The Consequences of Fatigue in Patients Diagnosed with Hepatobiliary Carcinoma

Background: Fatigue is one of the most common and distressing symptoms of patients diagnosed with cancer. However, few treatments have been developed to alleviate the symptoms of cancer-related fatigue. The aims of the present study were to prospectively (1) assess the prevalence of fatigue in patients diagnosed with hepatobiliary carcinoma, (2) evaluate the relationship among fatigue, depression, sleep, and pain, (3) examine the relationship between fatigue and biological factors while covarying for potential contributing psychological and biological factors in patients diagnosed with hepatobiliary carcinoma.

Method: One hundred and one patients diagnosed with hepatobiliary carcinoma were administered a battery of questionnaires that included the Functional Assessment of Cancer Therapy-Hepatobiliary and Fatigue modules as well as the Center for Epidemiological Studies-Depression scale prior to the initiation of treatment and at 2- and 4-months post-treatment. Granulocyte colony stimulating factor (G-CSF), white and red blood cell counts, hemoglobin levels and cytokine levels were measured in the patients’ sera at approximately the same time points as fatigue. Descriptive statistics, trajectory analyses and non-parametric analyses were employed to examine the relationships among variables.

Results: Nearly 100% of the patients included in the study reported symptoms of fatigue. Fatigue was significantly associated with depression at baseline (p < 0.001), two months (p = 0.02), and four months (p=0.003). Pain (r = 0.403, p = 0.02) and sleep (r = -0.29, p = 0.02) were both associated with fatigue at baseline but not at two months or four months. Prior to treatment, there was a trend towards significance for the association between fatigue and abnormal levels of GCSF (Mann-Whitney U = 454.5, p = 0.061). Fatigue was significantly associated with abnormal levels GCSF at both two months (Mann-Whitney U = 49.0, p = 0.009) and four months (Mann-Whitney U = 4.00, p = 0.008).

Conclusions: Consistent with prior research, fatigue is associated with decreased quality of life, depressive symptoms, sleep, and pain. The association between fatigue and abnormal levels of GCSF may be important as treatments are considered for patients experiencing symptoms of cancer-related fatigue.