Factors related to clinically relevant fatigue in disease-free stomach cancer survivors and expectation-outcome consistency

Abstract

Although early detection and improved treatment have increased the number of long-term survivors, little is known about the prevalence and associations of clinically relevant fatigue (CRF) in disease-free stomach cancer survivors. Because no effective CRF management strategy yet exists, understanding CRF risk factors is important for developing treatment approaches. Stomach cancer survivors (N = 374) completed a mailed survey that included the Brief Fatigue Inventory, Beck Depression Inventory, and the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire and its gastric module QLQ-STO22. We assessed sociodemographic, clinical, and symptom characteristics using multivariate logistic regression models to identify CRF-associated factors. Approximately half of disease-free stomach cancer survivors reported CRF, which was associated with female gender, low economic status, rural residence, current smoker, early tumor progress, current depression, and poor performance. Significant relationships of CRF with current depression and poor performance status remained robust after adjusting for potential confounders. Most functional and symptom scores of fatigued survivors deteriorated more than in non-fatigued survivors. Additionally, congruence between tumor progress and surgery type might influence CRF severity. In disease-free stomach cancer survivors, CRF is a common problem that is strongly associated with quality of life and other symptoms. Current depression, poor performance, and perceived understanding regarding postoperative condition are important CRF risk factors. Thus, CRF management in this population should focus on identifying these factors.