Cancer-related fatigue: Inevitable, unimportant and untreatable? Results of a multi-centre patient survey

Stone, Patrick; Richardson, Alison; Ream, Emma; Smith, A. G.; Dj, Kerr; Kearney, Nora

doi:10.1023/a:1008318932641

Cited by 377 publications

(182 citation statements)

References 11 publications

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“…Conclusions about ethnic differences in fatigue severity cannot be drawn because prior studies reported either no differences, 9,10,39–41 or higher levels of fatigue in Black patients. 42 Of note in previous studies of patients receiving CTX where no differences in fatigue severity were found, 9,10,39–41 90% of the patients were White. The underrepresentation of ethnic minorities in these studies may have limited the power to detect differences in fatigue severity in these patient populations.…”

Section: Discussionmentioning

confidence: 88%

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

Wright

Melkus

Hammer

et al. 2015

Journal of Pain and Symptom Management

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Context Fatigue is a distressing, persistent sense of physical tiredness that is not proportional to a person’s recent activity. Fatigue impacts patients’ treatment decisions and can limit their self-care activities. While significant interindividual variability in fatigue severity has been noted, little is known about predictors of interindividual variability in initial levels and trajectories of evening fatigue severity in oncology patients receiving chemotherapy (CTX). Objectives To determine whether demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of evening fatigue. Methods A sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (N=586) completed demographic and symptom questionnaires a total of six times over two cycles of CTX. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling (HLM) was used to answer the study objectives. Results A large amount of interindividual variability was found in the evening fatigue trajectories. A piecewise model fit the data best. Patients who were White, diagnosed with breast, gynecological, or lung cancer, and who had more years of education, child care responsibilities, lower functional status, and higher levels of sleep disturbance and depression reported higher levels of evening fatigue at enrollment. Conclusion This study identified both non-modifiable (e.g., ethnicity) and modifiable (e.g., child care responsibilities, depressive symptoms, sleep disturbance) risk factors for more severe evening fatigue. Using this information, clinicians can identify patients at higher risk for more severe evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.

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Section: Discussionmentioning

confidence: 88%

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

Wright

Melkus

Hammer

et al. 2015

Journal of Pain and Symptom Management

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show abstract

“…In prior studies of patients receiving CTX, there are inconsistent associations between ethnicity and mean daily fatigue scores. 7,8,15,36-38 In addition, definitive conclusions about the asssociation of ethnicity and morning and evening fatigue cannot be drawn given the paucity of studies that evaluated diurnal variations in fatigue severity.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue

Wright

Melkus

Hammer

et al. 2015

Journal of Pain and Symptom Management

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Context Fatigue is the most common symptom in oncology patients during chemotherapy (CTX). Little is known about the predictors of interindividual variability in initial levels and trajectories of morning fatigue severity in these patients. Objectives An evaluation was done to determine which demographic, clinical, and symptom characteristics were associated with initial levels as well as the trajectories of morning fatigue and to compare findings with our companion paper on evening fatigue. Methods A sample of outpatients with breast, gastrointestinal, gynecological, and lung cancer (N=586) completed demographic and symptom questionnaires a total of six times over two cycles of CTX. Fatigue severity was evaluated using the Lee Fatigue Scale. Hierarchical linear modeling (HLM) was used to answer the study objectives. Results A large amount of interindividual variability was found in the morning fatigue trajectories. A piecewise model fit the data best. Patients with higher body mass index (BMI), who did not exercise regularly, with a lower functional status, and who had higher levels of state anxiety, sleep disturbance and depressive symptoms, reported higher levels of morning fatigue at enrollment. Variations in the trajectories of morning fatigue were predicted by the patients’ ethnicity and younger age. Conclusion The modifiable risk factors that were associated with only morning fatigue were BMI, exercise, and state anxiety. Modifiable risk factors that were associated with both morning and evening fatigue included functional status, depressive symptoms, and sleep disturbance. Using this information, clinicians can identify patients at higher risk for more severe morning fatigue and evening fatigue, provide individualized patient education, and tailor interventions to address the modifiable risk factors.

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“…Sixty to ninety-six percent of women with breast cancer experience fatigue following diagnosis and treatment (Jacobsen et al, 1999; Longman, Braden, & Mishel, 1999; Portenoy & Itri, 1999; Shimozuma et al, 1999; Stone et al, 2000). Often the first and last symptom experienced during the course of cancer (Longman et al; Portenoy & Itri; Stone et al; Walsh, Donnelly, & Rybicki), cancer-related fatigue (CRF) is reported more frequently than other side effects and can be more disruptive (Wagner & Cella, 2004).…”

mentioning

confidence: 99%

Fatigued breast cancer survivors: The role of sleep quality, depressed mood, stage and age

Banthia

Malcarne

et al. 2009

Psychology & Health

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Cancer-related fatigue is associated with lower health-related quality of life and the majority of breast cancer survivors experience persistent fatigue after finishing treatment. The present study examined age, cancer stage, sleep quality, and depressed mood as predictors of five dimensions of fatigue in seventy fatigued breast cancer survivors who no longer evidenced any signs of cancer and were finished with treatment. Discriminant function analyses were used to predict fatigue subgroup membership (higher, lower) from age, stage, mood, and sleep for five subtypes: General, Mental, Emotional, and Physical Fatigue, and Vigor. Significant discriminant functions were found for all subtypes. Findings suggest that age, staging, mood, and sleep are all important predictors, but there are differential relationships when subtypes of fatigue are considered. Given current limitations in treating fatigue directly, interventions targeting mood and sleep should be considered as alternate approaches to reduce fatigue.

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Cancer-related fatigue: Inevitable, unimportant and untreatable? Results of a multi-centre patient survey

Cited by 377 publications

References 11 publications

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

Trajectories of Evening Fatigue in Oncology Outpatients Receiving Chemotherapy

Predictors and Trajectories of Morning Fatigue Are Distinct From Evening Fatigue

Fatigued breast cancer survivors: The role of sleep quality, depressed mood, stage and age

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