Cancer-related fatigue (CRF) remains one of the most debilitating and commonly reported symptoms among women battling malignant gynecological tumors. Despite its high impact on quality of life, the exact prevalence of CRF and the underlying risk factors have not been clearly defined, with past research offering inconsistent findings. A groundbreaking meta-analysis and systematic review published recently in BMC Cancer addresses these gaps, shedding light on the extent and determinants of CRF, thereby providing a comprehensive framework for future clinical interventions.
The study meticulously compiled data from 33 published studies, encompassing a wide array of patient demographics and malignancy types. The vast majority of these studies focused on ovarian, cervical, and endometrial cancers, as well as mixed gynecological malignancies. By systematically reviewing literature from major databases such as Web of Science, Cochrane Library, and PubMed, alongside several Chinese databases, this research offers a global perspective, especially emphasizing insights from developing countries where CRF prevalence appears notably high.
Remarkably, the meta-analysis revealed that the overall prevalence of cancer-related fatigue in women with malignant gynecological tumors stands at an astonishing 89%. Chronic CRF, defined as fatigue persisting long after primary treatment phases, was present in about a quarter of the patients. These figures underscore the pervasive nature of fatigue as a symptom, reflecting not only the physiological burden of the disease and its treatment but also the complex biopsychosocial interplay influencing patient experience.
Breaking down the data further, the prevalence rates exhibit variability depending on the tumor type. Cervical cancer patients exhibited the highest occurrence of CRF, with nearly 94% affected, followed closely by those with mixed gynecological malignancies at 93% and endometrial cancer patients at 90%. Ovarian cancer patients demonstrated a somewhat lower, yet still significant prevalence of 77%. Such differentiation suggests that tumor biology, treatment modalities, and possibly tumor microenvironment may differentially influence the fatigue experience.
This research highlights a critical methodological consideration: the diversity of measurement tools used to assess fatigue across studies. Fatigue, inherently subjective and multifactorial, lacks a gold standard assessment scale, which may contribute to heterogeneity in prevalence estimates. The inconsistency in fatigue measurement tools across studies poses challenges for cross-comparison and calls for standardized protocols to accurately capture the fatigue spectrum in this patient population.
Geographical disparities emerged prominently in the analysis. Women in developing countries, with a special emphasis on China, exhibited notably higher CRF prevalence. This disparity may reflect socio-economic factors, healthcare infrastructure inequalities, differing cultural perceptions of fatigue, and variable access to supportive care and symptom management strategies. Such findings advocate for region-specific interventions tailored to local healthcare challenges.
The meta-analysis also identified significant risk factors associated with heightened CRF in these patients. Advanced age was found to be a robust predictor, with older patients nearly 1.5 times more likely to experience fatigue. This may be attributed to age-related physiological decline, comorbidities, and altered pharmacodynamics and pharmacokinetics of cancer therapies, which can exacerbate fatigue symptoms.
Psychological factors emerged as key contributors to CRF, with patients presenting psychological distress such as anxiety and depression showing a 40% increased risk of fatigue. This finding underscores the complex interactions between mental health and physical symptomatology, affirming the importance of holistic care models that integrate psychological support to mitigate fatigue severity.
Disease stage also played a significant role, where patients with more advanced cancer stages had a 65% higher likelihood of experiencing CRF. This correlation may be due to higher tumor burdens, more aggressive treatments, and greater physiological stress, collectively amplifying fatigue levels. Such data emphasize the necessity for intensified fatigue management strategies in later-stage cancers.
Conversely, the study identified social support as a protective factor against CRF, with higher levels of support correlating with reduced fatigue risk. This not only reflects the buffering effect of emotional and practical assistance in coping with cancer-related challenges but also highlights potential intervention targets such as community engagement and caregiver support programs to improve patient outcomes.
The rigorous methodological approach, including independent data extraction and bias assessments using validated quality scales, lends strong credibility to the findings. Utilizing Stata 17.0 software to perform traditional meta-analyses consolidates disparate datasets into robust aggregated estimates, enhancing the reliability and generalizability of the results.
Clinically, these insights hold immense value. Understanding the prevalence and risk factors equips healthcare professionals with evidence-based knowledge to anticipate, identify, and manage CRF more effectively. Tailored interventions can be designed focusing on older patients, those exhibiting psychological distress, and individuals at advanced disease stages, while reinforcing social support mechanisms to ameliorate fatigue.
This study also serves as a clarion call for the standardization of CRF assessment tools and underscores the urgency for culturally sensitive research in underrepresented regions. Given the high global burden of gynecological malignancies and the profound impact of fatigue on survivorship, such strategic advancements could significantly enhance patient quality of life and treatment adherence.
Future research avenues stemming from this meta-analysis involve exploring biological markers underpinning CRF pathophysiology, such as inflammatory cytokines and neuroendocrine dysregulation, to further unravel mechanistic pathways. Equally pivotal is the development and testing of multifaceted intervention strategies that encompass pharmacological, psychosocial, and rehabilitative components.
Ultimately, this comprehensive review embodies a milestone in oncological symptom management, bridging gaps between epidemiological data and clinical application. By elucidating the prevalence trends and multifactorial risk architecture of cancer-related fatigue in women with gynecological tumors, it paves the way for targeted therapies and holistic care models that can profoundly transform patient experiences and outcomes worldwide.
Subject of Research: Cancer-related fatigue prevalence and risk factors in women with malignant gynecological tumors
Article Title: Prevalence and risk factors for cancer-related fatigue in women with malignant gynecological tumors: a meta-analysis and systematic review
Article References:
Zhao, J., Zhan, L., Pang, Y. et al. Prevalence and risk factors for cancer-related fatigue in women with malignant gynecological tumors: a meta-analysis and systematic review. BMC Cancer 25, 827 (2025). https://doi.org/10.1186/s12885-025-14210-z
Image Credits: Scienmag.com
