Desire to Limit Medications Drives Patients With Cancer to Underreport Fatigue

Barriers to discussing cancer-related fatigue with healthcare providers remain widespread and, in many areas, more intense now than they were 2 decades ago, according to results from a study published in Supportive Care in Cancer. 

In this cross-sectional study comparing present-day Polish patients with gynecologic malignancies to a 2002 cohort, more patients reported avoiding discussions about fatigue due to fears of treatment disruption, concerns that fatigue signals disease progression, and a desire to appear cooperative or “good.” These results suggest the need for targeted strategies to support communication regarding fatigue in oncology settings.

This study enrolled 54 hospitalized women undergoing surgical treatment for reproductive cancers, most commonly ovarian cancer (68%), followed by endometrial (22%) and cervical (6%) cancers. Fatigue-related communication barriers were assessed using the Polish adaptation of the Fatigue Management Barriers Questionnaire, which showed high internal consistency (Cronbach α = 0.92). Despite methodological advances and expanded supportive care, present-day patients reported more significant hesitation in voicing fatigue than their 2002 counterparts.

More than half of the participants cited a desire to reduce medication intake (53%) and to uphold a “good patient” persona (49%) as key reasons for silence. Many believed fatigue was either a normal side effect (38%) or a sign of disease progression (36%). Roughly 42% felt fatigue was not important enough to address, and 20% feared discussing it could lead to treatment discontinuation. 

These concerns reflect persistent misconceptions and emotional burdens that could compromise symptom management. Interestingly, neither intensity of fatigue nor duration of illness correlated significantly with reported barriers, nor did treatment length or perceived social support. 

However, patients who identified a trusted confidant outside family or friends showed slightly lower barrier scores on individual items, suggesting that some interpersonal factors may mitigate avoidance behaviors. Still, the overarching finding is that patient-provider communication about fatigue remains suboptimal.

Comparative analysis revealed that concerns related to treatment futility, jeopardizing care, and disease progression had all intensified since 2002. For example, while only 8% of earlier patients felt they lacked time to discuss everything with their doctor, that figure rose to 27% in the recent cohort. Nonetheless, some positive shifts were noted: more current patients believed that fatigue interventions existed (75% vs 57% in 2002), and 76% said their doctors responded when fatigue was raised, up from 53%.

Despite improvements in care delivery and provider responsiveness, these data show that substantial barriers to fatigue communication endure. Clinicians should proactively assess fatigue, dispel misconceptions, and foster open dialogue to support comprehensive cancer care.

“Although the patients in both studies were of similar age and shared comparable socio-demographic characteristics, key differences included country of origin, sex distribution, and cancer types,” the authors explained regarding limitations. They continued, “Given that sex and cancer type are recognized risk factors for cancer-related fatigue, these differences may have influenced our findings and should be considered when interpreting results. To our knowledge, no existing scientific data specifically examine how cancer type influences barriers to discussing fatigue with healthcare providers. Despite the limitations of this study, our findings offer valuable insights into this underexamined area.”

This article originally appeared on Oncology Nurse Advisor