title: Investigating the temporal course, relevance and risk factors of fatigue over 5 years: a prospective study among patients receiving allogeneic HSCT.
abstract: Although allogeneic hematopoietic stem cell transplantation (HSCT) features severe physical and psychological strain, no previous study has prospectively investigated fatigue beyond 3 years after transplantation. We investigated the temporal course of fatigue over 5 years, compared patients with the general population (GP) and tested for treatment- and complication-related risk factors. Patients were assessed before conditioning (T0, N=239) and at 100-day (T1, N=150), 1-year (T2, N=102) and 5-year (T3, N=45) follow-up. We measured fatigue with the Multidimensional Fatigue Inventory-20. Patients were compared with the GP at T0 and at T3. Global fatigue increased from T0 to T1 (t=3.85, P<0.001), decreased from T1 to T2 (t=-2. 92, P=0.004) and then remained stable (t=0.45, P=0.656). No difference in global fatigue was found between T0 and T3 (t=0.68, P=0.497). Compared with the GP, patients showed higher global fatigue at T0 (t=-6.02, P<0.001) and T3 (t=-2.50, P=0.014). These differences reached meaningful effect sizes (d⩾0.5). Acute and chronic GvHD predicted global fatigue at T1 (γ=0.34, P=0.006) and T2 (γ=0.38, P=0.010), respectively. To conclude, fatigue among allogeneic HSCT patients improves with time, finally returning to pretransplantation levels. However, even after 5 years, the difference from the GP remains relevant. Patients with GvHD are at risk for increased fatigue.
authors.affiliation: Division of Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
authors.forename: P
authors.identifier: http://orcid.org/0000-0002-4944-8020
authors.initials: P
authors.lastname: Esser
authors.affiliation: Division of Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
authors.forename: K
authors.identifier: http://orcid.org/0000-0002-7551-7931
authors.initials: K
authors.lastname: Kuba
authors.affiliation: Division of Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.|Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Mehnert
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schwinn
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Schirmer
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Schulz-Kindermann
authors.affiliation: Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Kruse
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Koch
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A R
authors.initials: AR
authors.lastname: Zander
authors.affiliation: Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.affiliation: Cancer Society Hamburg, Hamburg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Schilling
authors.affiliation: Division of Psychosocial Oncology, Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Götze
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Scherwath
mesh_terms: D000328:Adult; D005221:Fatigue / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous / Q000009:adverse effects