Aims. Cancer-related fatigue (CRF) can be a persistent problem for many patients post-treatment. The course and risk factors for CRF are not clear; nevertheless, such information is important for the clinical management of fatigue so that screening and interventions can take place at opportune times. This prospective longitudinal study aimed to explore the trajectory of fatigue from before chemotherapy and to examine the predictors of fatigue over time.

Methods. 100 patients (92% female; mean age = 49, SD= 11) with a variety of malignancies were recruited before chemotherapy (T1) and assessed again after treatment (T2) and at two follow-up times (T3: average of 4 months since treatment; T4: average of 8 months since treatment). Clinical (disease stage, treatment, comorbidities) and demographic (age, BMI, education) variables were recorded and participants completed questionnaires on fatigue severity, quality of life (QOL), psychological wellbeing (anxiety, depression and fear of recurrence), sleep disturbance, and activity levels across the four time-points. The prevalence and predictors of fatigue over time were investigated.

Results. The prevalence of severe fatigue increased after chemotherapy (48% with significant fatigue) but was comparable to baseline levels (38%) at follow-up (37%). Depression was the most significant predictor of fatigue across all time-points. Higher levels of fatigue before chemotherapy predicted more severe fatigue at follow-up. Participants with persistent fatigue across both follow-up assessments had significantly higher anxiety and depression at T1 and T2 and significantly lower QOL at T3 and T4. Clinical and demographic variables were not associated with CRF.

Conclusions. Although fatigue is common, most patients experience transient fatigue over the cancer trajectory. Nevertheless, persistent fatigue presents a significant problem for a minority of patients. The findings suggest that early interventions to reduce anxiety and depression might be effective in decreasing CRF and preventing the development of persistent fatigue post-treatment.