PREDICTORS OF FATIGUE AFTER TREATMENT FOR PROSTATE CANCER SALLY L. MALISKI, LORNA KWAN, JAMES R. ORECKLIN, CHRISTOPHER S. SAIGAL, AND MARK S. LITWIN ABSTRACT Objectives. To investigate whether post-treatment fatigue among men treated for prostate cancer varies by treatment, demographics, or pretreatment general and disease-specific health-related quality of life. We also sought to describe the baseline characteristics of men who were fatigued at follow-up to allow for interventions in those at greatest risk. Methods. We conducted a secondary analysis on data gathered from men with prostate cancer at biopsy and after treatment by examining factors that predicted for post-treatment fatigue. Results. Univariate and multivariate analysis results demonstrated that post-treatment fatigue was asso- ciated with baseline fatigue, role limitations due to emotional problems, treatment type, and treatment location. Results. Univariate analysis showed that those who were fatigued at follow-up were more likely to have been treated at a public facility (P = 0.0017), be nonwhite (Latino, African American, or Asian Pacific- Islander; P = 0.0362), be married (P = 0.0413), be not employed at least part-time (P = 0.0327), to have one or more comorbidities (P = 0.0005), and to have scored lower in all domains of the RAND 36-Item Health Survey and UCLA Prostate Cancer Index at baseline (all P 0.05) than those not fatigued at follow-up. Those who declined from baseline energy levels were more likely to have had lower baseline energy scores (P 0.0001), to have been treated in a public facility (P = 0.0578), and to have had a baseline prostate- specific antigen level of 10 ng/mL or greater (P = 0.059) than those who remained at their baseline energy level. Lower baseline role-emotional scores were associated with both fatigue at follow-up and a decline from baseline at follow-up. Conclusions. Men with lower pretreatment quality-of-life measures may be at increased risk of fatigue after prostate cancer treatment. UROLOGY 65: 101–108, 2005. © 2005 Elsevier Inc. C ancer-related fatigue, a debilitating tiredness or loss of energy, is subjective, multifactorial, and can have serious adverse effects on a patient’s quality of life. 1–3 Magnusson and colleagues 4 de- scribed cancer-related fatigue as a process that is expressed in a variety of ways by patients with can- cer, including abnormal weakness and difficulties in taking initiative. These expressions of fatigue may cause social limitations, diminished quality of life, and lowered self-esteem. As noted by the Na- tional Comprehensive Cancer Network, although it has been shown that fatigue has a significant affect on physical function during treatment, it is uncertain when, or whether, patients regain full functioning after treatment. 5 Because prostate cancer is the most commonly diagnosed noncutaneous malignancy among American men, 6,7 fatigue related to prostate cancer treatment may represent a substantial burden. Fa- tigue is negatively associated with quality of life 8,9 among men receiving treatment for prostate can- cer, especially those undergoing radiotherapy (RT). 10 Fatigue increases significantly during the course of RT. 9,11 However the persistence of fatigue after the completion of RT remains largely unex- plored. In one study comparing long-term morbid- From the Department of Urology, University of California, Los Angeles, David Geffen School of Medicine; Department of Health Services, University of California, Los Angeles, School of Public Health; and Department of Urology, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California Reprint requests: Sally L. Maliski, Ph.D., R.N., Department of Urology, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, A2-125 CHS, Los Angeles, CA 90092. E-mail: smaliski@mednet.ucla.edu Submitted: June 8, 2004, accepted (with revisions): August 16, 2004 ADULT UROLOGY © 2005 ELSEVIER INC. 0090-4295/05/$30.00 ALL RIGHTS RESERVED doi:10.1016/j.urology.2004.08.031 101