A multidimensional examination of correlates of fatigue during radiotherapy

Abstract

BACKGROUND: Cancer-related fatigue can be measured as both a unidimensional and a multidimensional construct. Unidimensional fatigue and its symptom correlates have undergone some previous investigation; however, minimal research has considered the differential effect of correlates on individual dimensions of fatigue. The objective of the current study was to investigate cancer-related fatigue in a radiotherapy sample using a multidimensional conceptualization to determine whether correlates of fatigue are consistent across all dimensions or whether each fatigue dimension has its own unique pattern of correlates. METHODS: The study used a prospective cohort design with data collected from radiotherapy patients at 3 time points; before, after, and 6 weeks after radiotherapy treatment. RESULTS: A total of 210 participants were enrolled in the study. Results indicated the following relations. Increased general fatigue was found to be associated with lower performance status, being in a de facto relationship, depression, having treatment to the brain, and reduced vigorous physical activity. Increased physical fatigue was associated with lower performance status, depression, reduced physical activity, reduced productive hours, and nausea. Higher levels of reduced activity were associated with depression, decreased participation in activities of daily living, decreased number of productive hours, and lower performance status. Higher levels of reduced motivation were associated with radiotherapy to the brain, reduced moderate physical activity, and depression. Increased mental fatigue was associated with diagnosis of a brain tumor, anxiety, depression, and sleep problems. CONCLUSIONS: The results of the current study support the recognition of multiple dimensions of fatigue, because each dimension examined had various correlates. These findings further develop our understanding of fatigue and may help clinicians provide more targeted information to people with cancer-related fatigue. Furthermore, these results can guide the development of group or individually tailored interventions that ultimately may reduce the impact of this distressing symptom on people with cancer. Cancer 2010;116:529-37.

Is education an effective management strategy for reducing cancer-related fatigue?

“…This discrepancy may be explained by potential compensatory rivalry between groups aware of the aim of the study or by sample bias. The recruitment rate for this study (37%) was significantly lower than the previous study in the same centre (70%) [5] potentially indicating a sample of motivated participants who had a different fatigue experience. However, we must also consider the impact of educational interventions which in themselves, may not be powerful enough to mediate substantial improvement in such a complex and multifactorial symptom as fatigue whilst it changes significantly under the influence of an external factor (radiotherapy treatment) [37].…”

“…The pattern of fatigue during radiotherapy is commonly thought to increase towards the end of treatment and decrease thereafter [3][4][5]. Cancer-related fatigue is thought to occur in association with a number of modifiable symptom correlates including reduced physical activity, participation in activities of daily living, performance status, social support, anxiety, depression, nausea and sleep problems [5,6].…”

“…The pattern of fatigue during radiotherapy is commonly thought to increase towards the end of treatment and decrease thereafter [3][4][5]. Cancer-related fatigue is thought to occur in association with a number of modifiable symptom correlates including reduced physical activity, participation in activities of daily living, performance status, social support, anxiety, depression, nausea and sleep problems [5,6]. It is suggested that identification and treatment of fatigue-related correlates through multi-focused symptom management is likely to have the greatest beneficial effect on reducing overall fatigue [7,8].…”

Elucidating the behavior of physical fatigue and mental fatigue in cancer patients: a review of the literature

“… Variables not related to either physical fatigue or mental fatigue in either univariate or multivariate analyses : marital status , household size , educational level , employment , disease stage , tumor load , presence of lymph node metastasis , time since diagnosis , time since treatment , disease recurrence , appetite loss , weight loss , weight , vomiting , diarrhea , constipation , hiccups , itch , red blood cells , hemoglobin level , white blood cells , creatinine , albumin , bilirubin , LDH , ASAT , TSH , previous surgery , type of surgery , days after surgery , chemotherapy , days after chemotherapy , number of chemotherapy lines received , radiotherapy , immunotherapy , treatment to the brain , treatment to the abdomen , psychological symptoms , psychiatric condition , extraversion , perception of disease recurrence , comorbidity , blood transfusions , attending a concurrent fatigue program , taking nutritional supplements , opioids , anti‐emetics , benzodiazepines , anti‐depressants , corticosteroids , neuroleptics , lean body mass , muscle force upper extremity , muscle force lower extr...…”

Living through pelvic radiotherapy:A mixed method study of self-care activities and distressful symptoms

“…Patients undergoing pelvic radiotherapy report an increased incidence and intensity of fatigue during treatment (Ahlberg et al, 2005a;Poirier, 2006;Purcell et al, 2010) and state that their fatigue affects their physical and social well-being (Ahlberg et al, 2005b;Magnusson et al, 1999). Patients also report frequent gastrointestinal symptoms including diarrhea, nausea, and pain, as highlighted in several studies (Ahlberg et al, 2005a;Christman et al, 2001;Guren et al, 2003;Khalid et al, 2006).…”