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OP166 Patterns and predictors of cancer-related fatigue in the year following diagnosis of head and neck cancer: longitudinal findings from the head & neck 5000 cohort
  1. Linda Sharp1,
  2. Laua-Jayne Watson2,
  3. Liya Lu1,
  4. Sam Harding3,
  5. Joanne Patterson4
  1. 1Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  2. 2Speech and Language Therapy, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
  3. 3Bristol Speech and Language Therapy Research Unit, Southmead Hospital North Bristol NHS Hospital Trust, Bristol, UK
  4. 4Liverpool Head and Neck Centre, Liverpool University, Liverpool, UK


Background Cancer-related fatigue (CRF) is a common side-effect of cancer and its treatments. It is defined as a subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer that is distressing, persistent, and not proportional to recent activity. It is generally not relieved by sleep or rest and can have a detrimental impact on functioning, social activities and quality-of-life. Using data from the Head and Neck 5000 cohort, we investigated clinically-important CRF over the year post-diagnosis. Specifically, we: (1) assessed temporal trends; (2) compared CRF across HNC sites and by treatment received; and (3) identified subgroups with higher odds of CRF.

Methods Recruitment of incident HNC patients was undertaken 2011–2014 from 76 UK hospitals. Socio-demographic and clinical data, and patient-reported CRF, measured using the EORTC QLQ-C30 fatigue subscale, was collected at baseline (after diagnosis but pre-treatment) and 4-, and 12- months post-baseline. Clinically important CRF was defined as scoring ≥39 of a possible 100 on the fatigue subscale. Mixed-effects logistic multivariable regression was used to investigate time trends, compare cancer sites and treatment groups, and identify associations between clinical, socio-demographic and lifestyle variables and CRF. Analyses were done in STATA 16. P<0.05 (two-sided) was considered statistically significant.

Results 2,847 patients were included in the analysis. At baseline, 27.8% scored in the range for clinically important CRF. This rose to 44.7% at 4 months (when many patients were still undergoing treatment) and declined to 29.6% at 12 months. When stratified by treatment received, at 4-months more than half of those who had multi-modal treatment had CRF (surgery plus chemoradiotherapy, 57.7%; chemotherapy+radiotherapy, 56.1%); prevalence was much lower among those who had a single treatment (surgery, 31.4%; radiotherapy 37.5%). In the multivariable model, after adjusting for time-point, treatment modality and other variables, those who had depression at baseline had almost 15-fold increased odds of CRF over 12 months (mvOR=14.7, 95%CI 8.81–24.6). Odds of CRF over 12 months were also statistically significantly increased in females and current smokers and those with more advanced cancer and comorbid conditions at diagnosis.

Conclusion Almost one-third of HNC patients report clinically-important CRF at 12-months post-diagnosis. This high prevalence indicates the need for additional focus during cancer follow-up on this debilitating symptom and for interventions and supports to be made available to those affected. These findings identify characteristics of at-risk groups towards whom such interventions could be targeted.

  • cancer
  • survivorship
  • symptoms

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