Study Finds Women with Gynecologic Cancers Have Significant Fatigue After Surgery

A 1-year longitudinal study published in Cancer suggested that almost half of women with gynecologic cancers had clinically significant fatigue after surgery, while 44% and 39% had fatigue 6 months and 1 year later, respectively.

According to researchers, this suggests that spontaneous regression of symptoms in this patient population is relatively rare. However, future studies should examine scalable interventions to improve fatigue in women with gynecologic cancers.

“These findings underscore the importance of developing scalable and effective transdiagnostic interventions to reduce fatigue in survivors of gynecologic cancers,” the authors wrote. “Because nearly one-third of fatigued patients reported concurrent depressive symptoms after the initial surgical treatment, psychological interventions that address fatigue and mental health may be the most effective strategy for improving quality of life among women with ovarian and endometrial cancers.”

In this prospective cohort study, researchers assessed women with newly diagnosed ovarian cancer (n = 81) and endometrial cancer (n = 181) that did not progress or recur within 1 year of treatment completion. Symptoms of fatigue, depression, and anxiety were evaluated after surgery and 6 and 12 months after treatment completion using the Fatigue Assessment Scale and the Hospital Anxiety and Depression Scale.

Of the total study cohort, 48% reported clinically significant fatigue following surgery. One year after surgery, the percentage decreased to 39% reporting fatigue. Notably, there were 6 patterns observed over time, including always low (37%), always high (25%), high then resolves (18%), new onset (10%), fluctuating (6%), and incidental (5%).

Patients with fatigue after their surgery were more likely to report fatigue at 12 months compared to other patients (OR, 6.08; 95% CI, 2.82-13.11; P < 0.001). Moreover, those with depressive symptoms also had higher odds of fatigue (OR, 3.36; 95% CI, 1.08-10.65; P = 0.039), though only one-third of patients with fatigue also reported depressive symptoms.

“Our findings also suggest that interventions targeting cancer- and treatment-related fatigue and depressive symptoms may be particularly promising; for example, using cognitive behavioral therapy to address psychological distress and change fatigue-related cognitions and behaviors may reduce fatigue while simultaneously improving depressive symptoms,” the authors wrote. “However, because 68% of fatigued patients did not report baseline depressive symptoms, interventions targeting depressive symptoms alone (i.e., antidepressants) are unlikely to improve fatigue in this population.”

Notably, women who were treated with surgery and radiation were less likely to report persistent fatigue at 12 months compared to women who were treated with surgery alone. However, all of those receiving surgery and radiation had endometrial cancer, and 93% had early-stage disease. Importantly, early-stage endometrial cancer is generally treated with brachytherapy and has fewer toxicities, a shorter treatment course, and less fatigue compared with external-beam radiation.

Moving forward, investigators indicated that future studies are necessary to determine whether unmeasured patient characteristics, such as body mass index and frailty, or specific treatment modalities, such as exploratory laparotomy vs laparoscopic surgery, may help further explain these study findings. Moreover, a few of the patterns of fatigue that were observed in this study had a small number of patients within the groups (e.g., the fluctuating and incidental patterns), representing clinically distinct subpopulations; therefore, a larger, prospective study is warranted to validate the patterns observed.

Reference:

Poort H, de Rooij BH, Uno H, Weng S, Ezendam NPM, van de Poll-Franse L, Wright AA. Patterns and Predictors of Cancer-Related Fatigue in Ovarian and Endometrial Cancers: 1-Year Longitudinal Study. Cancer. doi: 10.1002/cncr.32927.