Abstract
Purpose
Although sudden fatigue/exhaustion is a symptom expression that oncology clinicians frequently hear from their patients, empirical information about this phenomenon is limited. This study investigated the occurrence and characteristics of sudden fatigue in patients treated for breast cancer.
Methods
This cross-sectional descriptive study enrolled 114 breast cancer chemotherapy outpatients from a cancer clinic and an urban teaching hospital in the Midwestern United States. Subjects were screened for sudden fatigue and completed an investigator-developed Sudden Onset of Fatigue Questionnaire on the day of their chemotherapy treatment. Descriptive statistics were used to examine prevalence and clinical characteristics.
Results
Approximately half (46 %) of the patients (age 31–67, 62 % Black, and 70 % unemployed) experienced sudden fatigue. The majority (81 %) reported more than one (median = 3) episode per day; 67 % of episodes lasted 60 min or less. The sudden fatigue was most likely (77 %) to occur between 10 a.m. and 5 p.m., while individuals were active (94 %). When it occurred, individuals stopped activities and sought immediate rest. It was described as abrupt exhaustion/weakness often (66 %) accompanied by other symptoms. Fatigue intensity before, during, and after a specific episode were 5, 9, and 5, respectively, on 0–10 (highest) scale.
Conclusions
To better characterize sudden fatigue, a new descriptor, sudden exhaustion syndrome, which encompasses observed abrupt onset, transitory exhaustion/paralysis, and multiple symptoms, is proposed. Individuals may experience multiple occurrences of sudden exhaustion across a day, especially during activities. The syndrome needs to be recognized by oncology professionals. Patients should be educated about the syndrome to enhance sense of control and prevent harm.
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References
Prue G, Rankin J, Allen J, Gracey J, Cramp F (2006) Cancer-related fatigue: a critical appraisal. Eur J Cancer 42(7):846–863. doi:10.1016/j.ejca.2005.11.026
Radbruch L, Strasser F, Elsner F, Goncalves JF, Loge J, Kaasa S, Nauck F, Stone P (2008) Fatigue in palliative care patients—an EAPC approach. Palliat Med 22(1):13–32. doi:10.1177/0269216307085183
Alexander S, Minton O, Andrews P, Stone P (2009) A comparison of the characteristics of disease-free breast cancer survivors with or without cancer-related fatigue syndrome. Eur J Cancer 45(3):384–392. doi:10.1016/j.ejca.2008.09.010
Cavalli Kluthcovsky AC, Urbanetz AA, de Carvalho DS, Pereira Maluf EM, Schlickmann Sylvestre GC, Bonatto Hatschbach SB (2011) Fatigue after treatment in breast cancer survivors: prevalence, determinants and impact on health-related quality of life. Support Care Cancer. doi:10.1007/s00520-011-1293-7
Fleming L, Gillespie S, Espie CA (2010) The development and impact of insomnia on cancer survivors: a qualitative analysis. Psychooncology 19(9):991–996. doi:10.1002/pon.1652
Johansson E, Wilson B, Brunton L, Tishelman C, Molassiotis A (2010) Symptoms before, during, and 14 months after the beginning of treatment as perceived by patients with lymphoma. Oncol Nurs Forum 37(2):E105–E113. doi:10.1188/10.ONF.E105-E113
Servaes P, Verhagen S, Bleijenberg G (2002) Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Ann Oncol 13(4):589–598
Scott JA, Lasch KE, Barsevick AM, Piault-Louis E (2011) Patients' experiences with cancer-related fatigue: a review and synthesis of qualitative research. Oncol Nurs Forum 38(3):E191–E203. doi:10.1188/11.ONF.E191-E203
Byar KL, Berger AM, Bakken SL, Cetak MA (2006) Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life. Oncol Nurs Forum 33(1):E18–E26. doi:10.1188/06.ONF.E18-E26
Redeker NS, Lev EL, Ruggiero J (2000) Insomnia, fatigue, anxiety, depression, and quality of life of cancer patients undergoing chemotherapy. Sch Inq Nurs Pract 14(4):275–290
Bennett B, Goldstein D, Friedlander M, Hickie I, Lloyd A (2007) The experience of cancer-related fatigue and chronic fatigue syndrome: a qualitative and comparative study. J Pain Symptom Manage 34(2):126–135. doi:10.1016/j.jpainsymman.2006.10.014
Grunfeld EA, Cooper AF (2010) A longitudinal qualitative study of the experience of working following treatment for gynaecological cancer. Psychooncology. doi:10.1002/pon.1874
Rosedale M, Fu MR (2010) Confronting the unexpected: temporal, situational, and attributive dimensions of distressing symptom experience for breast cancer survivors. Oncol Nurs Forum 37(1):E28–E33. doi:10.1188/10.ONF.E28-E33
Rosman S (2009) ‘Recovered from cancer but still ill’: strategies used to legitimise extreme persistent fatigue in disease-free cancer patients. Eur J Cancer Care (Engl) 18(1):28–36. doi:10.1111/j.1365-2354.2007.00863.x
Wu HS, McSweeney M (2007) Cancer-related fatigue: “it's so much more than just being tired”. Eur J Oncol Nurs 11(2):117–125. doi:10.1016/j.ejon.2006.04.037
National Cancer Institute (2012) Fatigue. http://www.cancer.gov/cancertopics/pdq/supportivecare/fatigue/HealthProfessional. Accessed 14 May 2012
National Comprehensive Cancer Network (2012) Cancer-related fatigue (version 1). http://www.nccn.org/professionals/physician_gls/f_guidelines.asp. Accessed 14 May 2012
Berger AM (1998) Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncol Nurs Forum 25(1):51–62
Berger AM, Higginbotham P (2000) Correlates of fatigue during and following adjuvant breast cancer chemotherapy: a pilot study. Oncol Nurs Forum 27(9):1443–1448
de Jong N, Kester AD, Schouten HC, Abu-Saad HH, Courtens AM (2006) Course of fatigue between two cycles of adjuvant chemotherapy in breast cancer patients. Cancer Nurs 29(6):467–477
Richardson A, Ream E, Wilson-Barnett J (1998) Fatigue in patients receiving chemotherapy: patterns of change. Cancer Nurs 21(1):17–30
Schwartz AL (2000) Daily fatigue patterns and effect of exercise in women with breast cancer. Cancer Pract 8(1):16–24
Schwartz AL, Nail LM, Chen S, Meek P, Barsevick AM, King ME, Jones LS (2000) Fatigue patterns observed in patients receiving chemotherapy and radiotherapy. Cancer Invest 18(1):11–19
Wu HS, Dodd MJ, Cho MH (2008) Patterns of fatigue and effect of exercise in patients receiving chemotherapy for breast cancer. Oncol Nurs Forum 35(5):E90–E99. doi:10.1188/08.ONF.E90-E99
Molassiotis A, Chan CW (2001) Fatigue patterns in Chinese patients receiving chemotherapy. Eur J Oncol Nurs 5(1):60–67. doi:10.1054/ejon.2000.0098
Portenoy RK, Hagen NA (1989) Breakthrough pain: definition and management. Oncology (Williston Park) 3(8 Suppl):25–29
Portenoy RK, Hagen NA (1990) Breakthrough pain: definition, prevalence and characteristics. Pain 41(3):273–281
Portenoy RK, Payne D, Jacobsen P (1999) Breakthrough pain: characteristics and impact in patients with cancer pain. Pain 81(1–2):129–134
Holley S (2000) Cancer-related fatigue. Suffering a different fatigue. Cancer Pract 8(2):87–95
Ream E, Richardson A (1997) Fatigue in patients with cancer and chronic obstruction airways disease: a phenomenological enquiry. Int J Nurs Stud 34(1):44–53
Ferrell B, Grant M, Dean G, Funk B, Ly J (1996) “Bone tired”: the experience of fatigue and its impact on quality of life. Oncol Nurs Forum 23(10):1539–1547
Glaus A, Crow R, Hammond S (1996) A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals. Eur J Cancer Care (Engl) 5:8–23
Lindqvist O, Widmark A, Rasmussen BH (2004) Meanings of the phenomenon of fatigue as narrated by 4 patients with cancer in palliative care. Cancer Nurs 27(3):237–243
Gledhill J (2005) A qualitative study of the characteristics and representation of fatigue in a French speaking population of cancer patients and healthy subjects. Eur J Oncol Nurs 9(4):294–312. doi:10.1016/j.ejon.2004.11.002
Potter J (2004) Fatigue experience in advanced cancer: a phenomenological approach. Int J Palliat Nurs 10(1):15–23
Messias DK, Yeager KA, Dibble SL, Dodd MJ (1997) Patients' perspectives of fatigue while undergoing chemotherapy. Oncol Nurs Forum 24(1):43–48
Porock D, Juenger JA (2004) Just go with the flow: a qualitative study of fatigue in biotherapy. Eur J Cancer Care (Engl) 13(4):356–361. doi:10.1111/j.1365-2354.2004.00497.x
Cella D, Davis K, Breitbart W, Curt G (2001) Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol 19(14):3385–3391
Sadler IJ, Jacobsen PB, Booth-Jones M, Belanger H, Weitzner MA, Fields KK (2002) Preliminary evaluation of a clinical syndrome approach to assessing cancer-related fatigue. J Pain Symptom Manage 23(5):406–416
Van Belle S, Paridaens R, Evers G, Kerger J, Bron D, Foubert J, Ponnet G, Vander Steichel D, Heremans C, Rosillon D (2005) Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: proposal for use as a screening tool. Support Care Cancer 13(4):246–254. doi:10.1007/s00520-004-0734-y
National Cancer Institute (2011) US cancer survivors grows to nearly 12 million. http://www.cancer.gov/newscenter/pressreleases/2011/survivorshipMMWR2011. Accessed 14 May 2012
Pearce S, Richardson A (1996) Fatigue in cancer: a phenomenological perspective. Eur J Cancer Care (Engl) 5(2):111–115
Spichiger E, Rieder E, Muller-Frohlich C, Kesselring A (2011) Fatigue in patients undergoing chemotherapy, their self-care and the role of health professionals: a qualitative study. Eur J Oncol Nurs. doi:10.1016/j.ejon.2011.05.002
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This study was funded by Oncology Nursing Foundation/Novartis Nursing Research Grant.
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Wu, HS., Davis, J.E. Definition, prevalence and characteristics of sudden exhaustion: a possible syndrome of fatigue in cancer?. Support Care Cancer 21, 609–617 (2013). https://doi.org/10.1007/s00520-012-1555-z
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DOI: https://doi.org/10.1007/s00520-012-1555-z