Prevalence of cancer-related fatigue based on severity: a systematic review and meta-analysis

Abstract

Cancer-related fatigue (CRF) affects therapeutic compliance and clinical outcomes including recurrence and mortality. This study aimed to comprehensively and comparatively assess the severity-based prevalence of CRF. From two public databases (PubMed and Cochrane Library), we extracted data containing information on both prevalence and severity of fatigue in cancer patients through December 2021. We conducted a meta-analysis to produce point estimates using random effects models. Subgroup analyses were used to assess the prevalence and severity by the organ/system tumor development, treatment phase, therapeutic type, sex and assessment method. A total of 151 data (57 studies, 34,310 participants, 11,805 males and 22,505 females) were selected, which indicated 43.0% (95% CI 39.2-47.2) of fatigue prevalence. The total CRF prevalence including 'mild' level of fatigue was 70.7% (95% CI 60.6-83.3 from 37 data). The prevalence of 'severe' fatigue significantly varied by organ/system types of cancer origin (highest in brain tumors 39.7% vs. lowest in gynecologic tumors 3.9%) and treatment phase likely 15.9% (95% CI 8.1-31.3) before treatment, 33.8% (95% CI 27.7-41.2) ongoing treatment, and 24.1% (95% CI 18.6-31.2) after treatment. Chemotherapy (33.1%) induced approximately 1.5-fold higher prevalence for 'severe' CRF than surgery (22.0%) and radiotherapy (24.2%). The self-reported data for 'severe' CRF was 20-fold higher than those assessed by physicians (23.6% vs. 1.6%). Female patients exhibited a 1.4-fold higher prevalence of 'severe' fatigue compared to males. The present data showed quantitative feature of the prevalence and severity of CRF based on the cancer- or treatment-related factors, sex, and perspective of patient versus physician. In the context of the medical impact of CRF, our results provide a comparative reference to oncologists or health care providers making patient-specific decision.

Figure 1

PRISMA flow-chart of patient selection for the meta-analysis.

Figure 2

Prevalence of CRF according to severity and cancer type: The meta-analysis-derived prevalence of CRF according to 4 levels of severity and 8 organ/system types of cancer origin are presented inside each circle, and the prevalence rates are proportional to the size of the circles. The 95% CI is displayed only for the ‘total’ prevalence, which was synthesized with prevalence indicated as fatigue per data, regardless of severity. ^aindicates the number of data used for meta-analysis. ^bindicates the total number of patients enrolled for data analysis (some participants were counted repeatedly for mixed cancer). The detailed data can be found in Table S1.

Figure 3

Prevalence rates of CRF according to severity using 37 data: The prevalence of CRF was presented in three levels, using only 37 data representing 'mild', 'moderate' and 'severe' CRF. Meta-analysis, mean estimate and pooled prevalence were provided for each fatigue severity and their sum.

Figure 4

Prevalence rates of CRF according to phase and type of treatment: The meta-analysis-derived prevalence of CRF is presented by the organ/system of cancer origin using only data regarding the treatment phase (A), which showed statistical significance (p < 0.01). The prevalence of CRF in only those with ‘moderate’, ‘severe’ and ‘moderate to severe’ fatigue is presented by treatment phase (B) and type of treatment (C). The 95% CI is shown as a bar for each data. The statistical significance of the results in (B) and (C) is indicated by the p value. The detailed data can be found in Table S2.

Figure 5

Prevalence of ‘severe’ CRF according to sex: The meta-analysis-derived prevalence of CRF is presented based on sex across each subclass, with only data with sex-related information shown. The statistical significance (p < 0.05) is shown in only the subgroup analysis for those who were receiving ongoing treatment. The detailed data can be found in Table S3.

Figure 6

Prevalence of CRF according to assessment strategy and continent: The meta-analysis-derived prevalence of CRF was presented by assessment method (A), assessment tool (B) and continent (C). The detailed data including 95% CI can be found in Table S4.