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J Pain Symptom Manage. 2016 Sep;52(3):336-44. doi: 10.1016/j.jpainsymman.2016.02.017. Epub 2016 May 24.

Fatigue in Advanced Cancer Patients: Congruence Between Patients and Their Informal Caregivers About Patients' Fatigue Severity During Cancer Treatment With Palliative Intent and Predictors of Agreement.

Author information

1
Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Hanneke.Poort@radboudumc.nl.
2
Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
3
Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
4
Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, The Netherlands.
5
Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands; The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, United Kingdom.
6
School of Psychological Sciences and Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom.

Abstract

CONTEXT:

Informal caregivers (ICs) are increasingly involved in the monitoring of symptoms during advanced cancer patients' treatment with palliative intent. A common but subjective symptom during this extended treatment phase is fatigue.

OBJECTIVES:

This exploratory longitudinal study aimed to determine agreement between patients and ICs about patients' fatigue severity. In addition, predictors of agreement over time were studied.

METHODS:

A sample of 107 patients with advanced cancer (life expectancy ≥ six months) and their ICs completed the subscale fatigue severity of the Checklist Individual Strength based on the patient's status at baseline and six months later. This eight-item subscale has a validated cutoff to determine the presence of clinically relevant levels of fatigue. ICs' own fatigue severity, strain, self-esteem, and relationship satisfaction were examined as predictors of agreement.

RESULTS:

A total of 107 dyads completed measures at baseline and 69 dyads six months later. At baseline, ICs' significantly overestimated patients' fatigue severity (P < 0.001) with a moderate amount of bias (Cohen's d = 0.48). In 81 of the 107 dyads (76%), there was congruence about the presence or absence of severe fatigue. On a group level, congruence did not significantly change over time. On a dyad level, there was a tendency to either remain congruent or reach congruence. Next to baseline congruence, ICs' fatigue severity and strain predicted ICs' fatigue ratings (R(2) = 0.22).

CONCLUSION:

Most ICs accurately predict presence or absence of clinically relevant levels of patients' fatigue. ICs' own fatigue severity and strain should be taken into account as they influence agreement.

KEYWORDS:

Cancer; fatigue; informal caregiver; oncology; proxy-rating

[Indexed for MEDLINE]

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