Quality of Life in Women with Gynecologic Cancer and Coexisting Chronic Conditions: The Role of Cancer-Related Fatigue and Perceived Caregiver Support

Abstract

Background: Women with gynecologic cancer and coexisting chronic conditions may experience extensive symptom burden and impaired quality of life. However, the adjusted associations of cancer-related fatigue, multimorbidity, and perceived caregiver support with quality of life remain insufficiently understood. Methods: A cross-sectional study was conducted among 210 Chinese women with cervical, ovarian, endometrial, or vulvar cancer and at least one physician-diagnosed chronic condition. A structured questionnaire was used to collect socio-demographic data, clinical data, quality-of-life measures, cancer fatigue levels, and perceived caregiver support. Hierarchical linear regression models with robust standard errors were used to examine factors associated with quality of life. Results: The mean quality of life score was 62.16 (SD = 18.72), and the mean fatigue score was 26.80 (SD = 12.39). Ninety-two participants (43.8%) had two or more chronic conditions. Quality of life was strongly negatively correlated with fatigue (r = −0.78, p < 0.001) and positively correlated with perceived caregiver support (r = 0.33, p < 0.001). Demographic and clinical factors explained 26.2% of the variance in quality of life. Adding perceived caregiver support increased the explained variance to 28.6%, and greater support was associated with better quality of life (B = 3.45, p = 0.006). After fatigue was added, the explained variance increased to 68.0%. Greater fatigue was strongly associated with poorer quality of life (B = −1.11, p < 0.001), whereas perceived caregiver support was no longer significant (B = 0.40, p = 0.672). FIGO stage III–IV disease remained associated with lower quality of life (B = −4.39, p = 0.005). The association between multimorbidity and quality of life was attenuated in the final model (B= −3.11, p = 0.063). Conclusions: Cancer-related fatigue was strongly associated with poorer quality of life among women with gynecologic cancer and coexisting chronic conditions. Perceived caregiver support was associated with better quality of life before fatigue was included in the model, but this association was attenuated after adjustment for fatigue. These findings support routine fatigue assessment and integrated symptom management in supportive care for this population.