Prevalence of and factors associated with clinically important levels of fatigue, pain, and insomnia in survivors of cancer: a population-based cross-sectional study

PURPOSE: To identify risk factors and patient characteristics in survivors who report clinically important fatigue, pain, and insomnia.

METHODS: Cross-sectional study including 39,374 survivors of breast, prostate, lung, colon, rectum cancer, melanoma, and lymphoma diagnosed at age 40 or older between Jan 2010 and Dec 2019. Prevalences and odds ratios (ORs) with 95% confidence intervals (CI) for clinically important fatigue, pain, and insomnia by sociodemographic, clinical, and lifestyle factors were calculated.

RESULTS: Among all survivors, 42% reported clinically important fatigue, pain, or insomnia, and 21% reported concurring symptoms. Prevalences were highest in women, survivors of breast and lung cancer, with short education, low income, comorbidity, obesity, and smokers. Adjusted analyses showed increased odds in women (OR fatigue 1.46, 95% CI 1.39-1.54; OR pain 1.62, 95% CI 1.55-1.70; OR insomnia 2.11, 95% CI 1.99-2.24), survivors with comorbidity (OR fatigue 2.97, 95% CI 2.78-3.18; OR pain 2.13, 95% CI 2.00-2.27; OR insomnia 1.67, 95% CI 1.55-1.80), smokers (OR fatigue 1.96, 95% CI 1.80-2.13; OR pain 1.67, 95% CI 1.55-1.81; OR insomnia 1.46, 95% CI 1.33-1.60), and survivors with obesity (OR fatigue 1.92, 95% CI 1.80-2.06; OR pain 2.21, 95% CI 2.08-2.35; OR insomnia 1.32, 95% CI 1.22-1.42).

CONCLUSIONS: Clinically important fatigue, pain, or insomnia are common in survivors of cancer, and two in five report two or all three late effects. Report of these symptoms is associated with social and clinical vulnerability factors.

IMPLICATION FOR CANCER SURVIVORS: Management of survivorship care requires targeted consideration of the complexity and overall impact of these late effects.