gms | German Medical Science

The impact of fatigue on the quality of life of oncology patients is substantial and under recognized. Fatigue in these patients may begin with a simple decrease in physical activities, but can progress to include a wide range of negative effects that often culminate in patients feeling out of control, lonely, and isolated. According to the general paradigm of cancer survivors and understanding, in general, surviving cancer patients experience some limitations after the end of treatment but ultimately attain a reasonably good level of functioning. An examination of subpopulations and further analyses of data suggest, however, different recovery patterns which may not be in accordance with the above mentioned principle but reveal various patterns with changing levels of functioning. Disturbingly, 60% of the survivors in our population of patients with Hodgkin’s disease, who were treated in recent trials of the German Hodgkin Study Group and the European Organization for Research and Treatment of Cancer Lymphoma Group, have medium to high levels of fatigue after 5 cancer-free years and in conjunction with these findings show severe limitations in various areas of subjective quality of life. Fatigue levels are related to a number of variables including medical and psychosocial factors. From cross-sectional together with longitudinal data it can be concluded that at least for a subgroup of survivors (and a much smaller group of control persons) a high risk for developing fatigue levels above a relevant threshold can be identified. From the available data it can be hypothesised that the „high level fatigue“ subgroup is the group of survivors with the greatest risk for negative psychosocial consequences and maladaptation sequelae in various aspects of quality of life. Investigations are essential to determine the current status of long-term survivors in more detail and to link that status to conditions observed during the treatment of acutely ill patients. Data from different tumor entities, including testicular cancer and breast cancer, suggest furthermore that these findings may be different and varying according to tumor type.