title: The association between anemia and fatigue in patients with advanced cancer receiving palliative care.
abstract: BACKGROUND
  Fatigue has been reported to be associated with anemia in patients receiving cancer treatment. Treatment of anemia such as erythropoietin has been reported to decrease fatigue in these patients.
  
  
  OBJECTIVE
  To investigate the correlation between anemia and fatigue intensity in patients with advanced cancer receiving palliative care.
  
  
  METHODS
  We reviewed medical charts of 177 consecutive outpatients seen by our palliative care specialists. Information of fatigue intensity and hemoglobin level was collected.
  
  
  RESULTS
  Among 147 (83%) evaluable patients, the median hemoglobin level was 11.6 g/dL (range, 7.5-16.1). Eighty-two (56%) patients had a hemoglobin level 12 g/dL or less, whereas 125 (85%) had 10 g/dL or more. The median fatigue score in patients with a hemoglobin level 10 g/dL or more and 10 g/dL or less was 6 (range, 4-8) and 7 (range, 5-8), respectively (p = 0.048). The median fatigue score in patients with a hemoglobin level 12 g/dL or more and 12 g/dL or less was 6 (range, 4-7) and 6 (range, 4-8), respectively (p > 0.5). Spearman's rank correlation coefficient showed a significant association only between the hemoglobin level and the albumin level (r = 0.52, p < 0.0001). Hemoglobin level did not show a significant correlation with fatigue although there was a trend (p = 0.09). In a multivariate regression analysis of the intensity of fatigue and other clinical variables, three variables remained significant in the reverse elimination analysis: depression (p = 0.0067), albumin level (p = 0.0079), and sensation of well-being (p = 0.0569). The overall explained variance for this model was 0.22.
  
  
  CONCLUSIONS
  Our findings suggest that anemia is not one of the major contributors to fatigue in patients with cancer receiving palliative care.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Tina Noergaard
authors.initials: TN
authors.lastname: Munch
authors.forename: Tao
authors.initials: T
authors.lastname: Zhang
authors.forename: Jie
authors.initials: J
authors.lastname: Willey
authors.forename: J Lynn
authors.initials: JL
authors.lastname: Palmer
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy / Q000209:etiology*; D005221:Fatigue / Q000209:etiology*; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000628:therapy*; D010166:Palliative Care; D013781:Texas
chemical_list: D006454:Hemoglobins