Fatigue trajectories in long-term non-Hodgkin lymphoma survivors.

Abstract

e20053 Background: Fatigue is a common and distressing effect of cancer and its treatment. Prior research suggests fatigue persists long after diagnosis and treatment in non-Hodgkin lymphoma (NHL) survivors. This study aimed to identify distinct trajectories of fatigue in NHL survivors and predictors of trajectories that could inform clinical care. Methods: Our secondary analysis used data from a longitudinal study of NHL survivors (n = 886) at least 2 years post-diagnosis. Fatigue was measured using the SF-36 vitality subscale across three time points. Prior literature informed the selection of baseline demographic (e.g. age, gender, race) and disease characteristics [e.g. NHL type, comorbidities, post-traumatic stress disorder (PTSD)] explored as possible predictors of fatigue trajectories. We used group-based trajectory modeling to identify distinct groups of patients experiencing similar patterns of fatigue. Variables significant in bivariate analysis were included in a stepwise multinomial logistic regression to identify factors predictive of group membership. Results: We identified four distinct trajectories that suggest levels of fatigue persist unchanged over time. The Low Fatigue Group (15.6%) experienced less fatigue than the general population. The Population Norm Group (42.5%) experienced a similar level of fatigue to the general population mean. The Significant Fatigue Group (27.5%) experienced fatigue levels almost one standard deviation worse than the general population. The Worst Fatigue Group (14.3%) experienced fatigue almost two standard deviations worse than the population norm. PTSD symptoms and comorbidity scores were predictive of levels of fatigue over time. Greater age at diagnosis increases the odds survivors experienced worse fatigue than the population mean (Table). Conclusions: Levels of fatigue experienced early in an NHL patients’ disease trajectory may persist for many years. Higher levels of PTSD symptoms and comorbidities were predictive of worse fatigue over time. Early interventions addressing PTSD symptoms and comorbidities may improve long term fatigue outcomes. [Table: see text]