Investigating fatigue in adults with neuroendocrine neoplasms using a biopsychosocial model

Neuroendocrine neoplasms (NEN) are rare but increasingly recognized malignancies. Fatigue is common among individuals with NEN, but factors associated with fatigue in this population are not well described. Understanding these factors is essential for optimizing supportive care and quality of life. This study aimed to investigate factors associated with fatigue in patients with NEN using a biopsychosocial model.

Participants enrolled on a rare tumor natural history study (NCT03739827) were included in this analysis if they had NEN, were ≥ 18 years old, and completed at least one evaluation of patient-reported outcome measures. Fatigue was assessed using the Patient-Reported Outcome Measurement Information System (PROMIS).

Sixty-four adult participants with NEN (mean age = 59 years; SD = 12.0) completed PROMIS measures. Over half (53%) had PROMIS Fatigue T-scores > 55, indicating fatigue, including 31% in the moderate-to-severe range. Fatigue was highly correlated with pain, functional status, and psychosocial factors including depression, anxiety, and emotional support. There were no significant differences in fatigue based on identified sociodemographic or disease-related factors, although a significant association between fatigue and serotonin, a neuroactive peptide secreted by some NENs, was found in a subset of patients.

Fatigue is common in patients with NEN, with one-third having moderate to severe fatigue impacting daily functioning. Pain, anxiety, and depression were significantly associated with fatigue, suggesting that interventions targeting these symptoms also may improve fatigue in these patients. Further work is needed to investigate additional NEN-specific factors to optimize management of fatigue in individuals living with this long-term disease.