Fatigue in advanced cancer: a prospective controlled cross-sectional study

Abstract

Summary Uncontrolled studies have reported that fatigue is a common symptom among patients with advanced cancer. It is also a frequent complaint among the general population. Simply asking cancer patients whether or not they feel fatigued does not distinguish between the 'background' level of this symptom in the community and any 'excess' arising as a result of illness. The aim of this study was to determine the prevalence of fatigue among palliative care inpatients in comparison with a control group of age and sex-matched volunteers without cancer. In addition, the correlates of fatigue were investigated. The prevalence of 'severe subjective fatigue' (defined as fatigue greater than that experienced by 95% of the control group) was found to be 75%. Patients were malnourished, had diminished muscle function and were suffering from a number of physical and mental symptoms. The severity of fatigue was unrelated to age, sex, diagnosis, presence or site of metastases, anaemia, dose of opioid or steroid, any of the haematological or biochemical indices (except urea), nutritional status, voluntary muscle function, or mood. A multivariate analysis found that fatigue severity was significantly associated with pain and dypnoea scores in the patients, and with the symptoms of anxiety and depression in the controls. The authors conclude that subjective fatigue is both prevalent and severe among patients with advanced cancer. The causes of this symptom remain obscure. Further work is required in order to determine if the associations reported between fatigue and pain and between fatigue and dyspnoea are causal or coincidental.Keywords: fatigue; asthenia; neoplasms; palliative care; quality of life 1479British Journal of Cancer (1999) 79(9/10), 1479-1486 © 1999 Cancer Research Campaign Article no. bjoc.1998 Received SUBJECTS AND METHODSInpatients with advanced cancer were recruited from three palliative care units between April 1996 and January 1997. Radiotherapy or chemotherapy within the previous 4 weeks, clinically apparent confusion, poor English language skills, disability or pain affecting the non-dominant hand or an estimated prognosis of less than 2 weeks were all exclusion criteria. The principal investigator visited each of the participating units weekly and approached all patients identified as being eligible to enter the study. In the absence of the principal investigator, due to holidays or illness, recruitment was suspended. Thus, although the patient group did not represent a consecutive series of eligible patients (i.e. it was a convenience sample), there is no reason to suspect a systematic bias in patient selection. Control subjects were age and sex-matched volunteers without cancer. They were recruited from the 'League of Friends' at the respective units and were subjected to the same inclusion and exclusion criteria as the patients. The protocol was approved by the relevant Scientific and Ethics Committees.After informed consent had been obtained, the patients were asked to undergo a number of assessme...

Impact of Cancer-Related Fatigue on the Lives of Patients: New Findings From the Fatigue Coalition

“…The fatigue prevalence rate of 76% is consistent with results of our initial survey [6] and previous studies that assessed the prevalence of fatigue in patients with cancer [1,5,12,14,15,[18][19][20][21]. The high prevalence of fatigue in cancer patients may be due in part to the evolution of more intensive treatment strategies, including combined modality approaches and high-dose chemotherapy [17].…”

“…In addition, pain or depression was more likely to occur in patients experiencing fatigue on a daily basis than in those experiencing it less frequently. Available evidence suggests that these symptoms are correlated with fatigue in cancer patients [4,12,21]. The cause-and-effect relationships among pain and psychological distress and the physical manifestations of cancerrelated fatigue remain unclear, however, and require further investigation [13,15,18,22,25].…”

Cancer-Related Fatigue: The Scale of the Problem

“…It has been reported to occur in a majority of patients across a wide range of cancer types [1][2][3]. The impact of cancer-related fatigue (CRF) on a patient's ability to function is considerable; hence, this symptom is among the most distressing of all those reported by patients.…”

Assessment of cancer related fatigue

“…Fatigue is a widespread symptom in cancer patients and cancer survivors, which can occur in any stage of disease, during the treatment (2), in advanced stage of disease (3), as well as in cancer survivors (4) and to last for a long period after completion of treatment. According to the upto-date definition by National Comprehensive Cancer Network (5), cancer-related fatigue is a limitation of physical and mental capacity, which occurs in relation to the medical treatment, has a significant impact on patient's activity and cannot be reduced despite adequate rest and relaxation.…”