Fatigue and Functional Impairment in Early-Stage Non-Small Cell Lung Cancer Survivors

Abstract

Context Fatigue is the most common sequela among non-small cell lung cancer (NSCLC) survivors 1–6 years post-treatment and is associated with functional limitations. Objectives This study examined the prevalence, severity, and correlates of fatigue among early stage NSCLC survivors. Methods Three-hundred fifty individuals diagnosed and surgically treated for Stage IA or IB NSCLC completed a survey that included the Brief Fatigue Inventory (BFI) to assess the prevalence and severity of fatigue. The Self-Reported Karnofsky Performance Scale (SR-KPS) was used as a measure of functional status and was compared with the severity of fatigue though chi-square analyses. Demographic, psychological, and medical correlates of fatigue were examined using logistic regression. Results The prevalence of fatigue was 57%. Forty-one percent (n = 142) of participants had mild fatigue and 16.8% (n = 59) had moderate or severe fatigue (BFI ≥ 4). Among the individuals reporting moderate or severe fatigue, 23.7% (n=14) had significant functional impairment (SR-KPS ≤ 70%) compared to 2.8% (n =8) with mild or no fatigue (χ2 = 58.1, p < 0.001). In the multi-variate analysis, NSCLC survivors with pulmonary disease (OR = 2.28), depressive symptoms (OR = 6.99), and anxiety symptoms (OR = 2.31) were more likely to report experiencing clinically significant fatigue, while those who met physical activity guidelines (OR = 0.29) reported less fatigue. Discussion Fatigue is highly prevalent among NSCLC survivors and associated with more functional impairment. A comprehensive approach to the treatment of fatigue includes the screening and management of anxious and depressive symptoms, and pulmonary disorders such as chronic obstructive pulmonary disease.

The Relationship between Distressing Symptoms and Performance Status among Cancer Patients Receiving Palliative Care

“…Congruent with our results, other researchers found a significant negative relationship between symptom burden and functional status of advanced cancer patients [27][28][29][30][31] . In a recent study from Egypt that included patients with metastatic cancer, the total average ESAS score differed significantly according to the Eastern Cooperative Oncology Group (ECOG) performance scale from 34 in patients with an ECOG score of 1 to 70 in patients with an ECOG score…”

“…In another study that included pancreatic cancer patients; pain, digestive symptoms, cachexia and ascites were significantly more likely to be reported by patients with an ECOG score of ≥1 29 . In lung cancer patients, moderate/severe fatigue is associated with significantly poorer PS 30 . This was confirmed in another study where there was a strong negative relationship between Karnofsky PS and the top four symptoms (pain, fatigue, disturbed sleep and distress) in lung cancer patients 31 .…”

Impact of physiotherapy on patients with advanced lung cancer

“…It has been stated that the high level of fatigue despite the early stage of disease causes the impaired functional status of the patients. 65 It has been found that physical functioning of patients with advanced lung carcinoma decreased due to fatigue. The fatigue was not caused by weight loss and anemia but was related to psychological factors.…”

A Pan-Canadian Practice Guideline and Algorithm: Screening, Assessment, and Supportive Care of Adults with Cancer-Related Fatigue

“…Prevalence rates for crf are reported to range from 70% to 100% during active treatment and to be about 30% in post-treatment survivors [1][2][3][4][5] . Although definitions of crf vary, elements include a subjective feeling of tiredness or exhaustion, prompted by cancer or treatment and disproportionate to the level of recent exertion, that is not relieved by rest and that interferes with usual daily activities 6,7 .…”