Skip to main content
SpringerLink
Log in

Patients’ views about causes and preferences for the management of cancer-related fatigue—a case for non-congruence with the physicians?

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Cancer-related fatigue (CRF) is frequently overlooked. Adherence to treatment guidelines may be related to the patient’s views about illness. This study aimed at exploring patients’ views about CRF and determining whether they are congruent with best practice treatments.

Methods

Data were collected in 160 consecutive patients hospitalized in a supportive care setting. Biological, clinical, and psychological variables were assessed using validated questionnaires. Patients were also asked to complete the Brief Fatigue Inventory (BFI) and a questionnaire investigating their main symptoms and views about CRF and its management.

Results

Patients were mainly men (60%); median age was 66 years. Various cancer diagnoses were represented; 17.5% had primary local diseases, 40% local recurrences, and 42.5% metastatic diseases. The majority of the patients experienced moderate or severe CRF (76.3%) on the BFI. Fatigue was the most frequently reported symptom (87.5%). Only anxiety, depression, and dimensions of quality of life were significantly related with CRF. Two thirds of the patients associated CRF with cancer-related morbidities. As for the best treatments, patients first stressed control of adverse effects. Over half of the patients were reluctant to report fatigue, mainly because they considered fatigue as an unavoidable side effect, but also because they feared a change towards less active/aggressive treatments.

Conclusion

Patients mostly consider that CRF must be tolerated. Guidelines emphasize activity enhancement strategies as beneficial. The patients’ preferences for rest rather than activity may be related to their high level of fatigue, which leads them to disregard activity as a possible treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mock V, Atkinson A, Barsevick A et al (2000) NCCN practice guidelines for cancer-related fatigue. Oncology 14:151–161

    PubMed  CAS  Google Scholar 

  2. National Comprehensive Cancer Network (NCCN) clinical practice guidelines in oncology – cancer-related fatigue, v.1.2009. http://www.nccn.org/professionals/physician_gls/PDF/fatigue.pdf. Accessed 7 Dec 2009

  3. Stone PC, Minton O (2008) Cancer-related fatigue. Eur J Cancer 44:1097–1104

    Article  PubMed  CAS  Google Scholar 

  4. Ahlberg K, Ekman T, Gaston-Johansson F, Mock V (2003) Assessment and management of cancer-related fatigue in adults. Lancet 362:640–650

    Article  PubMed  Google Scholar 

  5. Dy SM, Lorenz KA, Naeim A, Sanati H, Walling A, Asch SM (2008) Evidence-based recommendations for cancer fatigue, anorexia, depression, and dyspnea. J Clin Oncol 26:3886–3895

    Article  PubMed  Google Scholar 

  6. Lesage P, Portenoy RK (2002) Management of fatigue in the cancer patient. Oncology 16:373–381

    PubMed  Google Scholar 

  7. Flechtner H, Bottomley A (2003) Fatigue and quality of life: lessons from the real world. Oncologist 8:5–9

    Article  PubMed  Google Scholar 

  8. Stasi R, Abriani L, Beccaglia P, Terzoli E, Amadori S (2003) Cancer-related fatigue: evolving concepts in evaluation and treatment. Cancer 98:1786–1801

    Article  PubMed  Google Scholar 

  9. Morrow GR, Andrews PL, Hickok JT, Roscoe JA, Matteson S (2002) Fatigue associated with cancer and its treatment. Support Care Cancer 10:389–398

    Article  PubMed  Google Scholar 

  10. Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR (2007) Cancer-related fatigue: the scale of the problem. Oncologist 12(Suppl 1):4–10

    Article  PubMed  Google Scholar 

  11. Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N (2000) Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer fatigue forum. Ann Oncol 11:971–975

    Article  PubMed  CAS  Google Scholar 

  12. Minton O, Stone P, Richardson A, Sharpe M, Hotopf M (2008) Drug therapy for the management of cancer related fatigue. Cochrane Database Syst Rev 1:CD006704

    PubMed  Google Scholar 

  13. Cramp F, Daniel J (2008) Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2:CD006145

    PubMed  Google Scholar 

  14. Goedendorp MM, Gielissen MF, Verhagen CA, Bleijenberg G (2009) Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev 1:CD006953

    PubMed  Google Scholar 

  15. Donovan JL, Blake DR (1992) Patient non-compliance: deviance or reasoned decision-making? Soc Sci Med 34:507–513

    Article  PubMed  CAS  Google Scholar 

  16. Haynes RB, Yao X, Degani A, Kripalani S, Garg A, McDonald HP (2005) Interventions for enhancing medication adherence. Cochrane Database Syst Rev, Issue 4

  17. Blank T, Graves K, Sepucha K, Llewellyn-Thomas H (2006) Understanding treatment decision making: contexts, commonalities, complexities, and challenges. Ann Behav Med 32:211–217

    Article  PubMed  Google Scholar 

  18. Piguet V, Cedraschi C, Dumont P, Desmeules J, Allaz AF, Dayer P (2007) Patients’ representations of antidepressants: a clue to nonadherence? Clin J Pain 23:669–675

    Article  PubMed  Google Scholar 

  19. Mendoza TR, Wang XS, Cleeland CS (1999) The rapid assessment of fatigue severity in cancer patients. Cancer 85:1186–1196

    Article  PubMed  CAS  Google Scholar 

  20. Whitehead L (2009) The measurement of fatigue in chronic illness: a systematic review of unidimensional and multidimensional fatigue measures. J Pain Symptom Manage 37:107–128

    Article  PubMed  Google Scholar 

  21. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  22. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. J Clin Oncol 5:649–655

    Article  CAS  Google Scholar 

  23. Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    Article  PubMed  CAS  Google Scholar 

  24. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

  25. Razavi D, Delvaux N, Farvacques C, Robaye E (1989) Validation de la version française du HADS dans une population de patients cancéreux hospitalisés. Rev Psychol App 39:295–308

    Google Scholar 

  26. Passik SD, Kirsh KL, Donaghy K, Holtsclaw E, Theobald D, Cella D, Breitbart W, Fatigue Coalition (2002) Patient-related barriers to fatigue communication: initial validation of the fatigue management barriers questionnaire. J Pain Symptom Manage 24:481–493

    Article  PubMed  Google Scholar 

  27. Escalante CP (2003) Treatment of cancer-related fatigue: an update. Support Care Cancer 11:79–83

    PubMed  Google Scholar 

  28. Echteld MA, Passchier J, Teunissen S, Claessen S, de Wit R, van der Rijt CC (2007) Multidimensional fatigue and its correlates in hospitalised advanced cancer patients. Eur J Cancer 43:1030–1036

    Article  PubMed  Google Scholar 

  29. Cella D (2006) Quality of life and clinical decisions in chemotherapy-induced anemia. Oncology 20:25–28

    PubMed  Google Scholar 

  30. Jacobsen PB, Garland LL, Booth-Jones M, Donovan KA, Thors CL, Winters E, Grendys E (2004) Relationship of hemoglobin levels to fatigue and cognitive functioning among cancer patients receiving chemotherapy. J Pain Symptom Manage 28:7–18

    Article  PubMed  CAS  Google Scholar 

  31. Romito F, Montanaro R, Corvasce C, Di Bisceglie M, Mattioli V (2008) Is cancer-related fatigue more strongly correlated to haematological or to psychological factors in cancer patients? Support Care Cancer 16:943–946

    Article  PubMed  CAS  Google Scholar 

  32. Collins S, de Vogel-Voogt E, Visser A, van der Heide A (2008) Presence, communication and treatment of fatigue and pain complaints in incurable cancer patients. Patient Educ Couns 72:102–108

    Article  PubMed  Google Scholar 

  33. Higginson IJ, Costantini M (2008) Dying with cancer, living well with advanced cancer. Eur J Cancer 44:1414–1424

    Article  PubMed  Google Scholar 

  34. Brown LF, Kroenke K (2009) Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics 50:440–447

    Article  PubMed  Google Scholar 

  35. Hay MC, Weisner TS, Subramanian S, Duan N, Niedzinski EJ, Kravitz RL (2008) Harnessing experience: exploring the gap between evidence-based medicine and clinical practice. J Eval Clin Pract 14:707–713

    Article  PubMed  Google Scholar 

  36. Greenfield S, Kravitz R, Duan N, Kaplan SH (2007) Heterogeneity of treatment effects: implications for guidelines, payment, and quality assessment. Am J Med 120:S3–S9

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

The authors are grateful to Mrs. Wendy Pickering-Di Silvestro for language editing.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of General Medical Rehabilitation, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, 26, Avenue Beau-Sejour, 1211, Geneva 14, Switzerland

    Christophe Luthy, Christine Cedraschi, Katie Di Silvestro, Beatrice Mugnier-Konrad & Anne-Francoise Allaz

  2. Division of Oncology, Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland

    Angela Pugliesi

  3. Cancer Registry, Institute of Social and Preventive Medicine, Geneva University Hospitals, Geneva, Switzerland

    Elisabetta Rapiti

Authors
  1. Christophe Luthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine Cedraschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Angela Pugliesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katie Di Silvestro
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Beatrice Mugnier-Konrad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Elisabetta Rapiti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anne-Francoise Allaz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christophe Luthy.

Additional information

The authors have full control of all primary data and agree to allow the journal to review their data if requested.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Luthy, C., Cedraschi, C., Pugliesi, A. et al. Patients’ views about causes and preferences for the management of cancer-related fatigue—a case for non-congruence with the physicians?. Support Care Cancer 19, 363–370 (2011). https://doi.org/10.1007/s00520-010-0826-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-010-0826-9

Keywords

Search

Navigation