Prevalence and risk factors of cancer-related fatigue: A systematic review and meta-analysis

Cancer-related fatigue, one of the most frequent side-effects of cancer treatment, affects the well-being of patients. Despite the fact that the estimated prevalence and risk factors of cancer-related fatigue are widely reported, these results have not been synthesized. To systematically assess the prevalence of cancer-related fatigue, including stratification by fatigue degree, sex, age, therapeutic method, cancer-related fatigue scales, countries, and risk factors for cancer-related fatigue. Systematic literature review and meta-analysis. PubMed, Cochrane Library, Web of Science, CINAHL Plus, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database (CBM), and Weipu Database (VIP) were comprehensively searched for observational studies investigating the prevalence and risk factors of cancer-related fatigue from inception to March 31st, 2019. Original journal articles were included which met the inclusion criteria. The quality of the included studies was evaluated independently by two investigators. Meta-analysis was conducted using Stata 12.0 software package, with estimates of cancer-related fatigue from pooled using a random-effects model. In total, 2641 articles were screened and data from 84 studies involving 144,813 subjects were used in meta-analysis. The prevalence of cancer-related fatigue in individual studies varied from 14.03% to 100%. The pooled prevalence of cancer-related fatigue was 52% (95% confidence interval, CI: 48% to 56%, I2 = 99.7%, P < 0.0001). After controlling for confounding variables, the following risk factors were associated with cancer-related fatigue: poor performance status (odds ratio, OR = 6.58, 95% CI: 2.60 to 16.67, I2 = 75.2%, P < 0.0001), chemoradiotherapy (OR = 2.25, 95% CI: 1.90 to 2.67, I2 =0%, P<0.0001), female sex (OR = 2.07, 95% CI: 1.51 to 2.84, I2 = 41.2%, P<0.0001), insomnia (OR = 2.83, 95% CI: 1.22 to 6.57, I2 = 98.3%, P = 0.015), neuroticism (OR = 1.23, 95% CI: 1.05 to 1.43, I2 = 88.9%, P = 0.01), pain (OR = 2.64, 95% CI: 1.20 to 5.80, I2 = 95.3%, P = 0.016), and depression (OR = 2.23, 95% CI: 1.70 to 2.93, I2 = 98.1%, P < 0.0001). The current analysis indicates an overall pooled prevalence of cancer-related fatigue of 52%. Poor performance status, chemoradiotherapy, female sex, insomnia, neuroticism, pain, and depression were identified as risk factors for cancer-related fatigue. Understanding the risk factors of cancer-related fatigue can provide the healthcare personnel with the theoretical basis for the management and treatment of the patients.