Clinically Significant Fatigue: Prevalence, Predictors, and Health-Related Quality of Life in Adult Leukemia Patients

Background: Cancer-related fatigue (CRF) is a common distressing symptom in leukemia patients. CRF becomes clinically significant (clinically significant fatigue-CSF) when adversely affects healthrelated quality of life (HRQoL) and warrants further workup, referrals, and treatment. We aimed to assess the prevalence and predictors of CSF and assess its impact on HRQoL in adult leukemia patients. Methods: Analysis was performed on 168 leukemia patients. The primary study outcomes were CSF (score ≥4) as measured by the fatigue numerical rating scale and HRQoL using a validated Functional Assessment of Cancer Therapy-Leukemia (FACT-Leu) scale. Univariate and multivariate regression analyses were conducted to identify independent predictors of CSF and HRQoL. Findings: A total of 168 leukemia patients were included in the study with a mean age of 43.99±19.20 years. The prevalence of CSF was 89 (53%) and 130 (77.4%) for CRF. The mean CSF score was 6.66±2.02. The ROC curves for the FACT-Leu scale indicated the score of ≥126 out of 176 as the optimal cut-off score for good HRQoL. About 106 (63.1%) of leukemia patient had poor HRQoL (102.61±23.50). Overall, FACT-Leu mean score indicated that study participants had poor HRQoL (114.70±29.67). There was a statistically significant difference in HRQoL between the patients with CSF 104.89±28.82 and Non-CSF 125.76±26.71, p<0.001. Poor appetite 3.02 [1.33-6.85] was statistically significant predictors (p<0.010) of CSF. Dependence on caregiver (odd ratio: 3.31 [95% CI: 0.41-0.75]) and having non-CSF (odd ratio: 5.22 [95% CI: 2.44- 11.19]) were found statistically significant predictors of good HRQoL. Interpretations: CSF is prevalent among leukemia patients, and adversely affects their HRQoL. The findings reported by patients are based on a patient-centered approach survey. Holistic assessment and supportive care are needed to reduce the burden of CSF and improve leukemia patients HRQoL. Funding Statement: The authors have stated: "None." Declaration of Interests: The authors have no competing conflict of interest. Ethics Approval Statement: Approval for the study was granted from the institutional review board at KFMC. Written informed consent was obtained prior to patients’ participation in the study.