Fatigue and Functional Ability in Patients Undergoing Upfront Surgical Treatment for Solid Malignancies

  • Parveen
  • Naveen Kumar
  • Aditi Prashant Sinha
  • Rakesh Garg
  • S. V. S. Deo
  • Sunil KumarEmail author
Original Article


Fatigue is an underassessed and underreported aspect of cancer patients undergoing treatment. In patients being treated with surgery, its extent and manifestations may be varied but it affects their functional quality of life. This study was designed to evaluate the level of fatigue in pre- and post-surgery period and its relation with the functional disability in patients undergoing upfront surgery for solid malignancies. A prospective observational study was conducted between 2016 and 2017. A total of 71 patients with malignant solid tumors (up to stage III) undergoing upfront surgery were included. The fatigue and functional disability were assessed in pre- and post-surgery period using Multidimensional Fatigue Inventory-20 (MFI-20) and Functional Assessment of Chronic Illness Therapy (FACIT-F) questionnaires respectively. The mean age was 42.4 years. The post-operative fatigue levels were significantly higher compared with the pre-operative levels (p = 0.001). The maximum levels of fatigue and loss of functional ability were seen at the time of discharge that recovered up to some extent after 30 days of surgery. Operative duration > 8 h, hospital stay > 9 days, and blood loss of > 200 ml were associated with increased fatigue level. Mental fatigue and limitation of physical activity were the most significant domains in pre- and post-surgery period respectively. This study concludes that cancer-related fatigue is present in both pre- and post-surgery period and it correlates with functional disability. Assessment of different dimensions of fatigue is important and patients need to be made aware about them for planning any specific intervention including life style modification to help them cope up with these practical issues.


Fatigue Functional ability Cancer Surgery 


Compliance with Ethical Standards

Informed consent was obtained from all individual participants included in the study. The study was approved by the Institutional Ethics Committee.

Conflict of Interests

The authors declare that they have no conflict of interest.


  1. 1.
    Berger AM, Abernethy AP, Atkinson A, Barsevick AM, Breitbart WS, Cella D, Cimprich B, Cleeland C, Eisenberger MA, Escalante CP, Jacobsen PB, Kaldor P, Ligibel JA, Murphy BA, O'Connor T, Pirl WF, Rodler E, Rugo HS, Thomas J, Wagner LI (2010) NCCN clinical practice guidelines cancer-related fatigue. J Natl Compr Cancer Netw 8:904–931CrossRefGoogle Scholar
  2. 2.
    Berger AM, Gerber LH, Mayer DK (2012) Cancer-related fatigue: implications for breast cancer survivors. Cancer 118:2261–2269CrossRefGoogle Scholar
  3. 3.
    Morrow GR, Andrews PL, Hickok JT, Roscoe JA, Matteson S (2002) Fatigue associated with cancer and its treatment. Support Care Cancer 10:389–398CrossRefGoogle Scholar
  4. 4.
    Smets EM, Garssen B, Bonke B et al (1995) The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39:315–325CrossRefGoogle Scholar
  5. 5.
    Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E (1997) Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manag 13:63–74CrossRefGoogle Scholar
  6. 6.
    Glaus A (1998) Fatigue in patients with cancer. Analysis and assessment. Recent Results Cancer Res 145:1–172CrossRefGoogle Scholar
  7. 7.
    Patarca-Montero R (2004) Handbook of cancer-related fatigue, 1st edn. The Haworth Medical Press, New YorkGoogle Scholar
  8. 8.
    Singer S, Kuhnt S, Zwerenz R, Eckert K, Hofmeister D, Dietz A, Giesinger J, Hauss J, Papsdorf K, Briest S, Brown A (2011) Age- and sex-standardised prevalence rates of fatigue in a large hospital-based sample of cancer patients. Br J Cancer 105:445–451CrossRefGoogle Scholar
  9. 9.
    Prue G, Allen J, Gracey J, Rankin J, Cramp F (2010) Fatigue in gynecological cancer patients during and after anticancer treatment. J Pain Symptom Manag 39:197–210CrossRefGoogle Scholar
  10. 10.
    Rotonda C, Guillemin F, Bonnetain F, Velten M, Conroy T (2013) Factors associated with fatigue after surgery in women with early-stage invasive breast cancer. Oncologist 18:467–475CrossRefGoogle Scholar
  11. 11.
    Timmerman JG, Dekker-van Weering MG, Tönis TM et al (2015) Relationship between patterns of daily physical activity and fatigue in cancer survivors. Eur J Oncol Nurs 19:162–168CrossRefGoogle Scholar
  12. 12.
    Servaes P, Verhagen C, Bleijenberg G (2002) Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions. Eur J Cancer 38:27–43CrossRefGoogle Scholar
  13. 13.
    Stone P, Hardy J, Broadley K, Tookman AJ, Kurowska A, A’Hern R (1999) Fatigue in advanced cancer: a prospective controlled cross-sectional study. Br J Cancer 79:1479–1486CrossRefGoogle Scholar
  14. 14.
    Johnston MP, Coward DD (2001) Cancer-related fatigue: nursing assessment and management: increasing awareness of the effect of cancer-related fatigue. Am J Nurs 10:19–22CrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  1. 1.College of NursingAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
  2. 2.Department of Surgical OncologyBRA - Institute Rotary Cancer Hospital, All India Institute of Medical SciencesNew DelhiIndia
  3. 3.Department of Anesthesiology, Pain and Palliative CareBRA - Institute Rotary Cancer Hospital, All India Institute of Medical sciences (AIIMS)New DelhiIndia

Personalised recommendations