Women with Endometrial and Ovarian Cancers Experience Significant Fatigue Following Surgery

Data from a one-year longitudinal study show that almost half of women with endometrial and ovarian cancers experience significant fatigue immediately following surgery.

The data, published in the journal Cancer, also show that around two-thirds of women with those gynecologic cancers continue to report consistent fatigue during the first year after surgery.

“Despite significant advances in the treatment of gynecologic cancers, patients with endometrial and ovarian cancers experience late effects from treatment,” the authors wrote. “Cancer‐related fatigue (CRF) is one of the most common and distressing symptoms reported. It occurs in up to 80% to 90% of patients with cancer during treatment, particularly women, and may persist for years afterward.”

To identify possible patterns of CRF in women with newly diagnosed endometrial (181 patients) and ovarian (81 patients) cancers that did not progress or recur within a year of treatment completion, the researchers conducted a secondary analysis of the Registrationsystem Oncological GYnecology (ROGY) Care trial.

Using the Fatigue Assessment Scale and the Hospital Anxiety and Depression Scale, researchers assessed symptoms of anxiety, depression and fatigue immediately following surgery, as well as six and 12 months after treatment was completed.

Nearly half (48%) of the patients reported experiencing significant fatigue following their surgery. The percentage of patients (44%) reporting significant fatigue six months following surgery dropped slightly from the initial total. Thirty-nine percent of the patients still reported significant fatigue one year following their surgery.

Patients who reported depressive symptoms were more likely to experience fatigue, even though only one-third of patients with fatigue also reported experiencing depressive symptoms.

Patients who received surgery along with radiation to treat their gynecologic cancers were less likely to experience fatigue at 12 months following treatment completion compared to patients who received surgery alone. However, all who received surgery and radiation had endometrial cancer, and 93% had early-stage disease.

The data demonstrated that age nor anxiety symptoms were associated with fatigue at 12 months.

“Our results extend the findings from a recent cross‐sectional study, which demonstrated that 20% of long‐term, relapse‐free survivors of ovarian cancer reported persistent fatigue by including both endometrial and ovarian cancers and patients with more advanced disease,” they wrote. “Our findings also suggest that interventions targeting cancer‐ and treatment‐related fatigue and depressive symptoms may be particularly promising; for example, using cognitive behavioral therapy to address psychological distress and change fatigue‐related cognitions and behaviors may reduce fatigue while simultaneously improving depressive symptoms.”

The authors note that the study had some limitations, including only 69% of patients were retained from the start of the trial to the 12-month follow-up. Additionally, some of the patterns of fatigue the researchers identified occurred in a small number of patients, which according to the authors, warrants further research to validate the findings.

“These findings underscore the importance of developing scalable and effective transdiagnostic interventions to reduce fatigue in survivors of gynecologic cancers,” the authors concluded. “Because nearly one‐third of fatigued patients reported concurrent depressive symptoms after the initial surgical treatment, psychological interventions that address fatigue and mental health may be the most effective strategy for improving quality of life among women with ovarian and endometrial cancers.”