Supportive Care in Cancer

, Volume 23, Issue 7, pp 2165–2174 | Cite as

Variation in fatigue among 6011 (long-term) cancer survivors and a normative population: a study from the population-based PROFILES registry

  • Olga Husson
  • Floortje Mols
  • Lonneke van de Poll-Franse
  • Jolanda de Vries
  • Goof Schep
  • Melissa S. Y. Thong
Original Article
First Online:
Received:
Accepted:

Abstract

Purpose

Cancer survivors commonly experience fatigue, related to disease and its treatment. This study aimed to compare fatigue severity among survivors of different cancer types with a normative population and also to identify variations in fatigue among cancer survivors according to clinical and demographic variables.

Methods

We used cancer survivorship data from the population-based PROFILES registry. We included survivors of endometrial (EC, n = 741) or colorectal cancer (CRC, n = 3878) (1998–2007), thyroid cancer (TC, n = 306) (1990–2008), Hodgkin (HL, n = 150) or non-Hodgkin lymphoma (NHL, n = 716), or multiple myeloma (MM, n = 120) (1999–2008). A representative Dutch normative population (n = 2040) was also assessed. Participants completed the Fatigue Assessment Scale.

Results

Cancer survivors were more often classified as fatigued (EC/CRC 39 %, HL 40 %, NHL 43 %, MM 51 %, TC 44 %) compared with the normative population (21 %; p < 0.001). MM survivors were more often classified as fatigued than all other cancer groups, except NHL (overall p = 0.02). Shorter times since diagnosis (<5 years, 41 versus 38 %; p < 0.05), younger age (≤65 years, 42 versus 39 %; p < 0.01), being female (43 versus 36 %; p < 0.01), chemotherapy treatment (43 versus 39 %; p < 0.01), comorbidity (no (27 %) versus 1 (35 %) versus ≥2 (52 %); p < 0.01), educational level (low (44 %) versus medium (41 %) versus high (32 %); p < 0.01), and absence of a partner (47 versus 38 %; p < 0.01) were associated with fatigue.

Conclusions

Fatigue levels are substantial in (long-term) cancer survivors and vary depending on cancer type, time since diagnosis, age, gender, treatment with chemotherapy, number of comorbid conditions, educational level, and partnership. Since significantly more cancer survivors feel fatigued in comparison with the normative population, appropriate information, assessment, and interventions for fatigue are needed during or after oncologic treatment. Furthermore, focus on better control or management of comorbid conditions of cancer survivors is recommended.

Keywords

Cancer Fatigue Normative population Population-based Survivors 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

We thank all survivors and their doctors for their participation in the study. Special thanks to Dr. M. van Bommel for her availability as an independent advisor and willingness to answer survivors’ queries. In addition, we thank the following hospitals for their cooperation: Amphia Hospital (Breda), Bernhoven Hospital (Veghel and Oss), Catharina Hospital (Eindhoven), Elkerliek Hospital (Helmond), Jeroen Bosch Hospital (‘s Hertogenbosch), Maxima Medical Center (Eindhoven and Veldhoven), St. Anna Hospital (Geldrop), St. Elisabeth Hospital (Tilburg), Twee Steden Hospital (Tilburg and Waalwijk), and VieCuri Hospital (Venlo and Venray).

Funding

The present research is supported in part by a Veni grant (no. 451-10-041) from the Netherlands Organization for Scientific Research (The Hague, The Netherlands) awarded to Floortje Mols, a Cancer Research Award from the Dutch Cancer Society (no. UVT-2009-4349) to Lonneke van de Poll-Franse and a Social Psychology Fellowship from the Dutch Cancer Society to Melissa Thong (no. UVT2011-4960). Data collection for this study was funded by the Comprehensive Cancer Centre South, Eindhoven, The Netherlands; the Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, The Netherlands; and an investment subsidy (no. 480-08-009) of the Netherlands Organization for Scientific Research (The Hague, The Netherlands). The funding sources were neither involved in the collection, interpretation, and analysis of the data, nor in the decision for the writing and submission of this report for publication.

Conflict of interest

None declared.

References

  1. 1.
    (2011) Cancer in the Netherlands until 2020. Trends and prognoses. [Kanker in Nederland tot 2020. Trends en prognoses]. KWF Kankerbestrijding, AmsterdamGoogle Scholar
  2. 2.
    Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64:9–29PubMedGoogle Scholar
  3. 3.
    Andrykowski MA, Donovan KA, Laronga C, Jacobsen PB (2010) Prevalence, predictors, and characteristics of off-treatment fatigue in breast cancer survivors. Cancer 116:5740–5748CrossRefPubMedCentralPubMedGoogle Scholar
  4. 4.
    Curt GA, Breitbart W, Cella D, Groopman JE, Horning SJ, Itri LM, Johnson DH et al (2000) Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. Oncologist 5:353–360PubMedGoogle Scholar
  5. 5.
    Barsevick AM, Irwin MR, Hinds P, Miller A, Berger A, Jacobsen P, Ancoli-Israel S et al (2013) Recommendations for high-priority research on cancer-related fatigue in children and adults. J Natl Cancer Inst 105:1432–1440PubMedCentralPubMedGoogle Scholar
  6. 6.
    Daniëls L, Oerlemans S, Krol AG, Poll-Franse L, Creutzberg C (2013) Persisting fatigue in Hodgkin lymphoma survivors: a systematic review. Ann Hematol 92:1023–1032PubMedGoogle Scholar
  7. 7.
    Servaes P, Verhagen C, Bleijenberg G (2002) Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions. Eur J Cancer 38:27–43PubMedGoogle Scholar
  8. 8.
    Goedendorp MM, Andrykowski MA, Donovan KA, Jim HS, Phillips KM, Small BJ, Laronga C et al (2012) Prolonged impact of chemotherapy on fatigue in breast cancer survivors: a longitudinal comparison with radiotherapy-treated breast cancer survivors and noncancer controls. Cancer 118:3833–3841CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Cheng KKF, Lee DTF (2011) Effects of pain, fatigue, insomnia, and mood disturbance on functional status and quality of life of elderly patients with cancer. Crit Rev Oncol Hematol 78:127–137PubMedGoogle Scholar
  10. 10.
    Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR (2007) Cancer-related fatigue: the scale of the problem. Oncologist 12(Suppl 1):4–10PubMedGoogle Scholar
  11. 11.
    Jim HSL, Jacobsen PB, Phillips KM, Wenham RM, Roberts W, Small BJ (2013) Lagged relationships among sleep disturbance, fatigue, and depressed mood during chemotherapy. US, American Psychological Association, pp 768–774Google Scholar
  12. 12.
    Fosså SD, Dahl AA, Loge JH (2003) Fatigue, anxiety, and depression in long-term survivors of testicular cancer. J Clin Oncol 21:1249–1254PubMedGoogle Scholar
  13. 13.
    Reinertsen KV, Cvancarova M, Loge JH, Edvardsen H, Wist E, Fossa SD (2010) Predictors and course of chronic fatigue in long-term breast cancer survivors. J Cancer Surviv 4:405–414PubMedCentralPubMedGoogle Scholar
  14. 14.
    Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, Belin TR (2006) Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer 106:751–758CrossRefPubMedGoogle Scholar
  15. 15.
    de Raaf PJ, de Klerk C, van der Rijt CCD (2013) Elucidating the behavior of physical fatigue and mental fatigue in cancer patients: a review of the literature. Psychooncology 22:1919–1929PubMedGoogle Scholar
  16. 16.
    Prue G, Rankin J, Allen J, Gracey J, Cramp F (2006) Cancer-related fatigue: a critical appraisal. Eur J Cancer 42:846–863PubMedGoogle Scholar
  17. 17.
    Braun IM, Greenberg DB, Pirl WF (2008) Evidenced-based report on the occurrence of fatigue in long-term cancer survivors. J Natl Compr Cancer Netw 6:347–354Google Scholar
  18. 18.
    Caravati-Jouvenceaux A, Launoy G, Klein D, Henry-Amar M, Abeilard E, Danzon A, Pozet A et al (2011) Health-related quality of life among long-term survivors of colorectal cancer: a population-based study. Oncologist 16:1626–1636PubMedCentralPubMedGoogle Scholar
  19. 19.
    Jansen L, Herrmann A, Stegmaier C, Singer S, Brenner H, Arndt V (2011) Health-related quality of life during the 10 years after diagnosis of colorectal cancer: a population-based study. J Clin Oncol 29:3263–3269PubMedGoogle Scholar
  20. 20.
    Joly F, Henry-Amar M, Arveux P, Reman O, Tanguy A, Peny AM, Lebailly P et al (1996) Late psychosocial sequelae in Hodgkin's disease survivors: a French population-based case-control study. J Clin Oncol 14:2444–2453PubMedGoogle Scholar
  21. 21.
    Le Borgne G, Mercier M, Woronoff A-S, Guizard A-V, Abeilard E, Caravati-Jouvenceaux A, Klein D et al (2013) Quality of life in long-term cervical cancer survivors: a population-based study. Gynecol Oncol 129:222–228PubMedGoogle Scholar
  22. 22.
    Barbera L, Seow H, Howell D, Sutradhar R, Earle C, Liu Y, Stitt A et al (2010) Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer 116:5767–5776CrossRefPubMedGoogle Scholar
  23. 23.
    Wikman A, Djärv T, Johar A, Lagergren P (2013) Health-related quality of life does not differ between short-term, long-term and very long-term cancer survivors in the Swedish general population. Psycho-Oncology 22:1369–1374CrossRefPubMedGoogle Scholar
  24. 24.
    van de Poll-Franse LV, Horevoorts N, Van Eenbergen MC, Denollet J, Roukema JA, Aaronson NK, Vingerhoets AJ et al (2011) The Patient Reported Outcomes Following Initial treatment and Long term Evaluation of Survivorship registry: scope, rationale and design of an infrastructure for the study of physical and psychosocial outcomes in cancer survivorship cohorts. Eur J Cancer 47:2188–2194PubMedGoogle Scholar
  25. 25.
    Husson O, Nieuwlaat WA, Oranje WA, Haak HR, van de Poll-Franse LV, Mols F (2013) Fatigue among short- and long-term thyroid cancer survivors: results from the population-based PROFILES registry. Thyroid 23:1247–1255CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Oerlemans S, Mols F, Issa DE, Pruijt JH, Peters WG, Lybeert M, Zijlstra W et al (2013) A high level of fatigue among long-term survivors of non-Hodgkin's lymphoma: results from the longitudinal population-based PROFILES registry in the south of the Netherlands. Haematologica 98:479–486CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Thong MS, Mols F, Wang XS, Lemmens VE, Smilde TJ, van de Poll-Franse LV (2013) 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. Eur J Cancer 49:1957–1966PubMedCentralPubMedGoogle Scholar
  28. 28.
    van de Poll-Franse LV, Mols F, Gundy CM, Creutzberg CL, Nout RA, Verdonck-de Leeuw IM, Taphoorn MJ et al (2011) Normative data for the EORTC-C30 and EORTC-sexuality items in the general Dutch population. Eur J Cancer 47:667–675PubMedGoogle Scholar
  29. 29.
    Janssen-Heijnen MLG, Louwman WJ, Van de Poll-Franse LV, Coebergh JWW (2005) Results of 50 years cancer registry in the South of the Netherlands: 1955–2004 (in Dutch). Eindhoven Cancer Registry, EindhovenGoogle Scholar
  30. 30.
    Mols F, Thong MS, van de Poll-Franse LV, Roukema JA, Denollet J (2012) Type D (distressed) personality is associated with poor quality of life and mental health among 3080 cancer survivors. J Affect Disord 136:26–34PubMedGoogle Scholar
  31. 31.
    Mols F, Denollet J, Kaptein AA, Reemst PH, Thong MS (2012) The association between Type D personality and illness perceptions in colorectal cancer survivors: a study from the population-based PROFILES registry. J Psychosom Res 73:232–239PubMedGoogle Scholar
  32. 32.
    Nicolaije KA, Husson O, Ezendam NP, Vos MC, Kruitwagen RF, Lybeert ML, van de Poll-Franse LV (2012) Endometrial cancer survivors are unsatisfied with received information about diagnosis, treatment and follow-up: a study from the population-based PROFILES registry. Patient Educ Couns 88:427–435PubMedGoogle Scholar
  33. 33.
    Husson O, Haak HR, Buffart LM, Nieuwlaat WA, Oranje WA, Mols F, Kuijpens JL et al (2013) Health-related quality of life and disease specific symptoms in long-term thyroid cancer survivors: a study from the population-based PROFILES registry. Acta Oncol 52:249–258PubMedGoogle Scholar
  34. 34.
    De Vries J, Van der Steeg AF, Roukema JA (2010) Psychometric properties of the Fatigue Assessment Scale (FAS) in women with breast problems. Int J Clin Health Psychol 10:125–139Google Scholar
  35. 35.
    Michielsen HJ, Drent M, Peros-Golubicic T, De Vries J (2006) Fatigue is associated with quality of life in sarcoidosis patients. Chest 130:989–994PubMedGoogle Scholar
  36. 36.
    UICC (1992) TNM Atlas Illustrated Guide to the TNM/pTNM classification of malignant tumours (ed 4th edn, 2nd revision) (pp 141–144). Springer, BerlinGoogle Scholar
  37. 37.
    Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN (2003) The self-administered comorbidity questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis Rheum 49:156–163PubMedGoogle Scholar
  38. 38.
    Mols F, Oerlemans S, Vos AH, Koster A, Verelst S, Sonneveld P, van de Poll-Franse LV (2012) Health related quality of life and disease-specific complaints among multiple myeloma patients up to 10 years after diagnosis: results from a population-based study using the PROFILES registry. Eur J Haematol 89:311–319PubMedGoogle Scholar
  39. 39.
    Vissers PAJ, Thong MSY, Pouwer F, Zanders MMJ, Coebergh JWW, van de Poll-Franse LV (2013) The impact of comorbidity on health-related quality of life among cancer survivors: analyses of data from the PROFILES registry. J Cancer Surviv 7:602–613PubMedGoogle Scholar
  40. 40.
    Ryan JL, Carroll JK, Ryan EP, Mustian KM, Fiscella K, Morrow GR (2007) Mechanisms of cancer-related fatigue. Oncologist 12:22–34PubMedGoogle Scholar
  41. 41.
    Illi J, Miaskowski C, Cooper B, Levine JD, Dunn L, West C, Dodd M et al (2012) Association between pro- and anti-inflammatory cytokine genes and a symptom cluster of pain, fatigue, sleep disturbance, and depression. Cytokine 58:437–447CrossRefPubMedCentralPubMedGoogle Scholar
  42. 42.
    Wang XS, Williams LA, Krishnan S, Liao Z, Liu P, Mao L, Shi Q et al (2012) Serum sTNF-R1, IL-6, and the development of fatigue in patients with gastrointestinal cancer undergoing chemoradiation therapy. Brain Behav Immun 26:699–705PubMedCentralPubMedGoogle Scholar
  43. 43.
    Khan ML, Reeder CB, Kumar SK, Lacy MQ, Reece DE, Dispenzieri A, Gertz MA et al (2012) A comparison of lenalidomide/dexamethasone versus cyclophosphamide/lenalidomide/dexamethasone versus cyclophosphamide/bortezomib/dexamethasone in newly diagnosed multiple myeloma. Br J Haematol 156:326–333PubMedGoogle Scholar
  44. 44.
    Thijs KM, Boer AGEM, Vreugdenhil G, Wouw AJ, Houterman S, Schep G (2012) Rehabilitation using high-intensity physical training and long-term return-to-work in cancer survivors. J Occup Rehabil 22:220–229PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Olga Husson
    • 1
  • Floortje Mols
    • 1
    • 2
  • Lonneke van de Poll-Franse
    • 1
    • 2
  • Jolanda de Vries
    • 1
    • 3
  • Goof Schep
    • 4
  • Melissa S. Y. Thong
    • 1
    • 2
  1. 1.CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical PsychologyTilburg UniversityTilburgThe Netherlands
  2. 2.Eindhoven Cancer RegistryComprehensive Cancer Centre NetherlandsEindhovenThe Netherlands
  3. 3.Department of Medical PsychologySt. Elisabeth HospitalTilburgThe Netherlands
  4. 4.Department of Sports Medicine (SportMáx)Maxima Medical CenterVeldhovenThe Netherlands

Personalised recommendations