Trajectories of postoperative fatigue and their association with physical and mental health among patients with peritoneal metastases from colorectal and appendiceal cancer after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a 1-year longitudinal study.

Postoperative fatigue (POF) is a common complication following major or medium-sized surgeries. It is influenced by surgical trauma, pain, sleep quality, nutrition, and mental state, and can significantly hinder postoperative recovery. As enhanced recovery protocols become more widely adopted in perioperative care, attention to the prevention and management of POF has increased. This 1-year longitudinal study enrolled patients with peritoneal metastases from colorectal and appendiceal cancer following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) at two tertiary hospitals. Participants completed self-administered questionnaires at discharge, and at 3, 6, 9, and 12 months after surgery. POF was assessed using the 10-item Identity-Consequence Fatigue Scale (ICFS-10). Group-based trajectory modeling (GBTM) was utilized to identify distinct POF trajectories, and multivariable models were fitted to examine their associations with sleep quality, pain, and physical and mental conditions over time. The reporting of this study adhered to the Guidelines for Reporting on Latent Trajectory Studies (GRoLTS) checklist. Among 182 participants who experienced POF during follow-up, three distinct fatigue trajectories were identified: high-increasing (29.67%), moderate-increasing (37.36%), and low-increasing (31.87%). Poor sleep quality, inadequate pain management, and compromised physical and mental conditions were linked to trajectory groups with more severe fatigue symptoms. After adjusting for covariates, the high-increasing trajectory group demonstrated significantly lower scores in mental dimensions at 12 months post-discharge. This study presents the cumulative incidence and longitudinal trajectories of POF over a 1-year postoperative period, analyzing the relationship between physical and mental conditions in peritoneal metastatic cancer survivors. Our findings underscore the importance of early identification and targeted treatment of high-risk patients to prevent the chronic progression of POF. These trajectory patterns provide potential clinical avenues for the early detection and management of persistent fatigue based on a patient's evolving symptom profile.