Comparison of Fatigue, Pain, and Depression in Patients With Advanced Kidney Disease and Cancer—Symptom Burden and Clusters

Abstract

Context. Although symptom clusters have been studied in the context of cancer, few data exist in chronic and end-stage kidney disease (CKD/ESKD) patients. Objectives. The objectives of this study were to 1) characterize and compare symptom cluster phenotypes in patients with advanced CKD, ESKD, and cancer and 2) explore predictors of symptom clusters. Methods. We conducted secondary data analysis of three prospective studies in which pain, depression, and fatigue were assessed in patients with Stage 4e5 CKD, ESKD, and gastrointestinal cancer. Tetrachoric correlations between these symptoms were quantified, and partitioning around medoids algorithm was used for symptom cluster analysis. Results. In the 82 CKD, 149 ESKD, and 606 cancer patients, no differences in the average fatigue (P ¼ 0.17) or pain levels (P ¼ 0.21) were observed. Over 80% of patients in each group had at least one symptom. Moderate or severe depressive symptoms were more common in patients with cancer (31% vs. 19% in ESKD vs. 9% in CKD; P < 0.001). Mild-moderate correlations were observed between the three symptoms in ESKD and cancer patients. Three distinct clusters were observed in each group. In ESKD, the HIGH cluster (with high probability of pain, depression, and fatigue) had higher body mass index (P < 0.001) and antidepressant use (P ¼ 0.01). In cancer patients, the HIGH cluster patients were more likely to be female (P ¼ 0.04), use antidepressants (P ¼ 0.04), and have lower serum albumin (P < 0.001) and hemoglobin (P ¼ 0.03) compared to the other two clusters. Conclusion. Although the burden of fatigue, pain, and depressive symptoms for CKD and ESKD patients is similar to patients with gastrointestinal cancer, symptom cluster phenotypes differed between the groups as did the predictors of symptom clusters.

Pain, fatigue and depression symptom cluster in survivors of prostate cancer

“…A recent study of 606 gastrointestinal cancer patients reported that 9.6% experienced the fatigue-pain-depression symptom cluster [27]. Higher figures have been reported in studies of patients with lung cancer (19%), which is often advanced at diagnosis, patients with advanced cancer (20%) and patients following a palliative pathway (27%) [11,28,29]. In terms of possible explanations for the lower observed prevalence of the symptom cluster in the current study population, this may be because the majority of survivors had localized disease at diagnosis and many had survived 10 years or more.…”

“…Cancer-related pain, fatigue and depression are recognized to co-exist in a ‘symptom cluster’ among cancer patients and survivors [ 9 – 11 ]. Moreover, there is some evidence that the immune/inflammation pathway provides a biological basis for the co-existence of these symptoms in a cluster [ 12 ].…”

Symptom-burden in people living with frailty and chronic kidney disease

“…People with both end-stage kidney disease and earlier stages of CKD report high symptom-burden that has a negative influence on health-related quality of life (HRQOL) [10][11][12][13][14]. Notably, frailty is independently associated with worse HRQOL in CKD populations [15][16][17].…”

When ESKD complicates the management of pain

“…Pain is one of the most common symptoms, reported by 30%‐60% of patients with end‐stage kidney disease (ESKD) 1‐3 . In fact, the prevalence of pain in this population is similar to that in patients with advanced cancer 3 . Unfortunately, pain is frequently underdiagnosed and undertreated in ESKD patients.…”

“…Unfortunately, pain is frequently underdiagnosed and undertreated in ESKD patients. Fewer than 50% of hemodialysis (HD) patients with pain report using analgesics, and 75% have ineffective pain management 2,4,5 . Untreated pain negatively impacts patient's health‐related quality of life (HRQOL), dialysis adherence, healthcare utilization, and mortality 6‐8 .…”