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Br J Cancer. Mar 1999; 79(9-10): 1479–1486.
PMCID: PMC2362706

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

Abstract

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. © 1999 Cancer Research Campaign

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993 Mar 3;85(5):365–376. [PubMed]
  • Aistars J. Fatigue in the cancer patient: a conceptual approach to a clinical problem. Oncol Nurs Forum. 1987 Nov-Dec;14(6):25–30. [PubMed]
  • Bland JM, Altman DG. Measurement error. BMJ. 1996 Jun 29;312(7047):1654–1654. [PMC free article] [PubMed]
  • Blesch KS, Paice JA, Wickham R, Harte N, Schnoor DK, Purl S, Rehwalt M, Kopp PL, Manson S, Coveny SB, et al. Correlates of fatigue in people with breast or lung cancer. Oncol Nurs Forum. 1991 Jan-Feb;18(1):81–87. [PubMed]
  • Brown ML, Carrieri V, Janson-Bjerklie, Dodd MJ. Lung cancer and dyspnea: the patient's perception. Oncol Nurs Forum. 1986 Sep-Oct;13(5):19–24. [PubMed]
  • Bruera E, Brenneis C, Michaud M, Jackson PI, MacDonald RN. Muscle electrophysiology in patients with advanced breast cancer. J Natl Cancer Inst. 1988 Apr 20;80(4):282–285. [PubMed]
  • Bruera E, Brenneis C, Michaud M, Rafter J, Magnan A, Tennant A, Hanson J, Macdonald RN. Association between asthenia and nutritional status, lean body mass, anemia, psychological status, and tumor mass in patients with advanced breast cancer. J Pain Symptom Manage. 1989 Jun;4(2):59–63. [PubMed]
  • Dimeo F, Stieglitz RD, Novelli-Fischer U, Fetscher S, Mertelsmann R, Keul J. Correlation between physical performance and fatigue in cancer patients. Ann Oncol. 1997 Dec;8(12):1251–1255. [PubMed]
  • Donnelly S, Walsh D. The symptoms of advanced cancer. Semin Oncol. 1995 Apr;22(2 Suppl 3):67–72. [PubMed]
  • Frisancho AR. Triceps skin fold and upper arm muscle size norms for assessment of nutrition status. Am J Clin Nutr. 1974 Oct;27(10):1052–1058. [PubMed]
  • Greig CA, Young A, Skelton DA, Pippet E, Butler FM, Mahmud SM. Exercise studies with elderly volunteers. Age Ageing. 1994 May;23(3):185–189. [PubMed]
  • Hardy JR, Turner R, Saunders M, A'Hern R. Prediction of survival in a hospital-based continuing care unit. Eur J Cancer. 1994;30A(3):284–288. [PubMed]
  • Higginson I, McCarthy M. Measuring symptoms in terminal cancer: are pain and dyspnoea controlled? J R Soc Med. 1989 May;82(5):264–267. [PMC free article] [PubMed]
  • Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S. Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ=C30 (+ 3). J Clin Oncol. 1998 Mar;16(3):1188–1196. [PubMed]
  • Hopwood P, Howell A, Maguire P. Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires. Br J Cancer. 1991 Aug;64(2):353–356. [PMC free article] [PubMed]
  • Klee M, Groenvold M, Machin D. Quality of life of Danish women: population-based norms of the EORTC QLQ-C30. Qual Life Res. 1997 Jan;6(1):27–34. [PubMed]
  • Krupp LB, LaRocca NG, Muir J, Steinberg AD. A study of fatigue in systemic lupus erythematosus. J Rheumatol. 1990 Nov;17(11):1450–1452. [PubMed]
  • Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol. 1989 Oct;46(10):1121–1123. [PubMed]
  • Lawrie SM, MacHale SM, Power MJ, Goodwin GM. Is the chronic fatigue syndrome best understood as a primary disturbance of the sense of effort? Psychol Med. 1997 Sep;27(5):995–999. [PubMed]
  • Lawrie SM, Pelosi AJ. Chronic fatigue syndrome in the community. Prevalence and associations. Br J Psychiatry. 1995 Jun;166(6):793–797. [PubMed]
  • Monga U, Jaweed M, Kerrigan AJ, Lawhon L, Johnson J, Vallbona C, Monga TN. Neuromuscular fatigue in prostate cancer patients undergoing radiation therapy. Arch Phys Med Rehabil. 1997 Sep;78(9):961–966. [PubMed]
  • Morant R. Asthenia: an important symptom in cancer patients. Cancer Treat Rev. 1996 Jan;22 (Suppl A):117–122. [PubMed]
  • Morant R, Stiefel F, Berchtold W, Radziwill A, Riesen W. Preliminary results of a study assessing asthenia and related psychological and biological phenomena in patients with advanced cancer. Support Care Cancer. 1993 Mar;1(2):101–107. [PubMed]
  • Packer TL, Martins I, Krefting L, Brouwer B. Activity and post-polio fatigue. Orthopedics. 1991 Nov;14(11):1223–1226. [PubMed]
  • Gaffney G, Sellers S, Flavell V, Squier M, Johnson A. Case-control study of intrapartum care, cerebral palsy, and perinatal death. BMJ. 1994 Mar 19;308(6931):743–750. [PMC free article] [PubMed]
  • Richardson A. Measuring fatigue in patients with cancer. Support Care Cancer. 1998 Mar;6(2):94–100. [PubMed]
  • Smets EM, Garssen B, Cull A, de Haes JC. Application of the multidimensional fatigue inventory (MFI-20) in cancer patients receiving radiotherapy. Br J Cancer. 1996 Jan;73(2):241–245. [PMC free article] [PubMed]
  • Visser MR, Smets EM. Fatigue, depression and quality of life in cancer patients: how are they related? Support Care Cancer. 1998 Mar;6(2):101–108. [PubMed]
  • Walsh TD, Saunders CM. Hospice care: the treatment of pain in advanced cancer. Recent Results Cancer Res. 1984;89:201–211. [PubMed]
  • Wearden AJ, Appleby L. Research on cognitive complaints and cognitive functioning in patients with chronic fatigue syndrome (CFS): What conclusions can we draw? J Psychosom Res. 1996 Sep;41(3):197–211. [PubMed]
  • Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. [PubMed]

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