FORT LAUDERDALE, FlaHow common is severe cancer-related
fatigue? In a survey study at the Cleveland Clinic, 72 of 172
palliative medicine consult patients contacted said they were too
tired to participate. While fatigue is fairly common in
patients with advanced cancer, the extent of their fatigue was
surprising, Kristine Nelson, MD, said at the Cleveland
Clinics Palliative Medicine 1999 meeting.
Dr. Nelson, director of the Palliative Medicine Research Program at
the Cleveland Clinic, said there are limits to patient surveys of
fatigue. Youre basically talking to the patients about
symptoms, and you usually dont attain any information about the
cause or mechanism of that symptom, she said. However, she
noted that palliative medicine is a young science, and
information is needed about the prevalence and severity of symptoms.
Patient surveys are an easy way to attain this
information, she said.
The study included a patient questionnaire as well as collection of
data on each patient (age, sex, primary diagnosis, extent of disease,
performance status, weight change since diagnosis, and certain
laboratory tests). Of the 100 participants in the survey (54 men and
46 women with a median age of 68 years), 27 different cancers were
reported, with the most common being lung cancer (26 patients). Most
patients (63) had an ECOG performance status of 3.
The median weight change since diagnosis was a loss of 24 pounds
(range, +20 to -90). The median laboratory values were hemoglobin,
10.6 g/dL; hematocrit, 32.2 mL/dL; and lactate dehydrogenase (LDH),
The survey questionnaire asked six questions:
Do you feel fatigued right now?
How fatigued did you feel this past week?
Circle one activity that you consider important. (Cooking, Dressing,
Visiting, Driving, Gardening, Family activities, Walking, Shopping,
Housework, Social activities)
How would you rate your ability to do this activity?
How was your quality of life this past week?
What does the word fatigue mean to you? (Tired, Lack of energy,
Depressed, General weakness, Dont know, Other)
Questions 1, 2, and 4 were rated on a 100 mm visual analog scale with
the following anchors: very fatigued to no fatigue for questions 1
and 2, and impossible to normal for question 4.
In question 1, the median patient rating for current fatigue was 22
mm (range, 0 to 98). For question 2, patients rated their fatigue
over the last week at a median of 12 mm (range, 0 to 90).
Most Important Activities
The most common responses for question 3 were walking (13), driving
(13), dressing (11), and social activities (11). In question 4, they
rated their ability to do these activities at a median of 10 mm
(range, 0 to 99).
I must admit Im a little bit perplexed by this
because we have other studies that show that families are usually the
winners in whats important to patients lives, Dr.
Nelson said. I can only say that, most likely, since the
patients were doing a fatigue questionnaire, they singled out the
physical problemsa physical activity that was important that
they couldnt do when they were fatigued.
In question 5, the majority of patients rated their quality of life
as bad (69), while 25 said it was acceptable,
and only 4 considered it good.
In question 6, the most common patient definitions for fatigue were
lack of energy (41), tired (38), and general weakness (19). Thus,
there is no clear, straight-forward definition of the word fatigue.
This may be one of the significant results of the study,
she said. So when you ask a patient, Are you tired? Are
you fatigued? you should be aware that there are many different
interpretations of the word, and the clinician and patient may not be
talking about the same thing.