Cancer-related fatigue: clinical practice versus practice guidelines.
OBJECTIVE
This study investigated adherence to treatment guidelines on cancer-related anaemia and fatigue (CRA/CRF) and factors influencing the choice of intervention.


METHODS
In this prospective, observational study, 136 cancer patients being treated with chemotherapy in a large community hospital completed a questionnaire at consecutive outpatient visits assessing fatigue (the Functional Assessment of Chronic Illness Therapy-Fatigue) and fatigue-related counselling and advice received. Data on administration of chemotherapy and use of epoetin or blood transfusions were abstracted from the medical records.


RESULTS
Fifty-three percent of patients with severe anaemia (Hb < 10 g/dl) and 6% of patients with less severe anaemia (Hb levels 10-12 g/dl) received treatment (epoetin and/or blood transfusions). Half of the patients with less severe anaemia reported clinically relevant levels of fatigue. More than 50% of all patients received fatigue-related counselling, primarily at the start of chemotherapy. Most counselling was directed at energy conservation. Fatigue was not associated significantly with the use of epoetin or blood transfusion. Patients receiving palliative treatment (17%), male patients (16%) and patients with a low Hb level (<6.2 g/dl, 38%) were treated significantly more often with epoetin.


CONCLUSIONS
In daily clinical practice, guidelines concerning the use of epoetin or blood transfusion in severe CRA are adhered to in about half of the cases. In patients with less severe anaemia, the level of fatigue did not play a significant role in the use of epoetin. According to current guidelines, counselling on CRF should be directed primarily at activity enhancement. However, only a minority of patients receive such counselling.
The Red Cross Hospital, Beverwijk, The Netherlands.
Doranne L
DL
Hilarius
Paul H
PH
Kloeg
Elsken
E
van der Wall
Manon
M
Komen
Chad M
CM
Gundy
Neil K
NK
Aaronson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000209:etiology / Q000628:therapy*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001803:Blood Transfusion / Q000379:methods; D004921:Erythropoietin / Q000627:therapeutic use; D005221:Fatigue / Q000209:etiology / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods; D010353:Patient Education as Topic / Q000379:methods / Q000592:standards; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors
D000970:Antineoplastic Agents; D004921:Erythropoietin