title: Comprehensively understanding fatigue in patients with myeloproliferative neoplasms.
abstract: BACKGROUND
  Patients with myeloproliferative neoplasms (MPNs) experience a high persistence, prevalence, and severity of fatigue. There is currently only limited information regarding factors that contribute to fatigue in patients with MPNs.
  
  
  METHODS
  A 70-item, Internet-based survey regarding fatigue was developed by MPN investigators and patients/advocates and hosted by the Mayo Clinic Survey Research Center.
  
  
  RESULTS
  Fatigue was found to be prevalent and severe among international survey respondents (1788 respondents). Higher body mass index (P<.001), current use of alcohol (P<.001), and current tobacco use (P = .0025) were found to be significantly associated with greater fatigue. Moderate/severe fatigue was present more frequently in those individuals who did not exercise compared with those who reported exercising at least once per week (P<.001). Medical comorbidities found to be significantly associated with greater fatigue included restless leg syndrome (P = .006), diabetes mellitus (P = .045), fibromyalgia (P < 0.001), chronic fatigue syndrome (P = .006), and chronic kidney disease (P = .02). Current use of antidepressants (P<.001), antihistamines (P = .0276), antianxiety medications (P = .0357), and prescription pain medications (P<.001) were found to be associated with worsened fatigue. Nearly 25% of respondents scored > 2 on the Patient Health Questionnaire, indicating a high probability of depression. Higher Brief Fatigue Inventory score, Myeloproliferative Neoplasm Total Symptom Score, and individual symptom items were all associated with a higher likelihood of depressive symptoms (P<.0001).
  
  
  CONCLUSIONS
  The management of fatigue should be multifactorial, with a comprehensive assessment and treatment plan to address all modifiable fatigue etiologies. Patients with MPNs likely have a higher prevalence of mood disturbances compared with the general population, suggesting the need to assess and intervene in this domain.
authors.affiliation: Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona.|Department of Hematology and Oncology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Scherber
authors.affiliation: Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Kosiorek
authors.affiliation: MPN Forum, MPN Research Foundation, Chicago, Illinois.
authors.forename: Zhenya
authors.initials: Z
authors.lastname: Senyak
authors.affiliation: Division of Biostatistics, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Amylou C
authors.initials: AC
authors.lastname: Dueck
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Clark
authors.affiliation: Arizona Oncology, Tucson, Arizona.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Boxer
authors.affiliation: Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Holly L
authors.initials: HL
authors.lastname: Geyer
authors.affiliation: MPN Forum, MPN Research Foundation, Chicago, Illinois.
authors.forename: Archie
authors.initials: A
authors.lastname: McCallister
authors.affiliation: MPN Forum, MPN Research Foundation, Chicago, Illinois.
authors.forename: Mary
authors.initials: M
authors.lastname: Cotter
authors.affiliation: MPN Research Foundation, Chicago, Illinois.
authors.forename: Barbara
authors.initials: B
authors.lastname: Van Husen
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.|MPN Voice, London, United Kingdom.
authors.forename: Claire N
authors.initials: CN
authors.lastname: Harrison
authors.affiliation: Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, Arizona.
authors.forename: Ruben A
authors.initials: RA
authors.lastname: Mesa
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000150:complications / Q000628:therapy; D019046:Bone Marrow Neoplasms / Q000150:complications*; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000150:complications / Q000628:therapy; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control; D005221:Fatigue / Q000209:etiology* / Q000517:prevention & control* / Q000523:psychology; D015673:Fatigue Syndrome, Chronic / Q000150:complications / Q000453:epidemiology; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000453:epidemiology; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D011788:Quality of Life; D012148:Restless Legs Syndrome / Q000150:complications / Q000453:epidemiology; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057566:Self Report; D012720:Severity of Illness Index
keywords: essential thrombocythemia; fatigue; myelofibrosis; polycythemia vera; quality of life