Cancer-related fatigue and functional impairment: Retrospective study in patients with newly diagnosed solid-tumor cancer.

Dori Michelle Beeler Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC info_outline Dori Michelle Beeler, Danielle Boselli, Patrick L. Meadors, Declan Walsh

Authors Dori Michelle Beeler Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC info_outline Dori Michelle Beeler, Danielle Boselli, Patrick L. Meadors, Declan Walsh Organizations Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, NC, Carolinas Healthcare System, Charlotte, NC Abstract Disclosures Research Funding No funding received None. Background: Functional impairment (FI) and debilitating cancer-related fatigue (CRF) occur across all cancers with negative impact on quality of life (QoL). The nature of the association between CRF and FIs is unknown. We conducted a retrospective, single institutional study to investigate the association between CRF and FIs prior to treatment in newly diagnosed solid tumors within Levine Cancer Institute (LCI), a regional, multi-site cancer system. Methods: Electronic Distress Screening (EDS) and Cancer Registry databases from Jan 2017 to Jan 2022 were sourced. CRF was defined as fatigue (0-10 scale) ≥4. FIs were assessed using three EDS questions with a two-week recall: (1) how well have you been able to manage your day-to-day life? (PM); (2) has your physical health kept you from doing things like household chores or climbing stairs? (PHL); and (3) do you have limited movement (LM) in any of the following [body parts]? These are proxies for activities of daily living and instrumental activities of daily living. LCI patients aged ≥18 years with one cancer diagnosis within 10 years, completed EDS ±2 weeks of diagnosis, and before treatment were included. Proportions were compared using Fisher’s Exact test; multivariable logistic regression models evaluated the prognostic value of FIs on CRF. Results: 3439 unique patients were identified with strong associations between CRF and FIs. Median age was 62 years (18 to 97); 68% female and 78% White. The largest diagnostic groups were breast (30%), upper GI (17%), and gynecologic (16%); and 21% had stage IV disease. High CRF was reported by 57% (N = 1946) patients. FIs included: poor PM of day-to-day life, PHL, and ≥1 one body area of LM which were reported by 18% (N = 613), 19% (N = 648), and 29% (N = 982) respectively. More patients with FIs indicated CRF: PM 92% v. no PM 49% (P < .01), PHL 92% v. no PHL 48% (P < .01), and LM 75% v. no LM 49% (P < .01). In multivariable modeling, all FIs were significantly associated with CRF. The Table outlines that all lower bounds of estimated 95% confidence intervals ratios associated with odds ratios were greater than 1.66 when adjusted for age at diagnosis, sex, race, diagnostic group, and advanced disease, highlighting that all are independently associated with CRF. Conclusions: FIs are highly associated with CRF prior to treatment for solid tumors in a large cohort of patients. Pre-diagnosis FI screening identifies patients at risk for significant CRF. Early CRF management is essential to reduce negative QoL impacts. Association and prognostic value. FI CRF (%, N) P OR (95% CI) P Management of day-to-day life Poor 92% (563) < .01 4.09 (2.83, 5.92) < .01 Well 49% (1383) Physical health limits A lot 92% (594) < .01 4.33 (3.01, 6.24) < .01 Less than a lot 48% (1352) Body areas of limited movement ≥1 75% (733) < .01 2.04 (1.66, 2.51) < .01 0 49% (1213)