Supportive Care in Cancer

, Volume 4, Issue 2, pp 82–96 | Cite as

A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals

  • Agnes Glaus
  • Rosemary Crow
  • Sean Hammond
Special Article


Interest in fatigue research has grown since the finding that fatigue/tiredness is the most frequently reported symptom of cancer and its treatment. But even though several authors have tried to conceptualise fatigue, its mechanisms are still poorly understood. The aim of this study was twofold: (a) to explore fatigue in cancer patients inductively, and (b) to compare experiences of fatigue/tiredness of healthy individuals with those of cancer patients to identify cancer-specific fatigue/tiredness and related concepts. A qualitative research strategy was adopted using a grounded-theory approach. The prospective study took place in the oncology department of the Kantonsspital, St. Gallen, Switzerland, with samples of 20 cancer patients and 20 healthy individuals. Unstructured, tape-recorded interviews were conducted to collect data. The transcripts of the interviews were analysed using content analysis and constant comparison. Different themes emerged between the two groups although both fitted a classification system that categorised fatigue into physical, affective and cognitive expressions of fatigue/tiredness. Physical signs were more frequent than affective and cognitive signs in both groups. In the cancer patients, fatigue involved decreased physical performance, extreme, unusual tiredness, weakness and an unusual need for rest, which was distinctly different for healthy persons. Affective and cognitive distress was also more prominent in cancer patients. Interestingly, the concept of malaise was not identified by either sample and not understood as an expression of fatigue by this German-speaking population. Linguistic differences in the description of fatigue/tiredness between healthy and ill individuals revealed different perceptions of the phenomenon. A step-like theory, explaining the production of fatigue/tiredness was tentatively put forward involving nociception, perception and expression of tiredness. The emerging concepts break tiredness/fatigue into an expression of physical, affective and cognitive tiredness/fatigue. The experience is different between healthy individuals and cancer patients. Care must be taken when drawing generalised conclusions but the results of the study identify and clarify ideas that might form an important basis for further, controlled studies.

Key words

Fatigue Tiredness Experience Theory Cancer Health 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Astair J (1987) Fatigue in the cancer patients: a conceptual approach to a clinical problem. Oncol Nurs Forum 14:25–30Google Scholar
  2. 2.
    Baker C, Wuest J, Stern P (1992) Method slurring: the grounded theory/phenomenology example. J Adv Nurs 17:1355–1360PubMedGoogle Scholar
  3. 3.
    Bruera E (1988) Asthenia in patients with advanced cancer. J Pain Symptom Manage 18:81–87Google Scholar
  4. 4.
    Bruera E (1994) New developments in the assessment of pain in cancer patients. J Support Care Cancer 2:312–318Google Scholar
  5. 5.
    Chalmers AF (1982) What is this thing called science? Open University Press, BuckinghamGoogle Scholar
  6. 6.
    Chenitz WC (1984) Surfacing nursing process: a method for generating nursing theory from practice. J Adv Nuts 9:205–215Google Scholar
  7. 7.
    Cimprich B (1992) A theoretical perspective on attention and patient education. Adv Nurs Sci 14:39–51Google Scholar
  8. 8.
    Clarke L (1995) Nursing research: science, visions and telling stories. J Adv Nurs 21:584–593PubMedGoogle Scholar
  9. 9.
    Field P, Morse J (1985) Nursing research: the application of qualitative approaches. Chapman & Hall, LondonGoogle Scholar
  10. 10.
    Gibson H, Edwards R (1985) Muscular exercise and fatigue. Sports Med 2:121Google Scholar
  11. 11.
    Glaus A (1993) Assessment of fatigue in cancer and non-cancer patients and in healthy individuals. J Support Care Cancer 1:305–315Google Scholar
  12. 12.
    Glaser B (1978) Theoretical sensitivity. Sociological Press, Mill Valley, CalifGoogle Scholar
  13. 13.
    Glaser B, Strauss A (1967) The discovery of grounded theory: strategies for qualitative research. Aldine, New YorkGoogle Scholar
  14. 14.
    Gordon M (1986) Differential diagnosis of weakness: a common geriatric symptom. Geriatrics 41:75–79Google Scholar
  15. 15.
    Grandjean E (1970) Fatigue. Am Ind Hyg Assoc J 31:401–411PubMedGoogle Scholar
  16. 16.
    Harris M (1968) The rise of anthropological theory. Crowell, New YorkGoogle Scholar
  17. 17.
    Hürny C, Bernhard J (1993) Fatigue and Malaise as a quality of life indicator in small-cell lung cancer patients. J Support Care Cancer 1:316–320Google Scholar
  18. 18.
    Irvine D, Vincent L, Graydon J (1994) The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiotherapy. Cancer Nurs 17:367–378PubMedGoogle Scholar
  19. 19.
    Kobashi J, Hanewald G, Van Dam F (1985) Assessment of malaise in cancer patients treated with radiotherapy. Cancer Nurs 8:306–313PubMedGoogle Scholar
  20. 20.
    Lincoln YS, Guba EG (1985) Naturalistic inquiry. Sage, Newbury Park, CalifGoogle Scholar
  21. 21.
    Mac Vicar MG, Winningham ML (1986) Promoting the functional capacity of cancer patients. Cancer Bull 38:235–239Google Scholar
  22. 22.
    Melia KM (1992) Tell it as it is — qualitative methodology and nursing research: understanding the student nurses' world. J Adv Nurs 12:331–337Google Scholar
  23. 23.
    Miles M, Huberman A (1984) Qualitative data analysis: a source book of new methods. Sage, Beverly Hills, CalifGoogle Scholar
  24. 24.
    Morant R (1991) Asthenia in cancer patients — a double edged inflammatory response against the tumour? J Palliat Care 7:22–24PubMedGoogle Scholar
  25. 25.
    Morse J (1989) Qualitative nursing research: a free-for-all? In: Morse J (ed) Qualitative nursing research: a contemporary dialogue. Sage, Newbury Park, CalifGoogle Scholar
  26. 26.
    Omery A (1983) Phenomenology, a method for nursing research. Adv Nurs Sci 5:49–63Google Scholar
  27. 27.
    Oppenheim AN (1992) Questionnaire, design, interviewing and attitude measurement. Pinter, LondonGoogle Scholar
  28. 28.
    Piper B (1993) Fatigue. In: Carrieri V, Lindsey A, West C (eds) Pathophysiological phenomena in nursing, human response to illness. Saunders, Philadelphia, pp 279–302Google Scholar
  29. 29.
    Piper B, Lindsey A (1989) Development of an instrument to measure the subjective dimension of fatigue. In: Funk S, Tornquist E (eds) Key aspects of comfort. Springer, New York Heidelberg Berlin, pp 199–208Google Scholar
  30. 30.
    Piper B, Rieger P (1989) Recent advances in the management of biotherapy-related side effects: fatigue. Oncol Nurs Forum 16 [Suppl]:27–34PubMedGoogle Scholar
  31. 31.
    Polit D, Hungler B (1993) Essentials of nursing research. Lippincott, PhiladelphiaGoogle Scholar
  32. 32.
    Schag C, Heinrich R, Ganz P (1984) Karnofsky performance status revisited: reliability, validity and guidelines. J Clin Oncol 2:187–193PubMedGoogle Scholar
  33. 33.
    St Pierre B, Kasper CE (1992) Fatigue mechanisms in patients with cancer: effects of tumor necrosis factor and exercise on skeletal muscle. Oncol Nurs Forum 19:419–425PubMedGoogle Scholar
  34. 34.
    Weis E (1990) PONS Kompaktwörterbuch. Klett, StuttgartGoogle Scholar
  35. 35.
    Winingham M, Nail L, et al (1994) Fatigue and the cancer experience: the state of the knowledge. Oncol Nurs Forum 21:23–36PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • Agnes Glaus
    • 1
  • Rosemary Crow
    • 2
  • Sean Hammond
    • 3
  1. 1.Medizinische Klinik CKantonsspitalSt. GallenSwitzerland
  2. 2.Department of Nursing and MidwiferyUniversity of SurreyGuildfordUK
  3. 3.Department of PsychologyUniversity of SurreyGuildfordUK

Personalised recommendations