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. 2025 Oct;133(6):831-843.
doi: 10.1038/s41416-025-03116-z. Epub 2025 Jul 15.

Fatigue in long-term cancer survivors: prevalence, associated factors, and mortality. A prospective population-based study

Melissa S Y Thong  1 , Daniela Doege  2 , Lena Koch-Gallenkamp  3 , Heike Bertram  4 , Andrea Eberle  5 , Bernd Holleczek  6 , Alice Nennecke  7 , Annika Waldmann  8 , Sylke Ruth Zeissig  9   10 , Ron Pritzkuleit  11 , Elmar Brähler  12   13 , Hermann Brenner  3   14 , Volker Arndt  2
Affiliations

Fatigue in long-term cancer survivors: prevalence, associated factors, and mortality. A prospective population-based study

Melissa S Y Thong et al. Br J Cancer. 2025 Oct.

Abstract

Background: We compared fatigue severity in breast, prostate or colorectal cancer survivors 5-16 years post-diagnosis with cancer-free controls, and examined factors associated with fatigue and its association with all-cause mortality in survivors.

Methods: Participants of the CAncEr Survivorship - A multi-Regional (CAESAR) study completed the Fatigue Assessment Questionnaire (FAQ) between 2009 and 2011. The FAQ assesses affective, cognitive, and physical fatigue, and sleep problems. We derived the odds of fatigue using logistic regression with the 75th percentile of population norms as the cut-off. All-cause mortality (up to end 2021) was estimated using Cox regression models.

Results: The sample comprised 6057 survivors, of whom approximately one-third reported affective, cognitive, or physical fatigue. Demographic (age, relationship), clinical (chemotherapy), comorbidity (depression), lifestyle, and psychological factors were associated with higher odds of fatigue symptoms and total fatigue. Fatigue symptoms, predominantly physical fatigue, were strongly associated with mortality (unadjusted hazard ratios (HRs) ranged from 1.48 to 2.40). The HRs were attenuated after adjustment for comorbidities and depressive symptoms, although affective and physical fatigue remained independent risk factors for mortality.

Conclusions: Demographic, clinical, comorbidity, lifestyle, and psychological factors were associated with fatigue in long-term survivors. Fatigued survivors have a higher mortality risk. Lowering the burden of fatigue by a comprehensive approach might result in better survival.

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Conflict of interest statement

Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The ethics committee of the University of Heidelberg (S499/2012) and the responsible local ethics committees of the participating cancer registries approved the CAESAR study. All participants provided written informed consent. All methods were performed in accordance with the relevant guidelines and regulations.

Figures

Fig. 1
Fig. 1. Mean fatigue scores of cancer survivors and non-cancer controls, stratified by age at survey.
Models are adjusted for age at survey, gender, and education. The y-axis indicates the maximum score range and the mean values are shown in the columns. All results are based on 25 imputations of missing values.
Fig. 2
Fig. 2. Mean fatigue scores of cancer survivors and non-cancer controls, stratified by sex and by cancer type.
Models are adjusted for age at survey and education. The p-values indicate the global comparison between cancer survivors and controls, separate by sex. The y-axis indicates the maximum score range and the mean values are shown in the columns. All results are based on 25 imputations of missing values.
See this image and copyright information in PMC

References

    1. De Angelis R, Demuru E, Baili P, Troussard X, Katalinic A, Chirlaque Lopez MD, et al. Complete cancer prevalence in Europe in 2020 by disease duration and country (EUROCARE-6): a population-based study. Lancet Oncol. 10.1016/S1470-2045(23)00646-0 (2024). - PubMed
    1. Arndt V, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B, et al. Quality of life in long-term and very long-term cancer survivors versus population controls in Germany. Acta Oncol. 2017;56:190–7. - PubMed
    1. Santos JC, Pyter LM. Neuroimmunology of behavioral comorbidities associated with cancer and cancer treatments. Front Immunol. 2018;9:1195. - PMC - PubMed
    1. Thong MSY, van Noorden CJF, Steindorf K, Arndt V. Cancer-related fatigue: causes and current treatment options. Curr Treat Options Oncol. 2020;21:17. - PMC - PubMed
    1. Schmidt ME, Wiskemann J, Schneeweiss A, Potthoff K, Ulrich CM, Steindorf K. Determinants of physical, affective, and cognitive fatigue during breast cancer therapy and 12 months follow-up. Int J Cancer. 2018;142:1148–57. - PubMed

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