Self-Reported Fatigue in Patients with Rheumatoid Arthritis Compared to Patients with Cancer – Results from Two Large Scale Studies

Abstract

Objectives: Fatigue is a common symptom in patients with rheumatoid arthritis (RA) and in patients with cancer (CA). We compared RA patients and CA patients with regard to the severity of fatigue and potential influencing factors. Methods: Data were collected by means of a survey with RA patients in Germany and an international validation study with CA patients. Both large scale studies used the EORTC QLQ-FA12 as fatigue assessment tool. The questionnaire assesses five components of fatigue: Physical, Emotional, Cognitive, Interference with Daily Life, and Social Sequelae. Scores range from 0 to 100; higher scores represent a higher symptom burden. Multivariable analyses made use of ANCOVAs. Results: Data of n = 705 RA patients and of n = 943 CA patients were available for analyses. RA patients reported significantly higher Physical Fatigue (mean difference = 7·0, 95% CI = 4·2 – 9·7, p < 0·001) and Social Sequelae (mean difference = 7·5, 95% CI = 4·7 – 10·2, p < 0·001). CA patients reported higher Cognitive Fatigue (mean difference = 3·5, 95% CI = 1·4 – 5·6, p = 0·001). No differences in Emotional Fatigue (p = 0·678) and Interference with Daily Life (p = 0·098) were found. In RA patients, mental health and pain were associated with fatigue (p values < 0·001). Conclusion: RA patients showed a considerable level of fatigue that is comparable to and in certain cases even higher than that of CA patients. The implementation of standardized diagnostic procedures and interventions to reduce fatigue in RA patients are recommended. Trial Registration: The trial was registered with study database of the German Network of Health Services (VfD_TRACE_14_003438). Funding: This work was supported by a grant from Chugai Pharma Germany GmbH (ID 16 Klinik Publikationsvertrag Version 4·0). Chugai Pharma Germany GmbH had no role in the design of the study or the approval of the study results. Declaration of Interest: JGK reports grants and personal fees from Chugai during the conduct of the study. JGK reports outside the submitted work grants, personal fees and non-financial support from Abbvie, Actelion, Boehringer-Ingelheim, Biogen, Gilead, GSK, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, Roche, Takeda, UCB. JW received a grant from EORTC Quality of Life Department and from DFaG for the development of EORTC FA12. MK received a grant from DFaG for the conduct of the TRACE study. All other authors have declared no conflicts of interest in the context of this research. Ethical Approval: Patients were recruited from February 2014 to February 2015. The TRACE study was approved by the Ethics Committee of the University of Regensburg (reference number 13-160-0275).