Fatigue in gynaecological cancer patients: a prospective ...



Fatigue in gynaecological cancer patients: a prospective longitudinal survey

Cancer-Related Fatigue (CRF) is a non-discriminatory, almost universal symptom in patients either receiving anti-neoplastic therapy or those in the advanced stages of the disease (3). It has a profound affect on the whole person persisting for months or even years following completion of treatment. CRF is an abstract concept that is predominately a subjective experience. It is multidimensional in its aetiology and manifestation (5), consisting of physical, emotional and mental components (2). It is known to differ from the fatigue experienced by the general population, a protective response to over-exertion which is easily remedied by rest, critically CRF is not and can even be exacerbated by inactivity (1). Gynaecological cancer was selected as it has received nominal attention in the area of CRF, and it has been proposed that this population may experience worse fatigue than individuals with other cancers (4). Despite this, there has been minimal investigation into CRF in this population and existing studies are limited by their methodologies. The aims of the investigation were twofold. Firstly, to analyse prospectively the onset and pattern of fatigue, if any, experienced over a twelve-month period by a gynaecological cancer population, and to determine if the fatigue experienced is more severe than the fatigue experienced by a matched group of non-cancer volunteers. Secondly, to explore the variables associated with CRF, for example, disease and treatment related variables, demographics, physical symptoms, psychological distress, activity level and quality of life and identify those associated with more severe fatigue in a gynaecological cancer population.

A multiple point prospective longitudinal survey was implemented involving gynaecological cancer patients from three cancer centres, and age and gender matched controls with no cancer history. Data was collected over a 12 month period during and after anti-cancer treatment. Fatigue was assessed using the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF). In addition to the MFSI-SF, the cancer subjects were asked to complete the Rotterdam Symptom Checklist (RSCL) at various intervals over the twelve month period to provide an indication of their symptom experience, activity level and quality of life. Sixty-five cancer patients (mean age = 57.4, SD 13.9) and 60 non-cancer subjects (mean age 55.4, SD 13.6) participated. Repeated Measurements Modelling (RMM) indicated that females with cancer had significantly worse fatigue than non-cancer females at all time points (p = 0.00). The RMM also indicated that the level of CRF changed with time (p = 0.02). When the impact of treatment received was compared descriptively, during chemotherapy, a peak in fatigue was apparent at the time of infusion, whereas during radiotherapy, a gradual increase in the level of fatigue was noted with time. After treatment, in both chemotherapy and radiotherapy, a drop in the level of fatigue was noted. A forward stepwise regression demonstrated that psychological distress level was the only independent predictor of CRF during anti-cancer treatment (p = 0.00), explaining 44% of the variance in fatigue. After treatment, both psychological distress level (p = 0.00) and physical symptom distress (p = 0.03) were independent predictors of fatigue, accounting for 81% of the variance.

It was concluded from the survey that individuals with gynaecological cancer experienced significantly worse fatigue than cancer-free women during treatment, and fatigue persisted after treatment was complete. Psychological distress was found to be an important indicator of CRF in this population. These findings signify a need for research regarding the management of CRF in women with gynaecological cancer.

References

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

2. Glaus A 1993 Assessment of fatigue in cancer and non-cancer patients. Supportive Care in Cancer 1: 305-315

3. National Comprehensive Cancer Network. 2006. NCCN Clinical practice guidelines in oncology: cancer related fatigue v.1.2006 [online]. National Comprehensive Cancer Network. Available from: fatigue.pdf/ [Accessed 10 October 2006]

4. Payne JK 2002 The trajectory of fatigue in adult patients with breast and ovarian cancer receiving chemotherapy. Oncology Nursing Forum 29: 1334 – 1340

5. Wagner LI Cella D 2004 Fatigue and cancer: causes, prevalence and treatment approaches. British Journal Cancer 91: 822-828

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