Patient Activation, Patient-Physician Communication Quality, and Cancer-Related Fatigue: A Longitudinal Study of...

Cancer-related fatigue (CRF) is highly prevalent and often insufficiently addressed in routine survivorship care. This study examined whether patient activation and patient-physician communication quality in early survivorship are associated with subsequent CRF among cancer survivors.

The observational German LIFT study enrolled 1175 adult survivors of various cancer types. CRF was assessed 4-6, 9, 12, and 24 months post-diagnosis using the EORTC QLQ-FA12. Patient activation was assessed with the German Patient Activation Measure (PAM-13-D (PAM)) and communication quality with an exploratory five-item scale (ComQ) 9 months after diagnosis. Multiple linear regression models examined associations of PAM and ComQ with physical and total CRF 12 months (n = 1132) and 24 months (n = 1067) after diagnosis, adjusting for sociodemographic and clinical covariates. Sensitivity analyses additionally adjusted for previous CRF 4-6 months after diagnosis. Missing data among alive participants were multiply imputed.

PAM at 9 months was negatively associated with physical and total CRF at both 12 and 24 months after diagnosis, whereas ComQ at 9 months was negatively associated with physical and total CRF at 12 months only. After additional adjustment for previous CRF at 4-6 months, negative associations for PAM with physical and total CRF persisted at 12 months but were attenuated.

Higher patient activation and better perceived patient-physician communication were associated with lower subsequent CRF, particularly within the first year after diagnosis. Activation-oriented and communication-focused strategies may complement existing CRF interventions and warrant further evaluation in pragmatic trials across different survivor groups and settings.