Fatigue and its associated psychosocial factors in cancer patients on active palliative treatment measured over time.
OBJECTIVE
Fatigue is a frequently reported symptom by patients with advanced cancer, but hardly any prospective information is available about fatigue while on treatment in the palliative setting. In a previous cross-sectional study, we found several factors contributing to fatigue in these patients. In this study, we investigated the course of fatigue over time and if psychosocial factors were associated with fatigue over time.


METHODS
Patients on cancer treatment for incurable solid tumors were observed over 6 months. Patients filled in the Checklist Individual Strength monthly to measure the course of fatigue. Baseline questionnaires were used to measure disease acceptance, anxiety, depressive mood, fatigue catastrophizing, sleeping problems, discrepancies in social support, and self-reported physical activity for their relation with fatigue over time.


RESULTS
At baseline 137 patients and after 6 months 89 patients participated. The mean duration of participation was 4.9 months. At most time points, fatigue scores were significantly higher in the group dropouts in comparison with the group participating 6 months (completers). Overall fatigue levels remained stable over time for the majority of participants. In the completers, 42% never experienced severe fatigue, 29% persisted being severely fatigued, and others had either an increasing or decreasing level. Of the investigated factors, low reported physical activity and non-acceptance of cancer were associated significantly to fatigue.


CONCLUSIONS
A substantial number of participants never experienced severe fatigue and fatigue levels remained stable over time. For those who do experience severe fatigue, non-acceptance of having incurable cancer and low self-reported physical activity may be fatigue-perpetuating factors.
Department of Medical Oncology (452), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands. marlies.peters@radboudumc.nl.
Marlies E W J
ME
Peters
Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Martine M
MM
Goedendorp
Department of Medical Oncology (452), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
Constans A H H V M
CA
Verhagen
Expert Center for Chronic Fatigue, Radboud University Medical Center, Nijmegen, the Netherlands.
Gijs
G
Bleijenberg
Department of Medical Oncology (452), Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
Winette T A
WT
van der Graaf
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
Advanced cancer; Cancer treatment; Fatigue; Palliative phase; Quality of life