Prevalence and impact of severe fatigue in adolescent and young adult cancer patients in comparison with population-based controls
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PURPOSE: The current study determined the prevalence of severe fatigue in adolescent and young adult (AYA) cancer patients (aged 18-35 years at diagnosis) consulting a multidisciplinary AYA team in comparison with gender- and age-matched population-based controls. In addition, impact of severe fatigue on quality of life and correlates of fatigue severity were examined. METHODS: AYAs with cancer (n = 83) completed questionnaires including the Checklist Individual Strength (CIS-fatigue), Quality of Life (QoL)-Cancer Survivor, Hospital Anxiety and Depression Scale (reflecting psychological distress), and the Cancer Worry Scale (reflecting fear of cancer recurrence or progression). RESULTS: The vast majority of participants had been treated with chemotherapy (87%) and had no active treatment at the time of participation (73.5%). Prevalence of severe fatigue (CIS-fatigue score ≥35) in AYAs with cancer (48%, n = 40/83) was significantly higher in comparison with matched population-based controls (20%, n = 49/249; p < .001). Severely fatigued AYAs with cancer reported lower QoL compared to non-severely fatigued AYAs with cancer (p < .05). Female gender, being unemployed, higher disease stage (III-IV) at diagnosis, receiving active treatment at the time of study participation, being treated with palliative intent, having had radiotherapy, higher fear of recurrence or progression, and higher psychological distress were significantly correlated with fatigue severity (p < .05). CONCLUSIONS: Severe fatigue based on a validated cut-off score was highly prevalent in this group of AYAs with cancer. QoL is significantly affected by severe fatigue, stressing the importance of detection and management of this symptom in those patients affected by a life-changing diagnosis of cancer in late adolescence or young adulthood.
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Fatigue is closely associated cross-sectionally with rumination and constructs mediated by rumination such as anxiety and depression.
“fatigue is closely associated cross-sectionally with rumination and constructs mediated by rumination such as anxiety and depression.1,17,22,25,44”
From Mindfulness and Psychosocial Symptoms in People with Cancer: Testing Rumination and Experiential Avoidance as Mediators, and Sex as a Moderator. (2025) · cites this paper as [22]
The Results section reports a strong cross-sectional correlation between fatigue severity and psychological distress in adolescents and young adults with cancer (R = .55); the Measures section says distress was assessed with the Hospital Anxiety and Depression Scale. The paper does not report an association with rumination or show that rumination mediates anxiety or depression. No page numbers were available in our copy. (LLM, conf=0.87)
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Monick, S. E., Hanson, C., Hoehn, K. S., Hlubocky, F. J., Stock, W., DuVall, A. S., McNeer, J. L., Henderson, T. O., Daugherty, C. K., & Wang, A. (2025) · Journal of Adolescent and Young Adult Oncology · doi:10.1177/21565333251389438
“16,23 Concurrent high anxiety, as seen in our cohort, has been associated with prolonged duration of other severe symptoms.”
Knoerl, R., Jahn, A., Grandinetti, K., Fecher, L. A., Henry, N. L., Karimi, Y. H., Ploutz-Snyder, R. J., Schuetze, S. M., Walling, E., & Iordan, A. D. (2025) · BMC Cancer · doi:10.1186/s12885-025-15328-w
“In the long term, anxiety is associated with severe fear of cancer recurrence [3, 4], work/school concerns [5, 6], fatigue [7, 8], sleep problems, and increased health care expenses [9].”
Use of cancer mobile app: A young adult patient-centered approach
Piombo, S. E., Pozo‐Kaderman, C., Concannon, S. F., Donovan, M., Malinowski, P. K., Ryan, A. K., Fasciano, K. M., & Hanania, J. W. (2026) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2026.2632685
“25,26 In one study, over 50% of AYAs who were employed or full time students reported difficulties with work or studies after diagnosis.”
Knoerl, R., Jardine, J., Chugh, R. K., Fecher, L. A., Henry, N. L., Joquico, M., Karimi, Y. H., Ploutz-Snyder, R. J., Taylor, S., Walling, E., et al. (2026) · Supportive Care in Cancer · doi:10.1007/s00520-026-10917-2
Exploring young adult cancer survivors’ perspectives on generative AI chatbots for symptom support
Kantabanlang, Y., Kanzawa-Lee, G. A., Pozzar, R. A., & Knoerl, R. (2026) · Supportive Care in Cancer · doi:10.1007/s00520-026-11254-0
“…that AYAs may continue to experience physical symptoms and ongoing support or information needs for years following completion of treatment [13, 14], participants were eligible if they were at different points in the post-treatment period to capture a range of survivorship experiences and…”
- Authors
- Poort, H., Kaal, S. E. J., Knoop, H., Jansen, R., Prins, J. B., Manten-Horst, E., Servaes, P., Husson, O., & van der Graaf, W. T. A.
- Affiliations
- Radboud University Medical Center (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Poort, Hanneke
- Venue
- Supportive Care in Cancer
- Published
- 2017-05-20
- Volume
- 25
- Issue
- 9
- Pages
- 2911-2918
- ISSN
- 0941-4355 (ISSN-L)
- 1433-7339
- PMC
- PMC5527068
- OpenAlex
- W2614119029
- Cited by
- 53
- References
- 31
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 6 · 2023: 6 · 2022: 8 · 2021: 6 · 2020: 8 · 2019: 5 · 2018: 4
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Update notices
- correction (2017-06-20)
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Supportive Care in Cancer (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, cc-by-nc)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Funders
- KWF Kankerbestrijding (KUN2011-5259)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- cancer-related fatigue, adolescent and young adult cancer, fatigue prevalence, quality of life, psychological distress, fear of cancer recurrence, chemotherapy, radiotherapy, palliative care, risk factors for fatigue, Checklist Individual Strength
- MeSH terms
- Adolescent, Adult, Fatigue, Female, Humans, Male, Neoplasms, Quality of Life, Surveys and Questionnaires, Prevalence, Survivors, Disease Progression, Young Adult
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