatment. In the first two years of treatment, there is a decreasing trend in fatigue syndrome, which remains a significant complication to be monitored over time and to be considered in patient management. Prevention pathways should be implemented.

During chemotherapy treatment of patients with bone and soft tissue sarcomas, a fatigue prevention plan should be implemented. Patients with tumor localisation in the upper limb, metastasis at onset and surgical treatment have a higher risk of developing a higher fatigue score.