Abstract 1563P
Background
Cancer patients with fatigue are commonly still counselled and treated in a very undifferentiated way without further evaluation of their symptomatology. Thus, we aimed to identify hallmarks of potential fatigue subgroups which might enable a more refined treatment of affected patients.
Methods
The observational FiX study assessed fatigue with the EORTC QLQ-FA12 in patients around 2 years after diagnosis of cancer (T0) including 15 different entities. After 2 years, a follow-up survey (T1) was conducted. The present analyses comprised all patients with prevalent fatigue at T0 (n=1080). A hierarchical cluster analysis was performed using the Ward method and including the dichotomized factors distress, pain, insomnia, and obesity. Psychological distress, i.e. depression and anxiety, was assessed by the PHQ-4. Insomnia and pain were based on the according symptom scores of the EORTC QLQ-C30. Further, analysis of covariance was conducted to investigate the association of the fatigue clusters at T0 with subsequent fatigue at T1 (dependent variable), adjusting for T0 fatigue levels, sex, entity and age.
Results
Based on a maximum pseudo-F value, 4 hierarchical clusters were identified. The first cluster comprised patients with moderate-to-severe distress. The remaining fatigue cases were differentiated by obesity and then by pain. Fatigue cases without any of these three symptoms comprised the last cluster. Fatigue levels in the distress cluster were highest regarding all dimensions (physical, emotional, and cognitive fatigue) and had highest impact on everyday life. Additionally, this T0 distress cluster was associated with more physical as well as emotional fatigue at T1 even when adjusting for baseline fatigue levels, age, and sex, compared to the other clusters. All other clusters showed significant decrease in fatigue at T1.
Conclusions
Fatigue in conjunction with high psychological distress has worse impact, persists longer, and likely may require other treatment approaches than fatigue in patients without psychological distress. Obesity and pain may be further distinguishing markers for the treatment of fatigue. Further research into these potential fatigue hallmarks is warranted.
Clinical trial identification
NCT03318224.
Editorial acknowledgement
Legal entity responsible for the study
Martina Schmidt, Karen Steindorf.
Funding
Has not received any funding.
Disclosure
K. Steindorf: Financial Interests, Personal, Invited Speaker: Hessian Society of Sports Medicine, Germany, Preventon, Frankfurt, Germany, Adviva, Heidelberg, Germany, Piere Fabre, Freiburg, Germany; Financial Interests, Personal, Expert Testimony: Institut National contre le cancer (INCA), Paris, France; Financial Interests, Personal, Expert Testimony, Member of Data Monitoring Board: Swiss Group for Clinical Research (SAAK), Switzerland. All other authors have declared no conflicts of interest.