Psychological distress, gender, education and development of cancer-related fatigue among patients undergoing chemotherapy: A URCC CCOP Study

Introduction: Cancer-related fatigue (CRF) is a debilitating symptom that affects patients' psychosocial functioning and quality of life. Reported incidence rates of CRF vary from 70 to 100%. The causes of CRF have been attributed to a combination of biopsychosocial factors including physiologic changes related to the malignant tumor, physical side effects of cancer treatment, and psychological correlates of the cancer diagnosis and associated treatments. The present study examines the contributions of psychosocial distress and patients' demographics to cancer-related fatigue.

Methods: 854 cancer patients beginning chemotherapy at 23 geographically different URCC CCOP affiliates were assessed for fatigue. Fatigue levels and psychological distress were assessed at Cycles 2 and 4 using psychometrically valid measures. An unbiased conditional tree analysis was conducted to examine the effects of psychosocial distress and socio-demographics on CRF. A total of 642 cancer patients (202 males and 440 females) between 18 and 90 years old provided complete data.

Results: Baseline tension/anxiety, reported cognitive difficulties, gender and education contributed significantly to fatigue at cycle 4 among patients with low to moderate baseline fatigue (all ps≤.01). Patients' psychosocial distress and socio-demographics had no significant effect on severe fatigue.

Conclusion: Psychological distress and socio-demographics influence the development of CRF. Efforts to control CRF should consider and integrate information about patients' psychological states and socio-demographic backgrounds.