Cancer-Related Fatigue: Perception of Effort or Task Failure?

Abstract

Context: Patient’s rating of perceived effort (RPE) is used to assess central fatigue. Cancer-related fatigue (CRF) is believed to be of central origin. The increased RPE with a motor task, such as the Finger-Tapping Test (FTT), can easily be measured in the clinical setting. Objectives: To correlate the FTT, RPE and the Brief Fatigue Inventory (BFI) rated fatigue severity in patients with cancer. Methods: Subjective fatigue was assessed in adult patients with cancer by the BFI. Participants performed a modified FTT with the index finger of the dominant hand: 15 seconds × 2, 30 seconds × 2, and 60 seconds × 2 with 1 minute of rest between each time trial. Rating of perceived effort at the end of task was measured by the Borg 10 scale. Exclusions: Brain metastasis, history of brain radiation, Parkinson disease, Huntington Chorea, multiple sclerosis, delirium, and depression. Pearson correlation coefficients were used to describe the relationships between BFI, FTT, and Borg 10 scale. Results: Thirty patients participated. Mean age was 56.2. Sixteen were females (53.3%). The mean BFI mean was 4.1, median 4.4. Tapping rate did not correlate with fatigue severity. The RPE correlated with the mean BFI: r s 0.438, P = .0155. These correlations persisted after adjustment for age. Conclusion: An increased RPE in the absence of task failure suggests that the origin of CRF is central. The performance of an FTT with RPE helps to improve our understanding of fatigue in the clinical setting.

Cancer-Related Fatigue: Causes and Current Treatment Options

“…Potential disruptions originating in the central (inflammation, hypothalamic-pituitary-adrenal axis) and/or peripheral (e.g., reduced energy metabolism) nervous systems may induce CRF [ 44 •]. Central fatigue can be characterized as a perceived reduced ability to complete physical or mental tasks without demonstrable cognitive or motor deficiencies [ 55 , 56 ]. Peripheral fatigue is ascribed as the inability of muscles to perform a task in response to stimulation (“muscle fatigue”) or reduced endurance [ 44 •, 57 •].…”

What is (perception of) effort? Objective and subjective effort during attempted task performance

“…61 Once upon a time I spoke some remedial French and am currently learning Japanese 62 He also suggests utilising the definition provided by Marcora (2010); though, both I and others (Halperin and Emanuel, 2020) find this definition to include unnecessarily misleading terms. 63 Although, 'pain' has been reported as perceptually distinct from 'discomfort' during exercise (Hamilton et al, 1996) and so the latter may be preferable for such exercise induced perceptions unless injury itself has occurred. when this involves those whose language treats the words as such.…”

“…Pageaux (2016) has argued that, considering many within the literature do in fact use the two terms as synonyms already, and that many languages do the same, it may be best to instead use the terms interchangeably 62 . Instead, the descriptors of other phenomenological aspects associated with exercise (such as 'strain') might be better termed as 'pain' or 'discomfort' 63 . Following from this disagreement within the literature my research group has also been suggested a combined approach to the terminology should be used (Steele et al, 2017b).…”

“…Perception of fatigue is something that is often measured as a state variable in response to, or during, task performance and indeed is often related to perception of effort; that is to say the greater the perception of fatigue, the greater the perception of effort (Benoit et al, 2019;Mickelwright et al, 2017;Milyavskaya et al, 2018;Greenhouse-Tucknott et al, 2019;Fernandez et al, 2020;Whitaker et al, 2019). Similarly, self-efficacy 74 has been examined and found to be related to perception of effort as a trait variable 75 (i.e.…”

Perception of effort and the allocation of physical resources: a generalization to upper-limb motor tasks

“…Due to its omnipresence in our daily life, the interest in understanding perception of effort is growing amongst researchers. This perception is linked to the task intensity and the amount of resources invested (Inzlicht et al, 2018); strongly influences the self-regulation of human behaviour (Inzlicht et al, 2018;Marcora, 2015); is one of the main features of fatigue in various contexts (Enoka & Stuart, 1992;Pageaux & Lepers, 2016); and is exacerbated in various pathologies such as chronic fatigue syndrome (Barhorst et al, 2020;Cook et al, 2007), stroke (Kuppuswamy et al, 2015), chronic kidney disease (Macdonald et al, 2012) or cancer (Fernandez et al, 2020). Perception of effort is a fundamental experience that directly influences our everyday decisions to engage or disengage in various actions, by monitoring the cognitive and motor resources necessary to perform any task (Pageaux, 2016;Preston, 2009).…”