Fatigue and Its Associated Factors among Colorectal Cancer Patients in Erbil City, Iraq

Abstract

Backgrounds and Objectives: Cancer-related fatigue (CRF) is one of the most common and distressing symptoms reported by patients with colorectal cancer (CRC), yet it remains poorly characterized and instrument-based epidemiological data are scarce. This study aimed to determine the prevalence of fatigue and its associated factors among colorectal cancer patients in Erbil City, Iraq.
Methods: A descriptive cross-sectional study on a non-probability purposive sample of 140 CRC patients currently receiving or having received cancer treatment at the oncology department in Nanakali Hospital in Erbil City. Data was collected from February to the end of May 2025 using a questionnaire developed for the purpose of data collection. Data were analyzed using descriptive statistics and the chi-square test of association, with statistical significance set at p < 0.05.
Results: Nearly all colorectal cancer patients in this sample experienced cancer-related fatigue, with the majority (85.7%) reporting severe fatigue and a substantial burden across the physical, cognitive, and affective domains (mean total CFS score 37.31 ± 2.66). Psychological distress was similarly pervasive, with 97.9% and 98.6% of patients scoring in the abnormal range for anxiety and depression, respectively. Fatigue severity was significantly associated with advanced cancer stage (p = 0.012), shorter actual sleep duration (p < 0.001), and reduced enthusiasm for daily activities (p = 0.005), but showed no significant relationship with sociodemographic characteristics, sleep timing, or other clinical variables. Cancer-related fatigue is closely intertwined with psychological distress, poor sleep quality, functional decline, and pain.
Conclusions: In this study, fatigue severity was significantly associated with cancer stage, shorter actual sleep duration, and difficulty maintaining sufficient enthusiasm for daily activities. However, no significant associations were observed between fatigue severity and most sociodemographic or clinical characteristics examined.