The Relationships Among Cancer-Related Fatigue Trajectories, Anxiety, and Health-Related Quality of Life in Ovarian Cancer Patients

Abstract

<p>Background: The relationship between cancer-related fatigue (CRF), anxiety, and health-related quality of life (HRQOL) over time is poorly understood in cancer patients due to a dearth of longitudinal studies. While the presence of CRF and anxiety are known to negatively impact HRQOL over time, the relationship between CRF and anxiety is equivocal, with some studies providing evidence for the impact of anxiety on CRF over time, and others noting the opposite relationship. In addition, while CRF and HRQOL are known to be correlated, the role of anxiety as a mediator or moderator in this relationship has yet to be explored. Methods: Participants (N = 202) recruited from Princess Margaret Cancer Centre completed a package of self-report questionnaires at baseline and three months post-baseline (follow-up). The four aims of this study were to (1) describe the different trajectories of CRF that develop between these two time points; (2) examine the direction of the relationship between CRF and anxiety over time; (3) examine how each CRF trajectory differentially predicts change in each of the following four domains of HRQOL over time: Physical, functional, social, and emotional wellbeing; and (4) examine the extent to which anxiety mediates and/or moderates the relationship between CRF trajectory and change in HRQOL over time. Results: For the first aim, four groups of CRF trajectories emerged: 54% of participants endorsed belonging to the CRF always present group, 16% to the CRF subsided group, 21% to the CRF developed group, and 9% to the CRF never present group. For the second aim, CRF trajectory was found to predict anxiety change over time, and not the other way around. For the third aim, results showed that as CRF developed, functional and physical wellbeing decreased; in contrast, as CRF subsided, functional, physical, and emotional wellbeing improved. However, CRF trajectory was not associated with change in social wellbeing over time. For the fourth aim, change in anxiety did not moderate the relationship between CRF trajectory and change in any of the four HRQOL domains. However, increased anxiety over time indirectly accounted for reduced functional, emotional, and physical wellbeing in individuals who developed CRF. In addition, increased anxiety indirectly accounted for reduced functional and emotional wellbeing in individuals whose CRF was always present. However, anxiety did not mediate the relationship between CRF trajectory and change in social wellbeing over time. Discussion: Divergent trajectories of CRF appear to differentially impact both anxiety and HRQOL over time, and changes in anxiety may mediate the detrimental effect of CRF development and maintenance on changes in the following HRQOL domains over time—functional, physical, and emotional wellbeing. However, a single domain of HRQOL—social wellbeing—appears to be unrelated to changes in CRF over time. Strategies targeting cognitions and behavioural strategies related to managing anxiety (e.g., psychoeducation, psychotherapy) may be useful in addressing worsening HRQOL commonly reported in cancer patients who endorse CRF.</p>