Comparison of fatigue, depression, and anxiety as factors affecting posttreatment health-related quality of life in lung cancer survivors

Objective: To compare the effects of fatigue, anxiety, and depression on health-related quality of life (HRQoL) in survivors of surgically resectable lung cancer. Methods: In total, 830 lung cancer survivors participated in the study. They completed a questionnaire consisting of items pertaining to sociodemographic characteristics, clinical variables, and HRQoL. We calculated prevalence rates for fatigue, anxiety, and depression and performed multiple logistic regression and general linear modeling to determine the main factors affecting HRQoL. Results: The prevalence rates for moderate fatigue (Brief Fatigue Inventory mean score: ≥4), borderline depression (Hospital Anxiety and Depression Scale-Depression score: ≥8), and borderline anxiety (Hospital Anxiety and Depression Scale-Anxiety score: ≥8) were 42.2%, 38.9%, and 20.9%, respectively. The main factor was fatigue, which demonstrated the strongest explanatory power for HRQoL including all 5 functional HRQoL components (ie, physical, role, emotional, cognitive, and social functioning) and global health status (partial R ² range:.13 to.19). However, anxiety (partial R ²  =.21) and fatigue (partial R ²  =.19) both demonstrated strong explanatory power for emotional HRQoL. In addition, depression demonstrated weak explanatory power for HRQoL including emotional HRQoL. Conclusions: Relative to depression and anxiety, fatigue exerted a stronger effect on lung cancer survivors' HRQoL. Health professionals should consider the reduction of fatigue a priority in improving cancer patients' HRQoL following the completion of cancer treatment.