PHILADELPHIAA study presented at the Oncology
Nursing Society’s 26th Annual Congress in San Diego underscores the
challenge of managing cancer-related fatigue: Fatigue frequently is part of
a cluster of interrelated symptoms, such as pain, depression, and poor sleep
Andrea M. Barsevick, DNSc, RN, director of nursing research
and education, Fox Chase Cancer Center, and her colleagues examined the
effects of symptom clustering in a group of 101 patients who were drawn from
the control group of a larger study of fatigue management.
The study group was composed of 89 women and 12 men, with a
mean age of 57 (range, 30 to 78). The majority of patients had breast
cancer, but other diagnoses included cervical cancer, lymphoma, and lung
cancer. All disease stages were represented in the group.
The investigators measured fatigue, pain, depression, and
sleep quality at baseline and at a time of expected high fatigue (at the end
of 5 weeks of radiation therapy or 48 hours after the second cycle of
Fatigue was measured with the Profile of Mood States
(fatigue scale), the Schwartz Cancer Fatigue Scale, and the General Fatigue
Sleep quality was assessed with the Pittsburgh Sleep Quality
Scale; depression, with the Profile of Mood States (depression scale); and
pain, with a Side Effects Checklist item (pain).
When the symptoms were considered individually, 36% of the
study participants experienced pain; 82% had sleep disturbances; 22% experienced depression; and 81% experienced
When the symptoms were grouped as triads, 7% of the patients
had fatigue-pain-depression; 21% had fatigue-pain-sleep disturbance; 7%
experienced pain-sleep disturbance-depression;
and 21% had fatigue-sleep disturbance-depression. Seven percent of the patients experienced all four symptoms.
The investigators concluded that symptom clustering is
common among patients undergoing cancer treatment and that fatigue is
significantly correlated with depression. Poor sleep quality also was
associated with fatigue, but the relationship did not reach statistical
The study did not find a correlation between fatigue and
pain, but the researchers noted that the pain measurement may not have been