Quantifying fatigue in (long-term) colorectal cancer survivors: A study from the population-based Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship registry

Background: Few studies specifically focus on fatigue of (long-term) colorectal cancer (CRC) survivors or compare fatigue levels with a normative population. Association between surviving multiple primary cancers and fatigue is also explored. Methods: Survivors diagnosed from 1998 to 2009 were identified from the Eindhoven Cancer Registry. In total, 3739 (79%) respondents and an age- and gender-matched normative population (n = 338) completed questionnaires on fatigue and psychological distress. Results: More survivors reported feeling fatigued than the normative population (39% versus 22%, p < 0.0001). Short-term survivors (<5 years post-diagnosis) had the highest mean fatigue scores compared with long-term survivors (≥5 years post-diagnosis) or the normative population (21 ± 7 versus 20 ± 7 versus 18 ± 5, p < 0.0001, respectively). Having primary cancers prior to CRC was associated with more fatigue. Surgery + chemoradiation was independently associated with fatigue (odds ratio (OR): 1.63, 95% confidence interval (CI): 1.17-2.29, p = 0.004) as were anxiety (OR: 1.16, 95% CI: 1.12-1.19, p < 0.0001) and depressive symptoms (OR: 1.38, 95% CI: 1.33-1.43, p < 0.0001). Conclusions: Fatigue is a significant problem, especially for short-term CRC survivors. The association between chemoradiation and fatigue suggests that patients could benefit from better information on treatment side-effects. When treating fatigue, clinical care should also focus on survivors' psychological needs, especially survivors of multiple primary cancers.

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