Factors associated with cancer-related fatigue in advanced hepatocellular carcinoma patients during the...

Cancer-related fatigue (CRF) is a significant concern in oncology, yet limited research has focused on its associated factors and pathways in hepatocellular carcinoma (HCC). This study aimed to identify the factors associated with CRF in advanced HCC patients and to explore the interrelationships among these factors using pathway analysis. This cross-sectional study enrolled participants from a tertiary cancer hospital. Data were collected through self-administered questionnaires assessing demographics, disease characteristics, positive emotions, physical activity (PA), and CRF. Multiple linear regression analyses and pathway modeling were employed to examine the associations among these variables. A total of 220 out of 275 eligible participants were included in the study. The mean Cancer Fatigue Scale (CFS) score was 31.30 (SD = 6.160, 95% CI: 30.20-32.40), with a clinical fatigue prevalence of 94.5%. Multiple linear regression analysis revealed that several factors were significantly associated with CRF, including the Herth Hope Index (HHI) (β=-0.281, 95% CI: 0.75-1.34, P < 0.01), insomnia (β = 0.22, 95% CI: 0.84-1.19, P < 0.01), economic burden (β=-0.20, 95% CI: 0.94-1.06, P < 0.01), Child-Pugh score (β = 0.19, 95% CI: 0.86-1.06, P < 0.01), General Self-Efficacy Scale (GSES) (β=-0.18, 95% CI: 0.81-1.24, P < 0.01), body mass index (BMI) (β=-0.13, 95% CI: 0.83-1.20, P < 0.01), marital status (β=-0.12, 95% CI: 0.95-1.06, P < 0.01), and Prognostic Nutritional Index (PNI) (β = 0.12, 95% CI: 0.92-1.09, P < 0.01). The pathway model showed HHI had the greatest correlation with CRF followed by GSES, Child-Pugh, and ISI. PA-Index indirectly related CRF mainly through HHI and GSES. This study highlights the high prevalence and severity of CRF in advanced HCC patients. Interventions aimed at improving physical activity, managing liver function, fostering positive emotions, enhancing sleep quality, and optimizing nutritional status may effectively reduce the risk of CRF in this population.