Clinical Study

BJC Open article

British Journal of Cancer (2008) 99, 1408–1414. doi:10.1038/sj.bjc.6604739
Published online 21 October 2008

Severe fatigue and related factors in cancer patients before the initiation of treatment

M M Goedendorp1, M F M Gielissen1, C A H Verhagen2, M E J W Peters2 and G Bleijenberg1

  1. 1Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, 4628, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
  2. 2Department of Medical Oncology, Radboud University Nijmegen Medical Centre, 452, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands

Correspondence: Dr MM Goedendorp, E-mail:

Received 27 May 2008; Revised 22 September 2008; Accepted 24 September 2008
Advance online publication 21 October 2008



It is generally known that fatigue is a common symptom during cancer treatment, and in cancer survivors. However, fatigue was never studied after diagnosis, before cancer treatment was initiated. This study investigated the prevalence of severe fatigue, and related factors, in cancer patients before the initiation of treatment. One hundred and seventy-nine patients with various malignancies were assessed before start of treatment with curative intention, including the Checklist Individual Strength, Sickness Impact Profile, Beck Depression Inventory Primary Care, Symptom Checklist-90, and six Numeric Rating Scales to measure fatigue, pain and physical activity. To test which factors contributed to severe fatigue a logistic regression analysis was performed. In total 23.5% patients were severely fatigued, varying between diagnoses; prostate cancer (14.3%), breast cancer (20.3%), and gastrointestinal cancer (28.1%). Currently lower physical activity (P=0.013), more depressive mood (P=0.014), impaired sleep and rest during the day and night (P=0.045), and fatigue 1 year before diagnosis (P=0.005) contributed to severe fatigue. Relatively large numbers of cancer patients already experience severe fatigue before initiation of treatment, varying between 14–28%. The factors that contributed to severe fatigue at this stage were physical activity, depressive mood, impaired sleep and rest, and fatigue 1 year before diagnosis.


depressive mood; diagnosis; fatigue; neoplasm; physical activity; sleeping problems



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