Fatigue Trajectories Research Articles

P-1977. Six-Month Trajectory of Symptoms of COVID-19 Fatigue by Age and BNT162b2 COVID-19 Vaccination Status: A Prospective Study among Symptomatic US Adults Testing Positive for SARS-CoV-2 at a National Retail Pharmacy

Abstract Background Fatigue is one of the most common symptoms experienced by patients with COVID-19, potentially interfering with daily activities. This study assessed the 6-month trajectory of fatigue from time of testing across age and BNT162b2 BA.4/5 bivalent COVID-19 Vaccine strata.Figure 1.Prevalence of symptoms of fatigue across groups defined by age and BNT162b2 COVID-19 Vaccination statusa) Overall cohort by BNT162b2 vaccination status Methods Symptomatic US adults testing positive for SARS-CoV-2 at CVS Health were recruited between 03/02-05/18/2023 (CT.gov: NCT05160636). Study participants self-reported symptoms of fatigue via an online survey during the acute (testing day, Week 1, Week 2) and long-term phase (Week 4, Month 3 and 6 after testing). The prevalence of fatigue was evaluated at each time point in the overall cohort and across groups defined by vaccination status and age (older adults: ≥50; younger adults: < 50). Between-group differences were tested by using chi-square statistics. b) Overall cohort by age Results The analyses included 643 study participants: 49% (316) vaccinated with BNT162b2 bivalent and 51% (327) unvaccinated; 43.1% (277) ≥50 and 56.9% (366) < 50 years old. A total of 424 (65.9%) participants self-reported symptoms of fatigue at time of testing. Their mean age was 46.5 years, 71.2% were female, 25.9% had ≥1 comorbidity, 43.2% had prior infection. The presence of fatigue was higher during the acute phase and remained prevalent during the long-term follow-up: 50.9% at Week 1, 41.1% at Week 2, 24.4% at Week 4, 19.6% at Month 3, and 18.5% at Month 6 (Figure 1a). While older and younger adults had similar prevalence of fatigue during the acute phase, at Week 4 the younger adults reported higher prevalence (28.7% vs 18.2%, p=0.007) (Figure 1b). In the overall cohort, and relatively consistently across age groups, those vaccinated with BNT162b2 reported significantly (p< 0.005) lower prevalence of fatigue at Week 4, Month 3 and 6 (Figures 1a, 1c, 1d). c) Younger adults (<50) Conclusion This study found that fatigue is a highly prevalent symptom affecting two-thirds of symptomatic adults at time of testing. While prevalence declined over time, fatigue symptoms persisted beyond the acute phase, with 1 in 5 still affected at Month 6. Compared with those vaccinated with BNT162b2 bivalent, the prevalence of fatigue was higher among unvaccinated throughout the follow-up, reaffirming the value of being up-to-date with COVID-19 vaccination. d) Older adults (≥50) Disclosures Manuela Di Fusco, PhD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Alexandra Berk, PhD, CVS Health: Employee|CVS Health: Stocks/Bonds (Public Company) Kristen E. Allen, MPH, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Thomas M. Porter, MPH, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Mary B. Alvarez, PharmD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Joseph C. Cappelleri, PhD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Mary M. Moran, MD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Xiaowu Sun, PhD, CVS Health: Employee|CVS Health: Stocks/Bonds (Public Company)

P1246 Fatigue trajectory and the impact of disease course through the first year after diagnosis in patients with Inflammatory Bowel Disease (the IBSEN III study)

Abstract Background Fatigue is common in both Crohn's disease (CD) and ulcerative colitis (UC), but the pathogenesis is still unclear. The primary aim of this study was to assess the odds for substantial fatigue (SF) and chronic fatigue (CF) one year after diagnosis based on the presence of SF at baseline. The secondary aim was to identify clinical factors that may be associated with SF one year after diagnosis. Methods Patients ≥18 years with a definite diagnosis of CD or UC at 1-year follow-up were recruited from the Inflammatory Bowel Disease South-Eastern Norway (IBSEN III) study, a population-based, observational inception cohort. Patients who completed the Fatigue Questionnaire (FQ) at the time of diagnosis and at the 1-year follow-up were included. CF was defined as a dichotomized FQ score ≥4 (SF) with duration ≥ 6 months. Univariate binary logistic regression analysis was used to estimate the odds for SF/CF one year after diagnosis depending on the presence of SF at baseline. Associations between SF at the 1-year follow-up and possible predictive clinical factors were included in a multivariate logistic regression model. All analysis were performed stratified by type of diagnosis. Results In total, 596/1370 (43.5%) patients were included (CD: 196 (32.9%), UC: 400 (67.1%)). The presence of SF at the time of diagnosis compared to no initial fatigue, significantly increased the odds for SF (CD: OR=8.23, 95% CI [4.13; 16.39], UC: OR=6.67, 95% CI [4.24; 10.49]) and CF (CD: OR=6.38, 95% CI [2.71; 15.03], UC: OR=4.59, 95% CI [2.68; 7.83]) at the 1-year follow-up. Among patients with CD, development of non-passable stricture and/or surgically treated stricture within first year of disease (OR=4.37, 95%CI [1.58;12.11]), subjective flares since diagnosis (OR=2.22, 95%CI [1.11; 4.43]), female gender (OR=2.96, 95%CI [1.47; 5.95]) and presence of comorbidities (OR=4.36, 95%CI [2.06; 9.22]) were all independently associated with SF at the 1-year follow-up. For patients with UC, current biological treatment (OR=5.14, 95%CI [1.56; 16.96]), Mayo endoscopic score (0-3) at the 1-year follow-up (OR=1.54, 95%CI [1.01; 2.35]), subjective flares since diagnosis (OR=2.66, 95%CI [1.24; 5.72]) and female gender (OR=2.20, 95%CI [1.06; 4.57]) were independently associated with SF at the 1-year follow-up. Conclusion Fatigue may be expected to persevere during the first year of disease if present at the time of diagnosis. For patients with CD as well as UC, clinical factors reflecting severe disease, as severe stricturing disease in CD, biological therapy and higher Mayo endoscopic score in UC, were significantly associated with SF one year after diagnosis. Furthermore, comorbidities (only CD), female gender and subjective flares since diagnosis increased the odds for SF.

Association Between Treatment-Related Adverse Event Trajectory and Prognosis in Esophageal Cancer Receiving Neoadjuvant Immunochemotherapy.

Immunochemotherapy is inevitably accompanied with treatment-related adverse events (TRAEs). However, TRAEs are typically assessed at a single time point, overlooking the complexity of TRAE trajectories over time. This study aimed to characterize TRAE trajectories during multi-cycle neoadjuvant immunochemotherapy (nICT) and identify potential prognostic factors for patients with esophageal squamous cell carcinoma (ESCC). This prospective cohort study enrolled locally advanced ESCC patients treated with nICT between July 2020 and August 2022. The study recorded and graded TRAEs according to common terminology criteria for adverse events (CTCAE) v5.0. Latent-class mixed-modeling (LCMM) was used to identify the TRAE trajectories. Prognosis and tumor response of different TRAE trajectories were further analyzed. The study finally enrolled 75 eligible patients (mean age, 62.4years; 77.3% male). The major TRAEs with high incidence were fatigue (90.7%), alopecia (74.7%), pruritus (60.0%), nausea (49.3%), vomiting (41.3%), and pain (33.3%). Two- and three-cluster trajectory models provided the best fit for TRAEs. Most TRAEs showed improvement over time except for the subgroups of fatigue and alopecia, which tendedto worsen. Furthermore, the patients with a severe gastrointestinal TRAE trajectory had poorer overall survival than those with a mild gastrointestinal TRAE trajectory (hazard ratioadjusted, 3.97; 95% confidence interval, 1.09-14.51; p = 0.037). Higher objective tumor response rates were associated with a mild fatigue trajectory (p = 0.039) and a mild pain trajectory (p = 0.016). For patients with locally advanced ESCC, most TRAEs such as pruritus, nausea, vomiting, and pain improvedover time, whereas fatigue and alopecia tendedto worsen in multi-cycle nICT. A mild gastrointestinal TRAE trajectory wasassociated with better survival.

Prevalence, Trajectory, and Predictors of Post-stroke Fatigue in Older Adults

ObjectiveTo explore the prevalence, trajectories, and predictors of Post-stroke fatigue (PSF) in older adults following a first ischemic stroke. DesignA longitudinal observational cohort study. SettingTwo hospitals. ParticipantsA total of 381 patients aged ≥ 65 years with their first ischemic stroke were included. The mean (SD) age was 71.1 (4.27) years, with 96 patients (25.2%) being women and 285 (74.8%) being men. InterventionsNot applicable. Main Outcome MeasuresPatients were assessed using the Fatigue Severity Scale (FSS) at admission, 3 months, and 12 months. Growth mixture models (GMM) were used to identify distinct fatigue trajectories, and baseline variables were analyzed to determine their association with these trajectories. ResultsThe prevalence of clinical fatigue was 39.11%, 33.33%, and 22.31% at admission, 3 months, and 12 months, respectively. Five distinct fatigue trajectories were identified: persistently low fatigue (class 1, 49.1%), persistently high fatigue (class 2, 21.5%), initial high but early decreasing fatigue (class 3, 15.0%), initial high but late decreasing fatigue (class 4, 8.7%), and increasing-then-decreasing fatigue (class 5, 5.8%). Multinomial logistic regression analysis revealed that several factors were significantly associated with high and persistent fatigue (class 2), including older age, lower social support, decreased physical activity, higher depression and anxiety scores, cognitive impairment, and greater stroke severity. ConclusionThese findings indicate significant variability in the progression of fatigue among stroke survivors. Further research is necessary to determine the outcomes linked to these fatigue trajectory subgroups and to identify the most effective treatment strategies tailored to each specific subgroup.

Fatigue trajectories by wearable remote monitoring of breast cancer patients during radiotherapy

The aim of this pilot study was to assess the compliance of breast cancer (BC) patients with fitness tracker (FT) monitoring program during radiotherapy (RT) and to characterize radiation-induced fatigue (RIF) status through objective evaluation using FT-collected parameters. Thirty-six BC patients were invited to wear FT during their RT course for continuous monitoring of heart rate (HR) and step counts (STP). RIF assessment was performed weekly, according to CTCAE v5.0 and dichotomized into G0 vs. any-grade. A novel concept based on patient Repeated Activity Window (RAW) was introduced to evaluate HR and STP variations during RT. Several Machine Learning (ML) methods were trained to characterize RIF on the basis of HR and STP collected data. RIF of any grade was reported by 17 out of 36 patients (47%) included in the study. None of patient clinical variables were significantly correlated with RIF. All patients accepted the FT monitoring program, and for 32 patients FT collection efficiency was greater than 60%. For each patient, a distinct distribution of RAWs was identifiable over RT and across the entire patient cohort, with a total of 7950 RAWs processed. Six features related to RAWs, HR and STP were identified as associated with RIF. The best-performing classifier was the Bagged Trees model, showing a cross-validated ROC-AUC of 89% (95% CI 88–90%). This study confirms the feasibility of continuous biomedical monitoring of BC patients by FT. We successfully identify objective indicators of RIF through HR and STP variation measures within each patient’s RAW, thus providing a novel and practical approach to assess and manage RIF. This can significantly aid medical staff in evaluating RIF trajectories, potentially leading to better individualized care strategies and improved patient outcomes.

Chronic fatigue in the general population: Prevalence, natural course and associations with chronic pain (theHUNT pain study).

Fatigue and pain are both prevalent and frequently co-occur. No standard measure of fatigue exists, but most definitions include a continuum between high levels of energy and fatigue. There is limited knowledge about the course of fatigue in the general population and its association with functioning and other health outcomes. Our main aim was to identify trajectories of energy and fatigue in the general population and to investigate whether chronic pain is related to a negative prognosis of chronic fatigue. Longitudinal latent class analysis was performed to classify 4771 individuals into trajectory groups based on five quarterly repeated measures. A five-cluster solution was identified: 'much energy' (n = 1471, [31%]), 'varying energy' (n = 1445, [30%]), 'some energy' (n = 921, [19%]), 'low energy' [chronic moderate fatigue] (n = 852, [18%]) and 'no energy'[chronic severe fatigue] (n = 82, [2%]). Individuals with chronic moderate fatigue who reported chronic pain had reduced probability of improvement over the following 3 years (OR = 0.67, 95% CI [0.52, 0.88]). Chronic fatigue is highly prevalent in the general population and a small proportion have chronic severe fatigue. When chronic pain co-occurs with chronic fatigue, improvement of chronic fatigue is less likely, indicating that these symptoms may perpetuate each other. Understanding the close relationship between chronic pain and chronic fatigue is important as they both contribute to suffering and loss of functioning, may be related to the same underlying diseases, or in the absence of disease, may share common mechanisms. This study highlights the important role of chronic pain in relation to chronic fatigue, both by showing a strong association between the prevalence of the two conditions, and by showing that chronic pain is associated with a negative prognosis of chronic fatigue.

The substantial role of sleep, stress and physical activity in persistent high levels of fatigue in patients with inflammatory bowel disease: A longitudinal trajectory study.

Fatigue is a common and burdensome problem for patients with inflammatory bowel disease (IBD). Previous studies lack insight into the individual variability in fatigue severity and course over time, and the characteristics of patients at risk of severe and persistent fatigue. This study aimed to identify distinct groups of IBD patients based on their level and course of fatigue over five years. Subsequently, we examined the relationship between these trajectories, patient characteristics and trajectories of perceived stress, sleep and physical activity. This longitudinal cohort study used prospectively collected data from the myIBDcoach telemedicine monitoring tool, including 320 IBD patients who completed three or more online consultations between 2016 and 2021. Latent class growth analyses were performed to identify distinct trajectories. We found five subgroups with distinct trajectories of fatigue, differing in level and course over time, with 33% of patients experiencing chronic stable and high levels of fatigue. Few differences in patient characteristics were found between trajectories, yet the chronic high fatigue subgroup was more likely to report persistent stable sleep problems, perceived stress, and little physical activity over time compared to the other groups. Distinct subgroups of IBD patients can be identified based on longitudinal fatigue trajectories. The relatively stable levels of fatigue, stress, sleep, and physical activity suggest that a one-time screening of patients on these topics may be sufficient to identify those at risk. Interventions aiming to reduce fatigue should target persistent stress, sleep problems, and low levels of physical activity.

One-year trajectories of physical and mental health-related quality of life, fatigue and dyspnoea in COVID-19 survivors.

A substantial number of people experience a persisting impact on health-related quality of life (HRQoL) after COVID-19. The current study aims to identify different trajectories of physical and mental HRQoL, fatigue severity, and dyspnoea severity following hospitalisation with COVID-19, and associated factors of these trajectories. 500 patients with COVID-19 were followed for one year in a longitudinal cohort study. Self-reported outcomes were measured at 3, 6, 9, and 12 months after hospitalisation. Distinct trajectories were characterised using Growth Mixture Modelling. Sociodemographic and clinical correlates of trajectories were investigated using multivariable (multinomial) logistic regression analyses. Three trajectories ('stable high' (16%), 'improving' (40%), and 'stable low' (44%)) were found for physical HRQoL, and four ('stable high' (43%), 'improving' (14%), 'middle declining' (17%), and 'low' (26%)) for mental HRQoL. Older age, overweight and obesity, lower education, and comorbidities were associated with 'low' physical HRQoL. Younger age was associated with 'low' mental HRQoL. Four fatigue trajectories ('no fatigue' (15%), 'improving' (40%), 'low-severe' (27%), and 'high-severe' (18%)) were found. Participants either experienced almost never ('no dyspnoea', 75%) or almost always ('severe', 25%) dyspnoea. High co-occurrences between low HRQoL and severe fatigue and dyspnoea symptom trajectories were found. A substantial number of COVID-19 survivors continue to struggle with reduced HRQoL over time. However, large variations in these physical and mental HRQoL trajectories exist, and trajectories are associated with persisting COVID-19-related symptoms or pre-hospitalised health status. Regular measurement of HRQoL and post-COVID symptoms may help identify those that may benefit from timely interventions.

Trajectories of self-reported fatigue following initiation of multiple sclerosis disease-modifying therapy

BackgroundWe analysed the COMparison Between All immunoTherapies for Multiple Sclerosis (NCT03193866), a Swedish nationwide observational study in relapsing–remitting multiple sclerosis (RRMS), to identify trajectories of fatigue and their association with...

Predictors of treatment response trajectories to cognitive behavioral therapy for chronic fatigue syndrome: A cohort study

BackgroundThe response to cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS) varies greatly between patients, but predictors of treatment success remain to be elucidated. We aimed to identify patient subgroups based on fatigue trajectory during CBT, identify pre-treatment predictors of subgroup membership, and disentangle the direction of predictor – outcome relationships over time. Methods297 individuals with CFS were enrolled in a standardized CBT program consisting of 17 sessions, with session timing variable between participants. Self-reported levels of fatigue, depressive, anxiety, and somatic symptoms, perceived stress, and positive affect were collected pre-treatment, and after 3, 10, and 15 sessions. Latent Class Growth Analysis (LCGA) was used to identify subgroups based on fatigue trajectories and baseline predictors of group membership. Cross-lagged structural equation models were used to disentangle predictor-outcome relationships. ResultsLCGA identified four fatigue trajectory subgroups, which were labelled as “no improvement” (23 %), “weak improvement” (45 %), “moderate improvement” (23 %), and “strong improvement” (9 %) classes. Higher pre-treatment levels of depressive, anxiety, and somatic symptoms, stress, and lower levels of positive affect predicted membership of the “no improvement” subgroup. Reductions in anxiety preceded reductions in fatigue, while the depressive symptoms – fatigue relationship was bidirectional. ConclusionsOn a group level, there were statistically significant reductions in fatigue after 15 sessions of CBT, with important individual differences in treatment response. Higher pre-treatment levels of anxious, depressive, and somatic symptoms and perceived stress are predictors of lack of response, with reductions in anxiety and stress preceding improvements in fatigue.

Trajectory patterns and predictors of cancer-related fatigue in postoperative lung cancer patients receiving chemotherapy.

Cancer-related fatigue (CRF) is a chronic symptom that can affect the overall functioning of lung cancer patients throughout the course of the disease. However, there is limited research on the trajectory and predictors of CRF specifically in lung cancer patients. Furthermore, few studies have investigated the predictive role of positive psychological and social factors in relation to CRF. This study aimed to explore the trajectory of CRF and its predictors in postoperative chemotherapy patients with lung cancer. A total of 202 lung cancer patients who underwent surgery and received adjuvant chemotherapy were recruited for this study. Baseline questionnaires were completed, covering sociodemographic information, disease details, CRF levels, personality traits, psychological resilience, and social support. CRF was assessed at three time points: first chemotherapy (T1), 3months after chemotherapy (T2), and 6months after chemotherapy (T3). Latent class growth modeling (LCGM) was used to identify distinct developmental trajectories of CRF. Logistic regression analysis was employed to examine predictors of CRF within different patient groups. The LCGM analysis revealed three distinct CRF trajectories: persistent high fatigue group (30.7%), rising fatigue group (30.7%), and no fatigue group (38.6%). Cancer stage (OR = 7.563, 95% CI = 2.468-23.182, P < 0.001), melancholic personality (OR = 6.901, 95% CI = 1.261-37.764, P = 0.026), and high psychological resilience (OR = 0.171, 95% CI = 0.041-0.706, P = 0.015) were associated with the CRF trajectory. On the other hand, sanguine personality (OR = 0.254, 95% CI = 0.071-0.916, P = 0.036) and high social support (OR = 0.168, 95% CI = 0.045-0.627, P = 0.008) were associated with the increasing fatigue trajectory. This study demonstrated that 60% of lung cancer patients experienced persistent fatigue throughout the assessment period. Moreover, it confirmed the heterogeneity of CRF trajectories among lung cancer patients. The severity of CRF was found to be higher in patients with advanced clinical stages, depressive personality traits, and lower psychological resilience.

Analysis of factors influencing the trajectory of fatigue in maintenance haemodialysis patients: a longitudinal study.

To explore the potential categories and influencing factors of fatigue trajectory in maintenance haemodialysis patients. Between June 2023 and December 2023, a convenience sample of 306 maintenance haemodialysis patients in a tertiary hospital haemodialysis centre in Zhenjiang City was selected as the study population, and patient information was collected monthly after the baseline survey using the General Information Questionnaire, Pittsburgh Sleep Quality Scale, Piper Fatigue Revision Scale, Collaborative Social Support Scale, Patient Health Questionnaire Depression Scale, Comprehensive Economic Toxicity Rating Scale, and Fear of Disease Progression Simplified Scale, for a total of six follow-up visits. In addition, the potential category growth model was used to identify the developmental trajectory of fatigue, and univariate analysis and binary logistic regression were used to analyse its determinants. The 6month fatigue trajectory of maintenance haemodialysis patients could be divided into two categories: persistent low-fatigue group (59.8%) and fluctuating high-fatigue group (40.2%). Age, surgical history, level of social support, sleep, economic toxicity, and changes in ultrafiltration volume during dialysis were the influencing factors for repeated fatigue in maintenance haemodialysis patients (p < 0.05). The fatigue trajectory of maintenance haemodialysis patients is heterogeneous, suggesting that clinical workers should focus on the haemodialysis patients with repeated fatigue and make targeted interventions to improve their fatigue status and reduce the occurrence of adverse events in patients.

The association analysis between fatigue and body composition loss in patients with nasopharyngeal carcinoma during radiotherapy: An observational longitudinal study

PurposeThis study aimed to reveal the association of fatigue with weekly changes in the body composition in patients with nasopharyngeal carcinoma (NPC) and identified the independent strength. MethodsFour body composition indexes and fatigue were assessed before treatment (T0, baseline) and once a week throughout radiotherapy (T1-T7). Generalized additive mixed models (GAMMs) were used to explore the trajectories and longitudinal relationships of fatigue and weekly changes in body composition. The marginal structural model (MSM) was used to control the effect of depression and anxiety. ResultsThe trajectories of fatigue in 105 participants reached a peak in the fifth week, and changes in body composition started appearing from the second week. Four body composition indexes, weight, body mass index (BMI), body fat rate, and lean body weight loss weekly were positively associated with fatigue. High magnitude of effects was revealed when anxiety and depression were controlled as time-dependent confounders. The positive associations with fatigue were manifested in patients aged >53 years, those with senior high and above education, no drinking, >5000 Y/month of family inflow, ≥ stage III, or those receiving a dose of ≥70 Gy, ≥3 cycles of induced chemotherapy, and ≤1 cycle of concurrent chemotherapy. ConclusionsLoss of weight, BMI, body fat rate, and lean body weight could be used to independently evaluate the development of fatigue in patients with NPC during radiotherapy. Positive associations between fatigue and weekly body composition loss were found in patients with certain characteristics.

P187 Fatigue in people with polymyalgia rheumatica: a key unmet need?

Abstract Background/Aims Polymyalgia rheumatica (PMR) is common in older adults, causing severe pain and stiffness, particularly in the shoulder and hip girdles. Glucocorticoids treatment generally focusses on reducing pain and stiffness, but there are other aspects to quality of life. Fatigue is a well-recognised symptom in other inflammatory rheumatological conditions and has been highlighted by people with PMR as a neglected symptom. Methods People with newly diagnosed PMR in English general practice (2012-2014, n = 652) were recruited to a postally-administered cohort study. Surveys included items relating to PMR, general health and well-being. The FACIT-Fatigue questionnaire was included in the survey at diagnosis, 1, 12, 24 and (mean) 61 months follow-ups. Latent class growth analysis was used to define trajectories, based on FACIT-Fatigue scores over time. Trajectories were characterised and compared at baseline and over time. Results 244 people participated at 24 months and 197 at 61 months. Individuals were allocated to one of five fatigue trajectories. Each represented a different average level of fatigue at diagnosis that remained stable over time (Table). From least to most fatigued, trajectory sizes were 111, 122, 211, 133 and 75. Two thirds of the cohort (the three “worst” trajectories) were, on average, more fatigued than reported in the general population. Worse fatigue trajectory was associated with female sex, higher pain and stiffness, higher levels of anxiety, depression, insomnia, and poorer physical function at baseline and throughout. Conclusion Fatigue is common in inflammatory conditions, but under-recognised in PMR. Fatigue severity at the time of diagnosis appears indicative of fatigue levels up to five years later and is associated with a broad range of health constructs at diagnosis and later. This represents an unmet need in a sizable proportion of those with PMR, who may need more help to manage their condition and allow them to return to full function. These findings also present a potential avenue for early identification of those with a poor prognosis related to their PMR. Disclosure S. Muller: None. J. Belcher: None. S. Hider: None. T. Helliwell: None. C.D. Mallen: None.

Trajectories of fatigue and related outcomes following mild acquired brain injury: a multivariate latent class growth analysis.

Fatigue is a common symptom following acquired brain injury although the severity and course differs for many individuals. This longitudinal study aimed to identify latent trajectory classes of fatigue and associated outcomes following mild brain injury. 204 adults with mild traumatic brain injury (159; 78%) or minor stroke (45; 22%) were assessed 4 times over 1 year. Subjective measures of fatigue, anxiety, depression, cognitive complaints and societal participation were collected. Multivariate Latent Class Growth Analysis identified classes of participants with similar longitudinal patterns. Demographic and injury characteristics were used to predict class membership. Analysis revealed four classes. Class 1 (53%) had mild, decreasing fatigue with no other problems. Class 2 (29%) experienced high persistent fatigue, moderate cognitive complaints and societal participation problems. Class 3 (11%) had high persistent fatigue with anxiety, depression, cognitive complaints and participation problems. Class 4 (7%) experienced decreasing fatigue with anxiety and depression but no cognitive or participation problems. Women and older individuals were more likely to be in class 2. Half the participants had a favourable outcome while the remaining classes were characterised by persistent fatigue with cognitive complaints (class 2), decreasing fatigue with mood problems (class 4) or fatigue with both cognitive and mood problems (class 3). Fatigue treatment should target combinations of problems in such individual trajectories after mild brain injury.

SARS-CoV-2 infection is associated with physical but not mental fatigue – Findings from a longitudinal controlled population-based study

ObjectiveFatigue has been identified as the core symptom of long-Covid, however, putative pandemic-related influences remain largely unclear. We investigated trajectories of total, physical and mental fatigue and the factors associated with it in previously infected and non-infected individuals up to one year post- infection. MethodsWe used data from a longitudinal cohort study of German adults with two samples: A representative probability sample and a sample of individuals with proven SARS-CoV-2 infection. Surveys were conducted in spring 2020(T1), autumn 2020(T2) and summer 2021(T3). Fatigue was assessed using the FAS, distinguishes between physical and mental fatigue. Depression, anxiety and stress were assessed using PHQ-4 and PSQ. Results1990 participants [mean age 47.2 (SD = 17.0), 30.5% previously infected] were included in the survey at T1 (n = 1118 at T2, n = 692 at T3). Total and physical fatigue, but not mental fatigue were significantly higher in the previously infected compared to the non-infected sample at T2, but this group difference disappeared at T3. We identified Covid-infection as a factor associated with transient total and physical fatigue at T2. Depression, anxiety and stress at T1 were associated with total, physical and mental fatigue at both follow-ups. ConclusionsOur results highlight the importance of considering physical and mental fatigue as separate entities, while suggesting a greater relevance of the physical signs of fatigue in understanding long-Covid. The results further showed that baseline mental health symptoms were the most strongly associated with fatigue trajectories.

A qualitative study of pain and related symptoms experienced by people with Ehlers-Danlos syndromes.

Individuals with Ehlers-Danlos syndromes (EDS) often have complex and multi-faceted symptoms across the lifespan. Pain and the related symptoms of fatigue and sleep disorders are common. The objective of this qualitative study was to understand how participants manage their pain and related symptoms. The design was a qualitative thematic content analysis. Twenty-eight interviews were conducted to collect data from individuals who were participants in a prior quantitative longitudinal study. A semi-structured interview guide was designed to focus on and understand the trajectory of pain, sleep, fatigue, and general function. The interview continued with questions about coping mechanisms and obstacles to maintaining a sense of well-being. Symptoms reported by participants were widespread and often interwoven. Pain was universal and often resulted in fatigue and disordered sleep which impacted physical function. Most participants reported that their symptoms worsened over time. Participants reported a wide range of effective interventions and most reported developing self-care strategies to adapt to their disabilities/limitations. Solutions included complementary interventions discovered when conventional medicine was unsuccessful. Very few relied on a "system" of health care and instead developed their own strategies to adapt to their disabilities/limitations. EDS symptoms are often debilitating, and their progression is unknown. For most participants, symptoms worsened over the time. Even though participants in our study, by experience, were self-reliant, the importance of knowledgeable medical providers to help guide self-care should be emphasized.

Cancer-related fatigue trajectories up to 5 years after curative treatment for oesophageal cancer

BackgroundWhether cancer-related fatigue develops differently after curative-intended oesophageal cancer treatment and the related modifiable factors are unclear.MethodsThis population-based and longitudinal cohort included 409 oesophageal cancer patients who underwent curative oesophagectomy in 2013–2020 in Sweden. The main outcome was cancer-related fatigue trajectories with measurements at 1, 1.5, 2, 2.5, 3, 4 and 5 years postoperatively by validated EORTC QLQ-FA12 questionnaire, and analysed using growth mixture models. Weighted logistic regressions provided odds ratios (OR) with 95% confidence intervals (95% CI) for underlying sociodemographic, clinical, and patient-reported outcome factors in relation to the identified trajectories.ResultsTwo distinct overall cancer-related fatigue trajectories were identified: low level of persistent fatigue and high level of increasing fatigue, with 64% and 36% of patients, respectively. The odds of having high level of fatigue trajectory were increased by Charlson comorbidity index (≥ 2 versus 0: OR = 2.52, 95% CI 1.07–5.94), pathological tumour Stage (III–IV versus 0-I: OR = 2.52, 95% CI 1.33–4.77), anxiety (OR = 7.58, 95% CI 2.20–26.17), depression (OR = 15.90, 95% CI 4.44–56.93) and pain (continuous score: OR = 1.02, 95% CI 1.01–1.04).ConclusionsLong-term trajectories with high level of increasing cancer-related fatigue and the associated modifiable factors were identified after oesophageal cancer treatment. The results may facilitate early identification and targeted intervention for such high-risk patients.

Trajectories and risk factors of fatigue following colorectal cancer diagnosis.

This study sought to identify groups of colorectal cancer patients based upon trajectories of fatigue and examine how demographic, clinical and behavioural risk factors differentiate these groups. Patients were from six cancer centres in the United States and Germany. Fatigue was measured using the fatigue subscale of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) at five time points (baseline/enrolment and 3, 6, 12 and 24 months after diagnosis). Piecewise growth mixture models identified latent trajectories of fatigue. Logistic regression models examined differences in demographic, clinical and behavioural characteristics between fatigue trajectory groups. Among 1615 participants (57% men, 86% non-Hispanic White, mean age 61 ± 13 years at diagnosis), three distinct groups were identified. In the high fatigue group (36%), fatigue significantly increased in the first 6 months after diagnosis and then showed statistically and clinically significant improvement from 6 to 24 months (P values < 0.01). Throughout the study period, average fatigue met or exceeded cutoffs for clinical significance. In the moderate (34%) and low (30%) fatigue groups, fatigue levels remained below or near population norms across the study period. Patients who were diagnosed with Stage II-IV disease and/or current smokers were more likely to be in the high fatigue than in the moderate fatigue group (P values < 0.05). A large proportion of colorectal cancer patients experienced sustained fatigue after initiation of cancer treatment. Patients with high fatigue at the time of diagnosis may benefit from early supportive care.

Duchenne Muscular Dystrophy Fatigue Trajectories.

Children with Duchenne muscular dystrophy (DMD) are at risk of experiencing fatigue that negatively impacts their health-related quality of life (HRQoL). This study aimed to assess the association between fatigue and HRQoL, by examining fatigue trajectories over 48 weeks, and assessing factors associated with these fatigue trajectories. The study sample consisted of 173 DMD subjects enrolled in a 48-week-long phase 2 clinical trial (NCT00592553) for a novel therapeutic who were between the ages of 5 and 16 years. The results of regression modeling show baseline fatigue and baseline HRQoL (R 2 = 0. 54 for child self-report and 0.51 for parent proxy report) and change in fatigue and HRQoL over 48 weeks (R 2 = 0.47 for child self-report and 0.36 for parent proxy report) were significantly associated with one another. Three unique fatigue trajectories using Latent Class Growth Models were identified for child and parent proxy reported fatigue. The risk of being in the high fatigue group as compared to the low fatigue group increased by 24% with each year increase in age and also with decreasing walking distance, as reported by children and parent proxy, respectively. This study identified fatigue trajectories and risk factors associated with greater fatigue, helping clinicians and researchers identify the profile of fatigue in DMD children.