title: Reductions in anaemia and fatigue are associated with improvements in productivity in cancer patients receiving chemotherapy.
abstract: OBJECTIVE
  Cancer-related anaemia is associated with fatigue that adversely affects patients' everyday functioning and wellbeing. We explore the impact of fatigue on patient productivity and caregiver burden.
  
  
  METHODS
  The analyses are based on data from a randomised, open-label, active-controlled, dose-finding trial of darbepoetin alfa among solid-tumour cancer patients with anaemia, who are receiving chemotherapy. Fatigue is assessed with the Functional Assessment of Cancer Therapy (FACT)-Fatigue subscale score. Productivity and caregiver outcomes include time (hours) missed from usual activities, amount of assistance (hours) needed from others, overall ability to perform desired activities and ability to perform family responsibilities. These outcomes are assessed at baseline and the end of the 12-week treatment period. ANOVA and linear regression models are used to evaluate associations.
  
  
  RESULTS
  Patients (n=300) were aged 61 years on average, with a mean (SD) baseline haemoglobin of 9.9 (0.9) g/dL. FACT-Fatigue subscale score improvements were significantly (p=0.003) associated with haemoglobin improvements. Over a 2-week period, after controlling for age, sex and disease progression, one-point improvements in FACT-Fatigue subscale scores corresponded to a 1-hour (95% CI 0.5, 1.5) gain in productive time, 0.7-hour (95% CI 0.4, 1.0) reduction in caregiver time and 1.6% (95% CI 1.4, 1.7) improvement in overall activity.
  
  
  CONCLUSIONS
  Reducing fatigue is associated with gains in productive time, reductions in caregiver burden and enhanced ability to perform activities. These outcomes may have broader implications for patients' wellbeing and for the societal impact of cancer-related fatigue and anaemia.
authors.affiliation: Massachusetts Institute of Technology Sloan School of Management, Cambridge, Massachusetts 02142, USA. eberndt@mit.edu
authors.forename: Ernst
authors.initials: E
authors.lastname: Berndt
authors.forename: Joel
authors.initials: J
authors.lastname: Kallich
authors.forename: Anne
authors.initials: A
authors.lastname: McDermott
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.forename: Howard
authors.initials: H
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Glaspy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000139:chemically induced* / Q000188:drug therapy / Q000191:economics*; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000068256:Darbepoetin alfa; D004305:Dose-Response Relationship, Drug; D004526:Efficiency; D004921:Erythropoietin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics* / Q000627:therapeutic use*; D005221:Fatigue / Q000139:chemically induced* / Q000188:drug therapy / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000191:economics*
chemical_list: D000970:Antineoplastic Agents; D004921:Erythropoietin; D000068256:Darbepoetin alfa