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L. Janssen et al.
ple in this population-based study allows translation of the findings to clinical practice. Lastly, we used a Likert scale for the assessment of QoL in order to reduce the length of our questionnaire to assess predictors of fatigue (Part 1) even though validated QoL questionnaires have been developed in the CML population. However, a sim- ple Likert scale has been shown to measure QoL ade- quately in cancer patients.31 A major strength of our study is the objective assessment of physical activity, which ruled out response bias. Another strength is the relatively large sample size and the small amount of missing data (<3% in both parts of the study).
In conclusion, we demonstrated that the majority of the CML patients receiving TKI therapy experienced severe fatigue and that severely fatigued patients have impaired QoL. Independent predictors of severe fatigue include: younger age, female gender, higher CCI, the use of comed- ication known to cause fatigue, and physical inactivity. Objective assessment of physical activity showed that, compared to patients without fatigue, severely fatigued CML patients sleep more and are less active during the day
on both week and weekend days. These findings empha- size the importance of recognizing the reduction of fatigue as a treatment goal in CML care and the need for future studies to identify physical activity as a possible target to achieve this goal.
Disclosures
No conflicts of interest to disclose.
Contributions
LJ performed the research, analyzed data and wrote the manu- script with support from all authors. NB performed research and supervised the study. MD performed research and analyzed data. EB analyzed data. MN and JJ performed research. ST and MH supervised the study.
Acknowledgments
The authors would like to thank Carlijn Maasakkers from the Radboud University Medical Center (UMC) for her support in analyzing activity monitor data and Maaike de Ruijter from the Amsterdam UMC for assistance in recruiting participants.
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