Cancer-related fatigue and its associated factors among breast cancer survivors in Sri Lanka: a cross-sectional study

Abstract

To investigate the predictors of fatigue in breast cancer survivors in Sri Lanka. Analytical cross-sectional study. National Cancer Institute, Maharagama, Sri Lanka. Using a systematic random sampling, from June 2022 to November 2022, we recruited 420 breast cancer survivors aged 18 years or more who were attending breast cancer follow-up clinics and were within 3–12 months after surgical treatment. We excluded those who had difficulty communicating or were diagnosed with a psychiatric disorder. Fatigue, sleep and mental health status were assessed using the validated Chalder Fatigue Questionnaire (CFQ), Pittsburgh Sleep Quality Index and Depression, Anxiety and Stress Scale 21, respectively. Demographic and social information was collected using a pretested interviewer-administered questionnaire. The intensity of any pain was assessed using a Visual Analogue Scale. Clinico-pathological information was extracted from the clinical records. Logistic regression models were used to determine the association of potential risk factors with fatigue. The mean age of the patients was 57.7 years (SD 10.2; range 29–89). The majority (79.0%) were fatigued. Depression, stress and anxiety were reported by 40.0%, 30.0% and 25.0%, respectively. Pain levels varied, with the majority (70.0%) reporting mild to moderate pain and 10.5% reporting severe pain. Fatigue was predicted by anxiety (OR 3.5; 95% CI 1.2 to 10.6), depression (OR 3.2; 95% CI 1.5 to 7.3), pain (OR 4.4; 95% CI 2.4 to 8.1) and chronic disease (OR 3.2; 95% CI 1.2 to 8.5) when compared with those without the respective condition but not by stress or sleep quality. Fatigue in breast cancer survivors is associated with pain and psychological factors rather than the type of breast cancer or treatment. Our findings could inform research to determine causal associations and preventive measures. The high prevalence of fatigue and psychological comorbidities must be considered in the follow-up of breast cancer survivors.