Prevalence of cancer-related fatigue based on severity: a systematic review and meta-analysis

Abstract

Cancer-related fatigue (CRF) affects therapeutic compliance and clinical outcomes including recurrence and mortality. This study aimed to comprehensively and comparatively assess the severity-based prevalence of CRF. From two public databases (PubMed and Cochrane Library), we extracted data containing information on both prevalence and severity of fatigue in cancer patients through December 2021. We conducted a meta-analysis to produce point estimates using random effects models. Subgroup analyses were used to assess the prevalence and severity by the organ/system tumor development, treatment phase, therapeutic type, sex and assessment method. A total of 151 data (57 studies, 34,310 participants, 11,805 males and 22,505 females) were selected, which indicated 43.0% (95% CI 39.2–47.2) of fatigue prevalence. The total CRF prevalence including ‘mild’ level of fatigue was 70.7% (95% CI 60.6–83.3 from 37 data). The prevalence of ‘severe’ fatigue significantly varied by organ/system types of cancer origin (highest in brain tumors 39.7% vs. lowest in gynecologic tumors 3.9%) and treatment phase likely 15.9% (95% CI 8.1–31.3) before treatment, 33.8% (95% CI 27.7–41.2) ongoing treatment, and 24.1% (95% CI 18.6–31.2) after treatment. Chemotherapy (33.1%) induced approximately 1.5-fold higher prevalence for ‘severe’ CRF than surgery (22.0%) and radiotherapy (24.2%). The self-reported data for ‘severe’ CRF was 20-fold higher than those assessed by physicians (23.6% vs. 1.6%). Female patients exhibited a 1.4-fold higher prevalence of ‘severe’ fatigue compared to males. The present data showed quantitative feature of the prevalence and severity of CRF based on the cancer- or treatment-related factors, sex, and perspective of patient versus physician. In the context of the medical impact of CRF, our results provide a comparative reference to oncologists or health care providers making patient-specific decision.

Cancer-Related Fatigue and Circulating Biomarkers in Breast Cancer Survivors

“…In our study women reported more severe fatigue than men (Kang et al, 2023), though there are inconsistent results regarding sex differences (Bensing et al, 1999;Oertelt-Prigione et al, 2021). Biological reasons for these sex differences may be related to reproductive function, psychological framework related to different personality and coping strategies, as well as different social positions for men and women.…”

Systematic review of fatigue severity in ME/CFS patients: insights from randomized controlled trials

“…Indeed, besides CFS, fatigue is one of the most common morbidities even in the general population, affecting approximately 20% [ 5 ]. Additionally, for certain diseases, fatigue is a critical feature of the representative symptoms with high prevalence, for example, 50% in cancer [ 6 ], 80% in fibromyalgia [ 7 ], and 90% in major depressive disorder (MDD) [ 8 ], respectively. Then, CFS has been identified as the most severe form of medically unexplained fatigue and much more severe than other fatigue-associated diseases.…”

Prevalence and biopsychosocial indicators of fatigue in cancer patients

“…For instance, female gender has been linked to CRF in many studies. 9,57,58 However, a large-scale international study could not show any differences in fatigue levels between male and female patients. 59 Besides, a recent study on long-term cancer survivors found fatigue to be more common in men than in women, when adjusted for age, comorbidities, partner, and employment status.…”