The Relationships between Physical Activity, Perceived Social Support, and Fatigue in Older Adults with Lung Cancer

Abstract

Introduction Fatigue is described as a pervasive feeling of weakness throughout the body that does not improve with rest. This debilitating symptom significantly impacts physical function, memory, concentration, mood, and the ability to engage in social activities. Fatigue is commonly observed in patients with lung cancer, particularly among older adults, who are in a vulnerable age group. The presence of fatigue often leads to a reduction in physical activity, which is crucial for the daily functioning and quality of life of older adults. Moreover, physical activity is essential for maintaining overall health and independence in older adults. However, the experience of fatigue may severely hinder their ability to participate in activities that promote mental and physical well-being. Beyond physical ramifications, fatigue is also associated with various psychological impacts. It can impair cognitive functions, leading to difficulties in thinking and processing information. Additionally, it often results in decreased social interactions, which can contribute to feelings of isolation and loneliness. If left unaddressed, this situation can potentially lead to depression, a significant health risk for older adults. Social support plays a critical role in the prevention of depression among this population. The awareness of support from close friends, special people, and family members is particularly essential, as it is directly linked to the quality of life of older adults. When older adult’s individuals with lung cancer perceive that they have robust social support networks, they are more likely to experience better emotional health and lower levels of fatigue. By addressing both the physical and psychological aspects of fatigue and enhancing social support, it becomes possible to improve the overall quality of life for older adults living with lung cancer.

Objectives This study aimed to 1) describe the level of fatigue in older adults diagnosed with lung cancer and 2) examine the associations between physical activity, perceived social support, and fatigue level in older adults diagnosed with lung cancer.

Design This is a descriptive correlational study based on the conceptual framework of Piper’s fatigue model, which provides a comprehensive understanding of cancer-related fatigue, linking both physical and psychological dimensions. This leads to a decrease in functional ability and physical activity, which is strongly correlated with increased fatigue. Conversely, lower levels of fatigue allow for greater participation in physical activities. In terms of psychological factors, higher perceived social support is associated with a reduced risk of depression, which in turn contributes to a decrease in fatigue. Methodology The participants consisted of 78 patients with lung cancer aged 60 and above who have been diagnosed with lung cancer and are receiving outpatient services at the National Cancer Institute, Bangkok, between July and November 2022. They were selected through purposive sampling based on the following inclusion criteria: 1) A diagnosis of lung cancer by a medical doctor and currently undergoing chemotherapy, radiotherapy, or palliative care; 2) The ability to effectively communicate and understand Thai language; and 3) No history or signs of cognitive impairment, screened using the Thai version of the 6 Cognitive Impairment Test (6 CIT), with a score of less than 8. The sample size was determined using the G*Power program, with a power set at .80, a statistical significance level (α) of .05, and an effect size of .411, resulting in a sample size of 70 participants. The researchers increased the sample size by approximately 10% to account for any incomplete data. Therefore, the study included 78 participants. The research instruments consisted of a personal information questionnaire, the revised Piper Fatigue Scale, the Global Physical Activity Questionnaire (GPAQ), and the Multidimensional Scale of Perceived Social Support. Data were collected through structured interviews and analyzed using descriptive statistics and Spearman’s rank correlation.

Results The mean age of the participants in this study was 68 years old (SD = 5.35), with 73.1% being married. Half of the participants (50%) had completed only primary education. Most participants in this study lived with their families (96.2%) and reported sufficient monthly income (93.6%). More than half had underlying health conditions (53.8%). Among the participants, 55.1% were diagnosed with stage 4 lung cancer, and 37.2% undergoing both chemotherapy and radiotherapy. The mean fatigue score among participants was 3.53 (SD = 1.55), suggesting that the overall level of fatigue was relatively low in this group. Furthermore, the analysis revealed a significant negative correlation between physical activity and fatigue levels (r = -.242, p < .05), whereas perceived social support did not show a statistically significant relationship with fatigue levels (r = -.103, p > .05).

Recommendation This study’s findings can serve as an approach for healthcare professionals to understand the importance of assessing fatigue and physical activity in older adults with lung cancer in order to aid in planning care for fatigue management and physical activity in this population.