Fatigue in survivors of malignant melanoma and its determinants: a register-based cohort study

• Published in: Supportive care in cancer 2019-08, Vol.27 (8), p.2809-2818
• Main Authors: Tibubos, Ana Nanette, Ernst, Mareike, Brähler, Elmar, Fischbeck, Sabine, Hinz, Andreas, Blettner, Maria, Zeissig, Sylke R., Weyer, Veronika, Imruck, Barbara H., Binder, Harald, Beutel, Manfred E.
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adult; Aged; Aged, 80 and over; Cancer patients; Cancer Survivors - psychology; Cancer Survivors - statistics & numerical data; Chronic diseases; Chronic illnesses; Cohort analysis; Cohort Studies; Fatigue; Fatigue - epidemiology; Fatigue - etiology; Female; Humans; Male; Medicine; Medicine & Public Health; Melanoma; Melanoma - complications; Melanoma - epidemiology; Melanoma - psychology; Melanoma, Cutaneous Malignant; Mental health; Middle Aged; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Patient compliance; Quality of Life; Quantitative analysis; Registries; Rehabilitation Medicine; Risk Factors; Skin cancer; Skin Neoplasms - complications; Skin Neoplasms - epidemiology; Skin Neoplasms - psychology; Social Support; Surveys and Questionnaires; Survivor
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-018-4587-1

Purpose Fatigue has found increasing attention as a debilitating and lasting condition of cancer patients. However, it has remained unclear to what degree long-term survivors of malignant melanoma suffer from fatigue. Therefore, this study aimed to determine fatigue and its link with quality of life, aftercare behavior, and mental and physical symptoms among melanoma survivors. Methods A register-based sample of 684 long-term survivors an average of 8.4 ( SD  = 1.72; range 5.67–12.17) years after diagnosis was compared to 2049 participants from a representative survey by the Multidimensional Fatigue Inventory. In a hierarchical linear regression, statistical predictors for fatigue were ascertained. Results Overall fatigue was not increased in melanoma survivors except for younger melanoma survivors under 40 years. As in the general population, fatigue increased with age, and it was higher in women compared to men. Fatigue was associated with decreased quality of life, reduced functioning, and increased physical and mental symptoms. Substantial predictors (30% explained variance) were higher age, additional chronic illness, self-blame, detrimental interactions and lack of social support, and also fear of recurrence. There was neither an effect of medical parameters (clinical stage, time since diagnosis) nor of participation in follow-up care. Conclusions Fatigue needs to be taken seriously in the aftercare of melanoma survivors as it is associated with multiple functional and quality of life impairments and heightened distress. Reduction of fatigue in melanoma patients should address younger survivors (under 40 years) and older survivors (over 60 years) with additional chronic illness and focus on illness coping and social support.