Cancer-related fatigue, anxiety, depression, and poor sleep quality are highly prevalent among chemotherapy patients, with fatigue strongly correlated with sleep quality and moderately correlated with anxiety and depression, and symptom severity varying significantly by cancer stage, type, duration, income, and education.
Key Findings
Results
Fatigue was the most prevalent symptom among cancer patients receiving chemotherapy, with a mean score of 24.93 ± 13.05.
Study included 150 cancer patients receiving chemotherapy at An Najah National University Hospital.
Convenience sampling was used in a quantitative, cross-sectional design.
Fatigue levels were higher in males compared to females, t(147) = 2.49, P = .014.
Married patients reported significantly higher fatigue levels compared to other marital status groups (P < .001).
Results
Anxiety affected 69.3% of chemotherapy patients, with 25.2% experiencing moderate to severe anxiety.
Sample size was 150 cancer patients undergoing chemotherapy.
Overall anxiety prevalence was 69.3% of the sample.
25.2% of patients experienced moderate to severe anxiety specifically.
Symptom severity varied significantly according to cancer stage (P < .01), cancer type (P < .05), and cancer duration (P < .01).
Results
Depression affected 67.1% of chemotherapy patients, with 28.1% experiencing moderate to severe depression.
Overall depression prevalence was 67.1% of the 150-patient sample.
28.1% of patients experienced moderate to severe depression.
Depression severity varied significantly by cancer stage (P < .01), cancer type (P < .05), income, and education (P < .05).
Depression was moderately correlated with fatigue (r = .372, P < .01).
Results
More than half of the cancer patients receiving chemotherapy reported poor sleep quality, at a rate of 52.7%.
52.7% of the 150 chemotherapy patients reported poor sleep quality.
Sleep quality was strongly correlated with fatigue (r = .644, P < .001).
Sleep quality varied significantly according to cancer stage (P < .01) and cancer type (P < .05).
Sleep quality also varied by income and education level (P < .05).
Results
Fatigue was strongly correlated with sleep quality and moderately correlated with both anxiety and depression.
Fatigue and sleep quality correlation: r = .644, P < .001.
Fatigue and anxiety correlation: r = .390, P < .01.
Fatigue and depression correlation: r = .372, P < .01.
All correlations were statistically significant, suggesting interrelated symptom burden.
Results
Symptom severity for fatigue, anxiety, depression, and sleep quality varied significantly according to several demographic and clinical characteristics.
Cancer stage was significantly associated with symptom severity (P < .01).
Cancer type was significantly associated with symptom severity (P < .05).
Duration of cancer was significantly associated with symptom severity (P < .01).
Income and education level were also significantly associated with symptom severity (P < .05).
What This Means
This research suggests that cancer patients undergoing chemotherapy face a heavy burden of interrelated symptoms. In a study of 150 patients at a university hospital in Palestine, nearly 70% experienced anxiety, over 67% experienced depression, more than half reported poor sleep, and fatigue was nearly universal. These were not mild complaints — roughly a quarter to a third of patients had moderate to severe anxiety and depression. Men and married patients reported higher fatigue levels than other groups.
This research suggests that these symptoms are closely linked to one another. Patients who slept poorly tended to report much higher fatigue, and those with more anxiety or depression also tended to experience more fatigue. The severity of all these symptoms was worse for patients with more advanced cancer, longer duration of illness, lower income, and lower education levels, highlighting that social and economic factors play a role alongside medical ones.
The practical implication of these findings is that treating the cancer itself is not enough — care teams need to routinely screen for and address fatigue, sleep problems, anxiety, and depression as part of standard chemotherapy care. The interconnected nature of these symptoms means that helping a patient sleep better, for example, might also reduce their fatigue and improve their psychological wellbeing. Patients from lower-income or less-educated backgrounds, and those with advanced disease, may need particular attention to these issues.
Said N, Alsayed A. (2026). Cancer-Related Fatigue, Psychological Symptoms, and Sleep Quality and Influencing Factors in Cancer Patients Receiving Chemotherapy.. Inquiry : a journal of medical care organization, provision and financing. https://doi.org/10.1177/00469580261422596