Depression, Rather Than Cancer-Related Fatigue or Insomnia, Decreased the Quality of Life of Cancer Patients

Abstract

Purpose: Cancer-related fatigue is a common and distressing symptom that occurs during cancer treatment. This study aimed to find factors that are related to cancer-related fatigue, and its effect on patients' quality of life.

Materials and methods: This study included 159 patients who completed questionnaires and interviews during their initial examination at the sleep clinic for cancer patients, Asan Medical Center, between December 2018 and January 2020. Their medical reports were reviewed retrospectively. Questionnaire data about depression, anxiety, insomnia, fear of disease progression, and dysfunctional beliefs about sleep, pain, and quality of life, were reviewed. Additionally, patient sleep structure data were analyzed.

Results: Factors such as depression (p < 0.001), anxiety (p < 0.001), fear of cancer progression (p < 0.001), fatigue (p=0.027), and time in bed during 24 hours (p=0.037) were significant expecting variables for low quality of life from logistic regression analysis. In pathway analysis, depression (p < 0.001), not cancer-related fatigue (p=0.537), act as a direct risk factor on quality of life. And also, depression was an overall risk factor for insomnia, fatigue, and daily activity of cancer patients.

Conclusion: Cancer-related fatigue did not show significant effect on patient's quality of life in this study. However, the result of pathway analysis highlights the importance of assessing depression in the process of cancer treatment and providing appropriate interventions.

Keywords: Cancer-related fatigue; Depression; Insomnia; Quality of life.

Fig. 1

Pathway analysis hypothesis model. C-DBS, Cancer-Related Dysfunctional beliefs about Sleep; Fatigue (NRS), Fatigue Numeric Rating Scale; FoP, Fear of Progression; ISI, Insomnia Severity Index; Pain (NRS), Pain Numeric Rating Scale; PHQ-9, Patient Health Questionnaire-9; STAI, State-Trait Anxiety Inventory; WHO-5 QoL, WHO-5 Questionnaire.

Fig. 2

Pathway analysis result. C-DBS, Cancer-Related Dysfunctional beliefs about Sleep; Faigue (NRS), Fatigue Numeric Rating Scale; FoP, Fear of Progression; ISI, Insomnia Severity Index; Pain (NRS), Pain Numeric Rating Scale; PHQ-9, Patient Health Questionnaire-9; STAI, State-Trait Anxiety Inventory; TIB/d, time in bed during 24 hours; WHO-5 QoL, WHO-5 Questionnaire.