Cancer-Related Fatigue and Its Influencing Factors Among Colorectal Cancer Patients: A Generalized Linear Modeling Approach

Purpose: This study aimed to improve cancer-related fatigue (CRF) and health outcomes of colorectal cancer patients by understanding the status quo of CRF, exploring the relations of coping, anxiety symptoms, depressive symptoms, body image perception and CRF, and also identifying the factors affecting CRF based on a generalized linear modeling approach. Patients and methods: An exploratory cross-sectional study was conducted on 370 colorectal cancer patients at two hospitals in Anhui Province, China, from July 2020 to February 2021. The data were collected by using general information questionnaire, cancer fatigue scale, simplified coping style questionnaire, generalized anxiety disorder-7 scale, patient health questionnaire-9, and body image scale. Descriptive statistics, t-tests, one-way analysis of variance, Pearson correlation analyses, and generalized linear model analyses were applied to analyze the data. Results: The average CRF score of the patients was 21.612 (SD=6.160), with a prevalence rate of 69.4% for clinically relevant fatigue. The generalized linear model revealed that: In step 1, gender (female) (B=1.799, Wald chi(2)=7.506, p=0.006), per capita monthly income (1001-3000 RMB) (B=-1.673, Wald chi(2)=5.536, p=0.019) and treatment modalities (chemotherapy+others) (B=2.425, Wald chi(2)=8.211, p=0.004) were related to CRF. In step 2, depressive symptoms (B=1.223, Wald chi(2)=129.019, p<0.001) and negative coping strategies (B=0.215, Wald chi(2)=11.347, p=0.001) exhibited significant positive correlations with CRF, positive coping strategies (B=-0.319, Wald chi(2)=59.175, p<0.001) showed significant negative correlations with CRF; While anxiety symptoms (B=0.162, Wald chi(2)=1.840, p=0.175) and body image perception (B=0.013, Wald chi(2)=0.048, p=0.826) had no correlations with CRF. Conclusion: The prevalence of CRF was relatively high among colorectal cancer patients. Coping and depressive symptoms were the modifiable influencing factors of CRF. Tailored interventions dedicated to promoting positive coping behavior, diminishing negative coping behavior and reducing depressive symptoms may improve the CRF of patients with colorectal cancer. Healthcare providers working with these patients should receive corresponding education and training in these complementary treatments. Additionally, when developing non-pharmacological interventions, appropriate consideration of the patients' gender, income condition and the type of anticancer treatment is also necessary.