The trajectory of cancer-related fatigue throughout lung cancer treatment and its association with physical activity

Background: Cancer-related fatigue (CRF) is a debilitating symptom in patients with lung cancer and is often more severe than in other cancer populations. This study investigated the impact of different cancer treatments on CRF trajectories and the role of physical activity (PA) during treatment. Methods: Patients with non-small cell lung cancer (NSCLC) were included. CRF was assessed at diagnosis, during treatment, and 12 weeks after treatment initiation using the Multidimensional Fatigue Inventory (MFI-20). Delta MFI-20 (T-followup - T-diagnosis) was compared across treatments (surgery, surgery and (neo-)adjuvant treatment, and non-surgical treatment). PA was measured with an Actigraph GT3X (for 1 week during hospitalization after surgery and/or halfway through (neo-)adjuvant treatment), capturing daily step count and minutes of moderate to vigorous PA (MVPA). Delta MFI-20 between the three groups and the association with PA during treatment were examined using multivariable general linear models. Results: Sixty-two patients (66 +/- 8 years, 66% male) were included. CRF increased significantly more in patients receiving surgery and (neo-)adjuvant treatment (n = 12) compared to surgery alone (n = 29) (Delta MFI-20, 16 +/- 17 vs. 0.3 +/- 13; p < 0.05). The increase in CRF in non-surgically treated patients (n = 21) (Delta MFI-20, 6 +/- 19) was not statistically different (p = 0.41) from those receiving surgery. Patients performed 3695 +/- 2288 steps/day and 11 +/- 14 min of MVPA/day during treatment. Patients engaging in higher levels of PA during treatment (> 5000 steps/day or > 10 min of MVPA/day) tended to have lower CRF increases compared to most inactive patients (< 3000 steps/day) (Delta MFI-20, 6.4 +/- 4.9; p = 0.06). Conclusions: Patients with lung cancer experience significant increases in CRF throughout treatment, particularly those receiving (neo-)adjuvant treatment and surgery. PA levels during treatment were very low and tended to be related to lower fatigue increases. These findings highlight the importance of measuring CRF and the potential for exploring PA interventions to manage CRF.