Patient Reported Experience with Fatigue, a Cross Sectional Study Examining Indolent and Aggressive Lymphomas

Introduction

Cancer-related fatigue (CRF) is a persistent, subjective sense of physical, emotional, or cognitive tiredness related to cancer or cancer treatment which negatively impacts functioning and quality of life (NCCN, 2015). The severity of CRF varies by lymphoma subtype, stage, and treatment received. Little information is known about patients’ experience with fatigue based on the rate of disease progression (indolent or aggressive lymphomas). This study aims to offer a unique insight into the fatigue experience of patients with indolent lymphomas compared to patients with aggressive lymphomas, using the Lymphoma Coalition (LC) 2022 Global Patient Survey (GPS) on Lymphomas and CLL.

Methodology

Globally, 8637 respondents comprised 7,113 patients and 1,524 caregivers from 84 countries completed the 2022 LC GPS. This analysis compared patients’ experience with fatigue in a subset of patients with aggressive lymphomas (n=2921) ('AL group') and indolent lymphomas (including CLL) (n=4573) ('IL group'). Demographics of both patient groups were used to analyze questions relating to patients’ experience of fatigue. Chi-square and p values were calculated as needed, and the statistical analyses were performed with IBM SPSS v27.

Results

Fatigue was the most reported symptom in both groups (IL group-67% and AL group -66%) (Table 1). While 46% of the AL group affected by fatigue as a symptom reported that their lymphoma treatment alleviated the fatigue, a lower proportion of patients in the IL group (37%) reported the same. Fatigue was also the top reported side effect for the IL group (65%) and the 2nd most reported side effect for the AL group (69%) (Table 1). When asked to rank the side effects that affected them the most, fatigue was one of the top 2 side effects, ranked 1 in both groups of patients (Table 1).

Patients were asked to rate the severity of their fatigue on a scale of 1 to 10 (1 being minimal fatigue and 10 being the worst fatigue imaginable). Results indicated that a higher proportion of patients in the AL group (50%) rated the severity between 6 -10 compared to those in the IL group (42%). Conversely, a higher proportion of patients in the IL group had experienced fatigue for 2 years or more (57%) compared to the AL group (36%). These differences are statistically significant (Table 1). Regarding fatigue's effect on the quality of life, half or more patients in both groups reported that fatigue affected their ability to carry out their general and physical activities and daily housework. In addition, fatigue was shown to affect mood, social activities, and enjoyment of life (Table 1).

Two-thirds of the IL group reported they had discussed their fatigue with their doctors in the last two years (from survey time), compared to half of the AL group. Over half of the patients in both groups reported that their doctors did not follow up on their fatigue (Table 1). Patients reported 'information about normal vs cancer-related fatigue and 'strategies to manage their fatigue as the top information given by their doctors, while 41% of the IL group were not provided with any information on fatigue by their doctors compared to 28% of AL group (Figure 1). Balancing time schedules was the top reported coping strategy in both groups (IL group-46% vs AL group- 42%). Exercise programs and mind-body interventions followed.

Conclusion

The results show that fatigue is the leading physical issue affecting the well-being of patients with indolent and aggressive lymphomas. However, some differences exist in how patients may experience fatigue in terms of fatigue severity and duration. These differences may be because aggressive and indolent lymphomas often differ in symptom presentation, severity, treatment type or whether patients communicate their fatigue with their doctor. Over 50% of all patients reported that when they expressed their fatigue to their doctor, they felt it was not addressed or followed up.

Given the multifactorial nature of fatigue, there is no standard treatment, and interventions that may help improve fatigue must be explored to treat underlying causes. The data highlights that regardless of lymphoma type, fatigue needs to be recognized and treated at all stages of a patient's disease, according to standard clinical practice guidelines. Healthcare providers and patients need to improve their communication about fatigue.

No relevant conflicts of interest to declare.