Patient Activation, Patient-Physician Communication Quality, and Cancer-Related Fatigue: A Longitudinal Study of Cancer Survivors.

OBJECTIVE

Cancer-related fatigue (CRF) is highly prevalent and often insufficiently addressed in routine survivorship care. This study examined whether patient activation and patient-physician communication quality in early survivorship are associated with subsequent CRF among cancer survivors.

METHODS

The observational German LIFT study enrolled 1175 adult survivors of various cancer types. CRF was assessed 4-6, 9, 12, and 24 months post-diagnosis using the EORTC QLQ-FA12. Patient activation was assessed with the German Patient Activation Measure (PAM-13-D (PAM)) and communication quality with an exploratory five-item scale (ComQ) 9 months after diagnosis. Multiple linear regression models examined associations of PAM and ComQ with physical and total CRF 12 months (n = 1132) and 24 months (n = 1067) after diagnosis, adjusting for sociodemographic and clinical covariates. Sensitivity analyses additionally adjusted for previous CRF 4-6 months after diagnosis. Missing data among alive participants were multiply imputed.

RESULTS

PAM at 9 months was negatively associated with physical and total CRF at both 12 and 24 months after diagnosis, whereas ComQ at 9 months was negatively associated with physical and total CRF at 12 months only. After additional adjustment for previous CRF at 4-6 months, negative associations for PAM with physical and total CRF persisted at 12 months but were attenuated.

CONCLUSIONS

Higher patient activation and better perceived patient-physician communication were associated with lower subsequent CRF, particularly within the first year after diagnosis. Activation-oriented and communication-focused strategies may complement existing CRF interventions and warrant further evaluation in pragmatic trials across different survivor groups and settings.