• Louise Baussard, Cécile Proust-Lima, Vivianne Philipps, Fabienne Portales, Marc Ychou, Thibault Mazard, and Florence Cousson-Gélie.
• University of Nîmes (L.B.), APSY-V Research Laboratory, Nîmes, France. Electronic address: Louise.baussard@unimes.fr.
• J Pain Symptom Manage. 2022 Jan 1; 63 (1): 140-150.

ObjectivesThis longitudinal prospective and observational study was designed to identify fatigue trajectories during a 6-month period of chemotherapy in patients with metastatic colorectal cancer, and examine the psychosocial factors predicting these trajectories. Associations between fatigue and survival were also investigated.MethodsA total of 169 patients (Mage = 64.36 years, SD = 10.5) reported their fatigue levels every 2 weeks for 6 months. Psychological variables (anxiety, depression, internal control, and coping) were assessed at baseline. A Growth Mixture Model was used to identify latent trajectories of fatigue, and a multinomial logistic regression tested covariate predictors of patients' trajectories.ResultsFour clinically distinct fatigue trajectories were identified: intense fatigue (6.51%), moderate fatigue (48.52%), no fatigue (33%), and increasing fatigue (11.83%). Fatigue severity was directly associated with overall survival. High depression levels were associated with fatigue severity over time for intense (OR = 1.80 [1.32-2.47]) and for moderate (OR = 1.58 [1.25-2.00]) fatigue, compared to patients reporting no fatigue. Patients who did not report fatigue were better adjusted, and had more resources, such as better internal control over the disease and less emotion-focused coping (guilt and avoidance), than those who reported intense (ORcontrol = 0.77 [0.65-0.92]) or moderate (ORcontrol = 0.89 [0.79-0.99] and ORcoping = 1.13 [1.02-1.24]) fatigue.ConclusionFatigue trajectories differed considerably across patients with metastatic colorectal cancer. This first longitudinal study on colorectal cancer patients involving transactional variables suggests that psychosocial interventions should target these specific outcomes, in order to help patients manage their fatigue.Copyright © 2021 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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