A multicentre survey of teenage and young adult cancer patients: fatigue is prevalent, poorly managed and perpetuates long term
Session type: Poster / e-Poster / Silent Theatre session
Fatigue is established as the most prevalent symptom in adults with cancer, with exercise the most effective intervention. The particular vulnerability of teenage and young adult (TYA) patients to fatigue has only recently been recognised, and fatigue hinders key developmental needs such as independence and socialisation. There have been no previous surveys focusing on TYA fatigue, nor interventional trials. This survey aimed to evaluate the severity, impact and current management of TYA cancer-related fatigue.
An electronic survey was sent to all patients aged 16-27 known to 3 of the 13 TYA cancer Principal Treatment Centres in the UK. One reminder was sent to non-responders.
Responders (n=80, response rate 41%) were aged 12-24 years at diagnosis and were 4-121 months after treatment (mean 27, SD 25; no difference from non-responders). Fatigue was the most prevalent and severe of 11 symptoms, occurring in 85% of respondents (68/80). It correlated strongly with poor quality of life (r=0.62, p<0.001). 41% (28/68) received no symptom management. Although advice to exercise was the most frequent management (27/68), paradoxically the greatest impact of fatigue was on the ability to exercise and only 8/27 found exercise advice helpful. Of note, fatigue was more severe (p=0.007) and less successfully managed (p=0.006) in those more than one year after the end of cancer treatment, compared to those within a year of treatment.
This survey provides the first evidence that fatigue can worsen beyond the accepted triggers of cancer diagnosis and treatment. This may reflect perpetuation by a deconditioning vicious cycle, TYAs being at particular risk of maladaptive behaviours such as inactivity. Current management is inadequate, with fatigue hindering the exercise that could ameliorate it. Research evaluating early intervention to promote activity should be prioritised, to prevent long-term perpetuation of this prevalent and debilitating symptom.