Double burden: fatigue and poor sleep quality comorbidity and its predictors among cancer patient in Amhara region, northwest Ethiopia: institutional based cross-sectional study design

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Abstract Background Cancer-related fatigue and poor sleep quality are among the most prevalent and distressing symptoms experienced by patients with cancer, significantly impairing physical, emotional, and cognitive functioning. Despite their high prevalence and detrimental impact on quality of life, the comorbidity of fatigue and sleep disturbances remains underexplored, particularly in low-resource settings where access to comprehensive oncology care is limited. Understanding the magnitude, contributing factors, and interrelationship of these symptoms is essential for developing targeted interventions. However, existing research predominantly focuses on either fatigue or sleep quality in isolation, highlighting a critical gap in evidence regarding their concurrent occurrence and synergistic effects on cancer patient. Method Institutional-based quantitative cross-sectional study was conducted among adult cancer patients receiving cancer treatment at an oncology unit from May to June 2025. A systematic random sampling technique was used to select 422 samples. After obtaining consent data were collected using a structured Interviewer-administered questionnaire. Then data were entered into Epi-data version 4.6 and exported to Stata version 14 for analysis. Model fitness was checked by the Hosmer-Lemeshow goodness of fit test. Descriptive statistics including, frequencies and proportions were computed and presented by using tables and texts. Bivariable and multivariable logistic regression analysis was computed considering p<0.05 to be statistically significant at the final model. Result A total of 405 cancer patients were included in this study, of whom 46.67% experienced comorbid fatigue and poor sleep quality. Age 61-89 years [ AOR = 2.79, 95% CI: [1.02, 7.62]. Rural residency [ AOR = 2.03 95%, CI: [1.02, 4.01], Married & divorced [ AOR = 2.65 95%, CI: (1.01, 6.90)] and [ AOR = 3.54 95% CI: (1.10, 11.40)], Inpatient [ AOR =2.84, 95%, CI: (1.63, 4.95)]. Stage II and Stage IV [ AOR =3.92, 95%, CI: ([1.89, 8.12] and [AOR= 2.52, 95% CI: (1.04, 6.15)] respectively, cancer duration [ AOR =2.70, 95% CI: (1.14, 6.39)]. Anxiety [ AOR = 1.93, 95% CI: (1.06, 3.51)]. depression [ AOR = 2.10, 95% CI: (1.19, 3.70)]. Conclusion and recommendation Comorbidity of fatigue and poor sleep affected nearly half of cancer patients, representing a substantial and underrecognized clinical burden that necessitates systematic assessment and integrated, multidisciplinary interventions in oncology care. Age, Residence, Marital Status, Cancer Stage, Cancer Duration, Inpatient Admission, And Anxiety and Depression were significant predictors. These findings highlight the need for routine screening and integrated interventions targeting both physical and psychosocial determinants, alongside strengthening supportive and multidisciplinary care to improve patient outcomes.

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