Fatigue is the Most Important Symptom for Advanced Cancer Patients Who Have Had Chemotherapy

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  • a From the Center on Outcomes, Research, and Education (CORE), Evanston Northwestern Healthcare, Evanston, Illinois; Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Institute of Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, Illinois; Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Oncology Research Program, National Comprehensive Cancer Network, Fort Washington, Pennsylvania; Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida; Biobehavioral Sciences, Clinical Research Division, Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington; and Division of Hematology/Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and Feinberg School of Medicine, Chicago, Illinois.

Cancer fatigue has been defined and described as an important problem. However, few studies have assessed the relative importance of fatigue compared with other patient symptoms and concerns. To explore this issue, the authors surveyed 534 patients and 91 physician experts from 5 NCCN member institutions and community support agencies. Specifically, they asked patients with advanced bladder, brain, breast, colorectal, head and neck, hepatobiliary/pancreatic, kidney, lung, ovarian, or prostate cancer or lymphoma about their “most important symptoms or concerns to monitor.” Across the entire sample, and individually for patients with 9 cancer types, fatigue emerged as the top-ranked symptom. Fatigue was also ranked most important among patients with 10 of 11 cancer types when asked to rank lists of common concerns. Patient fatigue ratings were most strongly associated with malaise (r = 0.50) and difficulties with activities of daily living, pain, and quality of life. Expert ratings of how much fatigue is attributable to disease versus treatment mostly suggested that both play an important role, with disease-related factors predominant in hepatobiliary and lung cancer, and treatment-related factors playing a stronger role in head and neck cancer.

Correspondence: Zeeshan Butt, PhD, Center on Outcomes, Research, and Education (CORE), Evanston Northwestern Healthcare, 1001 University Place, Suite 100, Evanston, lL 60201. E-mail: z-butt@northwestern.edu
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