Fatigue is a common symptom among colorectal cancer survivors and can substantially reduce overall quality of life and potentially affect survival. The QoLiRECT study aimed to quantify the prevalence of fatigue five years after treatment for rectal cancer and to identify baseline and treatment-related predictors of moderate–severe fatigue using the Piper Fatigue Scale (PFS).
This investigation used data from the QoLiRECT study, an international, prospective, longitudinal multicentre cohort of patients with rectal cancer. The study also incorporated information from the Swedish and Danish colorectal cancer registries. Patients were enrolled at diagnosis and before treatment and were followed with standardized questionnaires addressing bodily functions, symptoms and quality of life at baseline and at 1, 2 and 5 years after diagnosis.
A total of 1,024 patients who underwent surgery for rectal cancer comprised the initial cohort. Of these, 593 patients responded to the questionnaire at the 5-year follow-up. The authors report that baseline characteristics were comparable between the initial and the 5-year respondent cohorts.
Fatigue was measured with the Piper Fatigue Scale (PFS). The study categorized moderate–severe fatigue as PFS ≥ 4. Other patient-reported measures included general pain and overall quality of life (QoL). Clinical variables considered included baseline body mass index (BMI), presence of major low anterior resection syndrome (LARS), and whether the patient had a permanent stoma.
Potential predictors of moderate–severe fatigue (PFS ≥ 4) were evaluated using logistic regression in both univariate and multivariate analyses. Baseline characteristics and treatment-related factors were investigated as candidate predictors. Specific model-building strategies, adjustment sets, and handling of missing data were not reported in the abstract.
At five years post-treatment, 52.4% of respondents reported any level of fatigue. Moderate–severe fatigue (PFS ≥ 4) was present in 172 patients, corresponding to 29.0% of those who returned the 5-year questionnaire.
Important associations reported:
Higher baseline BMI was associated with moderate–severe fatigue in univariate analysis (OR 1.07 per BMI unit, 95% CI 1.02–1.11, p = 0.004); similar results were observed in multivariate analysis.
Major LARS was associated with PFS ≥ 4 in univariate analysis (OR 2.17, 95% CI 1.09–4.34, p = 0.028).
Having a permanent stoma was associated with PFS ≥ 4 in univariate analysis (OR 1.92, 95% CI 1.06–3.47, p = 0.032).
General pain showed a strong and statistically significant association with moderate–severe fatigue. In univariate analysis the OR was 4.34 (95% CI 2.91–6.49, p < 0.0001); in multivariate analysis the adjusted OR was 2.8 (95% CI 1.79–4.58, p < 0.0001).
Higher overall quality of life was inversely associated with moderate–severe fatigue in both univariate (OR 0.37, 95% CI 0.30–0.46, p < 0.0001) and multivariate analyses (OR 0.34, 95% CI 0.27–0.4, p < 0.0001).
The study finds that moderate–severe fatigue is common among rectal cancer survivors at five years after surgery, affecting nearly one-third of respondents. Several potentially modifiable factors were associated with increased odds of fatigue, notably general pain and higher BMI, while better overall QoL was protective. Treatment sequelae that affect bowel function and body image—major LARS and permanent stoma—were associated with fatigue in univariate analyses. The authors suggest that targeted prevention or management of fatigue could improve overall QoL in this population.
The abstract does not provide full methodological detail on several points: the complete multivariable model covariates and selection procedure, how missing data were handled, rates and reasons for nonresponse at 5 years beyond the reported respondent count, and whether fatigue trajectories over time were modelled. Specific intervention recommendations or evaluations of causal mechanisms were not reported in the abstract. Full-text review would be required for these methodological and contextual details.
In this multicentre prospective cohort derived from the QoLiRECT study and national registries, fatigue at five years after rectal cancer surgery was common: 52.4% reported fatigue and 29.0% had moderate–severe fatigue (PFS ≥ 4). Higher baseline BMI, general pain, major LARS, and permanent stoma showed associations with fatigue (with pain and QoL retaining strong associations in multivariate analysis). The authors conclude that addressing fatigue may offer an opportunity to improve long-term quality of life for rectal cancer survivors.