A Comparison of Fatigue Among Resectable Colorectal and Pancreatic Cancer Patients

Purpose: Both colorectal and pancreatic cancer patients suffer from gastrointestinal associated symptoms that cause nutrition insufficiency. Under impaired nutritional status, cancer patients are prone to experience fatigue. However, there is currently no study that compares fatigue status between colorectal cancer and pancreatic cancer patients. Therefore, the aim of this study was to compare the perceived fatigue among patients with colorectal cancer and pancreatic cancer; and to explore the associated factors among demographic and clinical characteristics, functional lower extremity strength, and grip strength for fatigue in overall patients.

Methods: A cross-sectional research design was conducted. Data were collected using a structured questionnaire including demographic and clinical characteristic form, and the Chinese version of the Fatigue Symptom Inventory (FSI). Grip strength was tested by the Jamar^R plus+ digital hand dynamometer. Functional lower extremity strength was evaluated with the 30-second chair stand test. A total of 64 preoperative cancer patients, including 32 with colorectal cancer and 32 with pancreatic cancer, were recruited from a medical center in northern Taiwan. The generalized estimating equation (GEE) was used to examine the significant associated factors with fatigue for overall patients.

Results: There were no significant differences in demographic factors in the two groups. However, the disease characteristics including functional status (p=.005), cancer stage (p=.005), body mass index (p=.020), regular exercise habit (p=.001), and having comorbid chronic illness (p=.003) demonstrated significant statistical differences. Furthermore, there were significant differences in fatigue between the two preoperative cancer groups; and pancreatic cancer patients had higher FSI score than colorectal cancer patients. However, the statistical significance of cancer types disappeared after adjustment for functional status, cancer stage, body mass index, regular exercise habit, and having comorbid chronic illness. The significant associated factor with fatigue was functional status measured by Karnofsky Performance Status Scale (KPS). Patients who had lower KPS score (β=-.976, p=.018) reported higher score in FSI. There were no significant statistical differences in the 30-second chair stand test and grip strength between the two groups.

Implication for practice: Healthcare providers should pay extra attention and assess potential fatigue conditions for cancer patients with lower preoperative functional status. Nursing education regarding fatigue management may be indicated for both cancer populations who experience impaired functional status. Further research with larger sample size should be done to examine fatigue characteristics among both groups and intervention should also be developed accordingly.