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.