Cancer-related fatigue and depression limiting leisure activities in survivors

Cancer-related fatigue and depression limiting leisure activities in survivors

Cancer survivors who reported feeling cancer-related fatigue or depression reduced their leisure activities nearly twofold, with women more likely than men to report feeling either cancer-related fatigue or depression, according to a retrospective study presented at the American Association for Cancer Research (AACR) 2025 Annual Meeting, April 25-30.

Cancer-related fatigue affects more than 80% of patients receiving chemotherapy or radiation therapy, while depression affects about 25% of cancer patients. Unlike typical fatigue, cancer-related fatigue does not go away with rest and can persist for weeks, months or even years, explained Simo DU, MD, MHS, a resident at NYC Health + Hospitals/Jacobi and Albert Einstein College of Medicine.

“During my stay, I saw many cancer patients both in the clinic and inpatient settings, and cancer-related fatigue was one of the most common complaints they raised,” said Du, who presented the study. "It impacts not only their daily activities but also their overall quality of life and mental health, making tasks like climbing stairs, carrying groceries or overwhelming laundry."

Previous studies have found that cancer-related fatigue can affect men and women differently, but DU and her colleagues wanted to better understand these differences and examine how they affect quality of life. They analyzed data from the 2015-2016 and 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES), which annually collects information about the health and nutrition of adults and children in the United States, including a section on depression and anxiety. Responses from 1,555 cancer survivors were included in their analysis, representative of 25 million cancer survivors in the United States based on the sampling method used. The sampling model was also adjusted for age, race, socioeconomic status, and comorbidities. Cancer survivors' ability to perform either work-related or leisure activities was used as a surrogate for quality of life.

Female cancer survivors were 69% more likely to have cancer-related fatigue and 58% more likely to be attributed to depression compared to male survivors. While women scored higher on most depression metrics, men scored higher on one item.

DU explained that the reasons for these differences are likely multifactorial. For example, women are more likely to experience side effects from chemotherapy, radiation, and long-term use of endocrine treatments. This could be due to slower drug clearance in their bodies leading to higher concentrations and more toxicity, a stronger immune response that may increase inflammatory side effects, and differences in body composition that may affect drug distribution and radiation dosimetry. Social roles may also play a role, as women may assume more caregiving responsibilities, which could influence the development and experience of cancer-related fatigue.

Among all cancer survivors, those who reported cancer fatigue were 86% more likely to reduce their amount of moderate leisure activities such as brisk walking, leisurely cycling, golfing, and light gardening or yard work. Those who reported feeling depressed were 65% more likely to reduce both moderate recreational activities and vigorous activities such as jogging or running, cross-country skiing, skiing, steep terrain, and vigorous gardening. Neither depression nor cancer-related fatigue significantly influenced work-related activities.

Our findings highlight the importance of providing special attention and tailored interventions such as exercise programs, support groups and behavioral techniques for vulnerable groups and behavioral techniques for mind bodies to effectively manage and improve participation in leisure activities, as they are an essential aspect of quality of life. “

Simo DU, MD, MHS, resident at NYC Health + Hospitals/Jacobi and Albert Einstein College of Medicine

DU and her colleagues plan future studies that evaluate the effectiveness of tailored interventions to improve cancer fatigue, examine the association between cancer-related fatigue and different mechanisms such as inflammatory markers to determine whether gender modifies the association, and long ago examine these factors across more data sets.

A limitation of the study is the use of self-reported data, and the fact that women may override symptoms of fatigue and men may underreport symptoms of depression. However, DU noted that the NHANES uses standardized protocols to minimize such biases.

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