Fatigue five years after treatment for rectal cancer – results from the QoLiRECT study

BACKGROUND AND PURPOSE: Fatigue affects colorectal cancer survivors and has a significant impact on overall quality of life (QoL) and possibly overall survival. Fatigue, with focus on patients with rectal cancer, is less studied. The aim of this study was to investigate fatigue prevalence at 5 years after rectal cancer surgery. PATIENT/MATERIAL AND METHODS: Data were collected from the Quality of Life in RECTal cancer study, a prospective longitudinal multicenter study of patients with rectal cancer, also using data from Swedish and Danish colorectal cancer registries. Baseline characteristics and treatment-related factors were investigated as potential predictors for fatigue measured with the Piper Fatigue Scale (PFS). Patients were included at diagnosis and answered questionnaires at baseline and at 5 years after diagnosis. RESULTS: The cohort consisted of 1024 patients who underwent surgery for rectal cancer. Five hundred and ninety three patients responded to the 5-year follow-up questionnaire. At 5 years, 52.4% of patients experienced fatigue. Moderate-severe fatigue (PFS ≥ 4) was reported by 172 patients (29%). Higher Body mass index (BMI) at baseline was associated with PFS ≥ 4 (Odds ratio [OR] 1.07, 95% Confidence interval [CI] 1.02–1.11, p = 0.004) in the univariate analysis, with similar results in multivariate analysis. A significant association was found between pain and moderate-to-severe fatigue in univariate analysis, OR 4.34 (p < 0.0001, 95% CI 2.91–6.49), but not in multivariate analysis, 2.8 (p < 0.0001, 95% CI 1.79–4.58). Higher QoL was negatively correlated with PFS ≥ 4 in both uni- and multivariate analyses (OR 0.37, 95% CI 0.30–0.46, p < 0.0001; OR 0.34, 95% CI 0.27–0.44 p < 0.0001). Major low-anterior resection syndrome (OR 2.17, 95% CI 1.09–4.34, p = 0.028) and permanent stoma (OR 1.92, 95% CI 1.06–3.47, p = 0.032) were associated with PFS ≥ 4 in the univariate, but not in the multivariate, analysis. INTERPRETATION: Moderate-severe fatigue is prevalent in rectal cancer survivors. Targeted prevention of fatigue might be of interest in long-term rehabilitation of rectal cancer survivors.