Artikel
Patient-reported fatigue up to five years after radiotherapy in an international multicentre cohort study of men with non-metastatic prostate cancer
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Autoren
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Philipp Heumann
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Medical Faculty Heidelberg, Heidelberg University, Heidelberg, Germany
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Juan C. Rosas
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Miguel E. Aguado-Barrera
- Instituto de Investigación Sanitaria De Santiago de Compostela, Santiago de Compostela, Spain
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David Azria
- ICM Institut du Cancer Montpellier, Montpellier, France
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Erik Briers
- Patient Advocate, Hasselt, Belgium
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Rudolf Kaaks
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Carlos López-Pleguezuelos
- Instituto de Investigación Sanitaria De Santiago de Compostela, Santiago de Compostela, Spain
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Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Tim Rattay
- University of Leicester, Leicester, United Kingdom
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Barry Rosenstein
- Mount Sinai School of Medicine, New York, United States
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Elena Sperk
- Mannheim Cancer Center, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Hilary Stobart
- Patient Advocate, London, United Kingdom
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Chris Talbot
- University of Leicester, Leicester, United Kingdom
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Ana Vega
- Instituto de Investigación Sanitaria De Santiago de Compostela, Santiago de Compostela, Spain; Fundacion Publica Galega Medicina Xenomica, Santiago de Compostela, Spain
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Tim Ward
- Patient Advocate, London, United Kingdom
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Adam Webb
- University of Leicester, Leicester, United Kingdom
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Catharine M. West
- The University of Manchester, Manchester, United Kingdom
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Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| Veröffentlicht: | 6. September 2024 |
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Gliederung
Text
Background: Patient-reported fatigue was investigated longitudinally in prostate cancer (PCa) patients treated with radiotherapy (RT).
Methods: 1,760 men with non-metastatic PCa were enrolled before RT in the REQUITE observational study between 2014 and 2016 in 5 European countries and the USA. 1,096 had prospectively assessed fatigue before RT, at the end of RT, and then annually for up to 5 years using the Multidimensional Fatigue Inventory (MFI) [1] and the EORTC QLQ-C30 (C30) [2]. For the MFI, scores (range: 4–20) were calculated for the general fatigue (GF), physical fatigue (PF), mental fatigue (MF), reduced activity (RA) and reduced motivation (RM) dimensions. Moderate-to-severe fatigue levels were defined as scores above the 75% percentile in the male German general population ≥60 years [3]. EORTC QLQ-C30 normalised scores (range: 0–100) were calculated for the fatigue symptom scale (items 10, 12, 18), and moderate-to-severe fatigue levels defined as scores above the proposed threshold for clinical importance (≥39;) [4]. Higher scores indicate higher fatigue levels. Relationships between the fatigue symptom scale in the C30 and the MFI dimensions were quantified using Spearman's rank correlation coefficients. Percent agreement and deviations in the categorisation of patients as fatigued in both questionnaires were calculated. GF scores at the end of RT were analysed using a Tobit model in patients who underwent external beam RT (N=884) with adjustments for age, BMI, hormone therapy, prostatectomy, RT dose, tumour size, nodal involvement and baseline fatigue scores.
Results: The highest mean fatigue scores were observed at the end of RT for GF (score=10; N=1,005), PF (score=9.7) and RA (score=9.5). One year post-RT (N=894), scores approached pre-RT values and remained largely stable up to 5 years post RT (N=328). The highest proportion of patients with moderate-to-severe fatigue (>12 scores; 28%), was observed for GF at the end of RT, corresponding to an increase of 10% points from pre-RT. Moderate-to-severe PF and/or RA (>12 scores) at the end of RT were reported in 27% and 25%, respectively. In the multivariable analysis (N=884), receipt of hormone therapy and continuous pre-RT fatigue scores were associated with an increase in general fatigue at the end of RT by 1 (P<0.01) and 0.73 scores (P<0.01), respectively. Increasing age (β=-0.06, P<0.01) was associated with lower fatigue levels.
Fatigue scores in the C30 correlated most strongly with GF (rs=0.72), followed by PF (rs=0.59), and most weakly with RM (rs=0.42). 50.3% of patients reported no-to-low fatigue at the end of RT in both C30 and MFI, while 17.3% agreed on moderate-to-severe fatigue levels. 1.8% were identified as fatigued only in the C30, whereas 30.6% reported moderate-to-severe levels for at least one MFI dimension, but not in the C30 fatigue scale.
Discussion: More than one in four men with PCa reported clinically important fatigue levels at the end of RT, in particular with hormone therapy, higher pre-RT fatigue scores and younger age. Agreement between MFI and C30 reported fatigue levels was limited. Further multivariable longitudinal analyses will investigate the course of patient-reported fatigue.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
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