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Husivargova A, Timkova V, Macejova Z, Kotradyova Z, Sanderman R, Fleer J, Nagyova I. A cross-sectional study of multidimensional fatigue in biologic-treated rheumatoid arthritis: which variables play a role? Disabil Rehabil 2023:1-9. [PMID: 37731384 DOI: 10.1080/09638288.2023.2258333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 09/07/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE Despite efficient biological disease-modifying antirheumatic drugs (bDMARDs) Rheumatoid Arthritis (RA) patients still suffer from high fatigue. This study aims to further our knowledge by assessing severity levels of the various fatigue dimensions and their associations with pain, sleep quality, and psychological well-being in bDMARDs treated RA patients. MATERIAL AND METHODS The sample consisted of 146 RA patients (84.9% females; mean age 56.6 ± 13.6 years), who completed the MFI-20, SF-36, PSQI, GAD-7 and PHQ-9. Correlation analyses and multiple linear regressions were used to analyse the data. RESULTS General fatigue was the highest reported type of fatigue, followed by physical fatigue dimensions. In the final regression model, pain and disability were significantly associated with physical fatigue (p ≤ 0.001, p ≤ 0.05, respectively) and reduced activity (p ≤ 0.01, p ≤ 0.05, respectively). Anxiety was significantly associated with mental fatigue (p ≤ 0.05) and reduced motivation (p ≤ 0.01). Regression analyses showed no significant associations between depression, sleep quality, and fatigue in any of the final models. CONCLUSIONS Our findings indicate that effectively addressing fatigue in RA patients requires an individualized approach. This approach should acknowledge the varying degrees of fatigue across different fatigue dimensions (physical or mental), while also taking into account the patient's mental health problems, pain levels, and disability levels.
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Affiliation(s)
- Alexandra Husivargova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Vladimira Timkova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
| | - Zelmira Macejova
- 1st Department of Internal Medicine, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia & UNLP, Kosice, Slovakia
| | - Zuzana Kotradyova
- 1st Department of Internal Medicine, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia & UNLP, Kosice, Slovakia
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Psychology Health and Technology, University of Twente, Enschede, The Netherlands
| | - Joke Fleer
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University, Kosice, Slovakia
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2
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Sauer C, Grapp M, Bugaj TJ, Maatouk I. Suicidal ideation in patients with cancer: Its prevalence and results of structural equation modelling. Eur J Cancer Care (Engl) 2022; 31:e13650. [PMID: 35801643 DOI: 10.1111/ecc.13650] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/03/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Patients with cancer have a higher risk of suicidal ideation (SI) and suicidality than the general population. This study was designed to investigate the prevalence of SI and its association with psychosocial and sociodemographic factors and tumour entity. METHODS In this observational cross-sectional study, 4372 adult patients with different cancer entities were enrolled. We assessed the outcome variables (i.e. SI, depressive and anxiety symptoms, mental and physical fatigue and sociodemographic data) using self-report questionnaires. Data were analysed via descriptive statistics, binomial logistic regression and structural equation modelling (SEM). RESULTS Among all patients, 627 (14.3%) reported SI, of whom 12.8% reported SI on several days, 0.9% on half of the days and 0.6% nearly every day. Age, anxiety, mental fatigue and the Patient Health Questionnaire-9 items 'feeling down, depressed and hopeless', 'feeling bad about oneself' and 'slowing or agitation' were significant predictors of SI. SEM, including all significant predictors with a latent depressiveness-demoralisation variable, explained 30.3% variance of SI, showing a good fit. CONCLUSIONS Our results showed that a significant number of patients with cancer show SI. Future long-term studies are needed to address the differential contribution of depression and demoralisation on SI in patients with cancer.
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Affiliation(s)
- Christina Sauer
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Miriam Grapp
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Till J Bugaj
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, Germany
| | - Imad Maatouk
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Section of Psychosomatic Medicine, Psychotherapy and Psychooncology, Department of Internal Medicine II, Julius-Maximilian University Würzburg, Würzburg, Germany
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3
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Díaz-García J, González-Ponce I, Ponce-Bordón JC, López-Gajardo MÁ, Ramírez-Bravo I, Rubio-Morales A, García-Calvo T. Mental Load and Fatigue Assessment Instruments: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:419. [PMID: 35010678 PMCID: PMC8744873 DOI: 10.3390/ijerph19010419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 11/23/2022]
Abstract
Mental load and fatigue are important causes of performance decreases and accidents in different activities. However, a robust systematic review, detailing the instruments used to quantify them, is currently lacking. The purpose of this study was to summarize and classify by derivations the validated instruments used to quantify mental load and fatigue. The most representative electronic databases in the scope of this review, PubMed, WOS, Scopus, SPORTDiscus, and PsycINFO (until September 2020) were searched for studies that included instruments to analyze mental load and fatigue. The quality of the selected studies was scored using a quality assessment checklist. A total of 40 papers were included. Most of the papers used subjective scales (75%) to quantify mental load and fatigue, with a small presence of behavioral (n = 5) and objective techniques (n = 5). Less is known about the analysis of mental load and fatigue using a combination of derivations. Despite the high cost and complexity of objective techniques, research that applies these measures is important for further analysis of brain processes in mental load and fatigue. The design of a battery of tests that include the three types of derivations also seems necessary.
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Affiliation(s)
- Jesús Díaz-García
- Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (J.D.-G.); (J.C.P.-B.); (M.Á.L.-G.); (I.R.-B.); (A.R.-M.); (T.G.-C.)
| | | | - José Carlos Ponce-Bordón
- Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (J.D.-G.); (J.C.P.-B.); (M.Á.L.-G.); (I.R.-B.); (A.R.-M.); (T.G.-C.)
| | - Miguel Ángel López-Gajardo
- Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (J.D.-G.); (J.C.P.-B.); (M.Á.L.-G.); (I.R.-B.); (A.R.-M.); (T.G.-C.)
| | - Iván Ramírez-Bravo
- Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (J.D.-G.); (J.C.P.-B.); (M.Á.L.-G.); (I.R.-B.); (A.R.-M.); (T.G.-C.)
| | - Ana Rubio-Morales
- Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (J.D.-G.); (J.C.P.-B.); (M.Á.L.-G.); (I.R.-B.); (A.R.-M.); (T.G.-C.)
| | - Tomás García-Calvo
- Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain; (J.D.-G.); (J.C.P.-B.); (M.Á.L.-G.); (I.R.-B.); (A.R.-M.); (T.G.-C.)
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Pedersen L, Lund L, Petersen MA, Sjogren P, Groenvold M. Methylphenidate as Needed for Fatigue in Patients With Advanced Cancer. A Prospective, Double-Blind, and Placebo-Controlled Study. J Pain Symptom Manage 2020; 60:992-1002. [PMID: 32464260 DOI: 10.1016/j.jpainsymman.2020.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/06/2020] [Accepted: 05/16/2020] [Indexed: 11/12/2022]
Abstract
CONTEXT Cancer-related fatigue is a highly prevalent symptom with a strong negative impact on patients' daily life. OBJECTIVES To evaluate the efficacy of methylphenidate as needed for the management of fatigue in patients with advanced cancer. METHODS A prospective, controlled, double-blind, and paired design, where the patient was her and/or his own control. Patients with advanced cancer with a tiredness score of ≥50 on a 0-100 visual analogue scale (VAS) were included. Patients were given 10 placebo and 10 methylphenidate tablets numbered 1-20 packed in blocks of four with two active and two placebo tablets (randomly arranged). Patients taking minimum three tablets were regarded evaluable. Primary effect parameters were mean differences in VAS for tiredness after two and five hours. With 28 evaluable patients, the study had a power of 0.90 to detect a mean difference of 15 between active and placebo. RESULTS Thirty-eight patients were enrolled to get 28 evaluable patients. Mean tiredness score before taking the tablets was 75 for placebo and 72 for methylphenidate on VAS (0-100). Mean changes (decrease) for methylphenidate after two and five hours were 20 and 17, respectively, and eight and five for placebo. Comparing mean differences, a significant decrease for methylphenidate compared with placebo was observed after two hours (P = 0.004) and five hours (P = 0.001), respectively. CONCLUSION In this controlled and double-blind study in patients with advanced cancer, methylphenidate as needed was significantly more effective than placebo in relieving fatigue after two and five hours.
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Affiliation(s)
- Lise Pedersen
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Line Lund
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Morten A Petersen
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Per Sjogren
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Section of Palliative Medicine, Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Mogens Groenvold
- Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Section of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Saim A, Gernier F, Licaj I, Rod J, Velten M, Klein D, Mercier M, Joly F. [Long-term occupational situation after cancer: A French registry-based study]. Bull Cancer 2020; 107:867-880. [PMID: 32919610 DOI: 10.1016/j.bulcan.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/16/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Few studies have explored the long-term occupational situation after cancer. The aim of our study were to study the employment status among long-term cancer survivors and to compare it to cancer-free controls from the general population at 5, 10 or 15 years after cancer diagnosis. METHODS From data of a registry-based study, long-term survivors from breast,cervical and colorectal cancer, randomly selected from three tumor registries in France, were compared to cancer-free controls randomly selected from electoral lists. We selected active cancer survivors and cancer-free controls aged less than 60 at the time of the survey. We have studied the employment status of cases vs. controls and the factors associated with employment status. RESULTS At 5, 10 or 15 years after diagnosis, we did not observe any significant difference in employment status between cases and controls. Among cases, 17% had lost their jobs. Older age, lower incomes, lower education, a short-term employment contract, the presence of co-morbidities, fatigue and a worse quality of life were associated with job loss. DISCUSSION Although the employment status of the cases was comparable to that of the controls, efforts should be intensified to make it easier for patients diagnosed with cancer to return to work.
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Affiliation(s)
- Akila Saim
- Université de Caen Basse-Normandie, Caen, France; Centre François-Baclesse, UMR 1086 Inserm « ANTICIPE », Caen, France
| | - François Gernier
- Centre François-Baclesse, UMR 1086 Inserm « ANTICIPE », Caen, France; Centre de lutte contre le cancer François-Baclesse, département de recherche clinique, UNICANCER, Caen, France.
| | - Idlir Licaj
- Centre François-Baclesse, UMR 1086 Inserm « ANTICIPE », Caen, France; Centre de lutte contre le cancer François-Baclesse, département de recherche clinique, UNICANCER, Caen, France
| | - Julien Rod
- Centre François-Baclesse, UMR 1086 Inserm « ANTICIPE », Caen, France; CHU de Caen, département de pédiatrie, Caen, France
| | - Michel Velten
- Centre Paul-Strauss, département de biostatistique et d'épidémiologie, EA3430, Strasbourg, France; Hôpitaux universitaires de Strasbourg, Inserm IRFAC UMR-S 1113, Strasbourg, France; Registre des cancers du Bas-Rhin, Strasbourg, France
| | | | - Mariette Mercier
- Université of Franche-Comté, EA3181, Besançon, France; Université de Franche-Comté, Inserm UMR 1098, Besançon, France
| | - Florence Joly
- Université de Caen Basse-Normandie, Caen, France; Centre François-Baclesse, UMR 1086 Inserm « ANTICIPE », Caen, France; Centre de lutte contre le cancer François-Baclesse, département de recherche clinique, UNICANCER, Caen, France; CHU de Caen, département d'oncologie, Caen, France
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6
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Wen-Pei C, Hsiu-Ju J. Changes in fatigue in rectal cancer patients before and after therapy: a systematic review and meta-analysis. Support Care Cancer 2020; 28:2513-2522. [PMID: 32002618 DOI: 10.1007/s00520-020-05325-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/23/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE Fatigue is a common problem among rectal cancer patients and can affect their quality of life. This study conducted a systematic review to better understand changes in fatigue severity in rectal cancer patients before, during, and after they undergo therapy. METHODS We used preset keywords to search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and ProQuest databases for relevant studies published between 2000 and 2018, and data analysis was performed using Comprehensive Meta-Analysis (CMA) software (version 2.2.048) and SPSS software (version 19.0). In total, nine articles with complete data were included in our meta-analysis. RESULTS Fatigue conditions were compared before the start of therapy (baseline) and at 1 month (time 1), 3 months (time 2), 6 months (time 3), and 12 months (time 4) after the start of therapy. The standardized mean differences (SMDs) of the pooling effects size were 1.013 (95% confidence interval (CI) 0.217-1.810), - 0.551 (95% CI - 0.647 to - 0.456), - 0.330 (95% CI - 0.427 to - 0.233), and - 0.149 (95% CI - 0.221 to - 0.078), respectively. Subsequent analysis with a linear mixed effect model revealed that the estimate of the time variable was - 0.226 (p = 0.047), which indicates that the severity of fatigue varies over time and over the course of treatment. The results reveal that fatigue affects rectal cancer patients even before they start therapy. CONCLUSION Although fatigue worsened during the first month after cancer therapy, it gradually improved thereafter.
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Affiliation(s)
- Chang Wen-Pei
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan. .,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
| | - Jen Hsiu-Ju
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, No.291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan
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7
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Bazazan A, Rasoulzadeh Y, Dianat I, Safaiyan A, Mombeini Z. Occupational fatigue and mental health complaints among 8-hour shift workers of petrochemical industries in Iran. Work 2019; 62:309-317. [PMID: 30829641 DOI: 10.3233/wor-192865] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Shift working is unavoidable in many industries with continual material processing such as petrochemical plants. So, the adverse effects of shift working on workers should be seriously considered. OBJECTIVE This cross-sectional study evaluated occupational fatigue and mental health complaints and their relationship in rotating 8-hour shift workers. METHOD In this study, 287 shift workers participated. The Multidimensional Fatigue Inventory (MFI-20) and General Health Questionnaire (GHQ-28) were used to evaluate the level of fatigue and mental health, respectively. RESULT A relatively high prevalence of mental health complaints (particularly social dysfunction) and fatigue (especially general fatigue) were found among the study population. In general, 43.4% of participants reported a mental health problem. A moderate correlation was found between fatigue and mental health (r = 0.58). The stepwise regression model revealed that fatigue was significantly related only to "anxiety and insomnia" and "severe depression". CONCLUSION This study revealed that the 8 h shift workers in studied areas are exposed to a considerable risk of mental health and fatigue. So, improving the ergonomics and health aspects of the workplace is recommended to reduce related risk factors.
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Affiliation(s)
- Ahmad Bazazan
- Department of Occupational Health and Ergonomics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yahya Rasoulzadeh
- Department of Occupational Health and Ergonomics, Tabriz University of Medical Sciences, Tabriz, Iran.,Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Iman Dianat
- Department of Occupational Health and Ergonomics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolrasoul Safaiyan
- Department of Vital Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zohreh Mombeini
- Department of Occupational Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Multidimensional Fatigue Inventory in People With Hepatitis B Infection: Cross-cultural Adaptation and Psychometric Evaluation of the Persian Version. Gastroenterol Nurs 2018; 40:380-392. [PMID: 28957969 DOI: 10.1097/sga.0000000000000250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
There is no valid and well-established tool to measure fatigue in people with chronic hepatitis B. The aim of this study was to translate the Multidimensional Fatigue Inventory (MFI) into Persian and examine its reliability and validity in Iranian people with chronic hepatitis B. The demographic questionnaire and MFI, as well as Chronic Liver Disease Questionnaire and EuroQol-5D (to assess criterion validity), were administered in face-to-face interviews with 297 participants. A forward-backward translation method was used to develop a culturally adapted Persian version of the questionnaire. Cronbach's α was used to assess the internal reliability of the scale. Pearson correlation was used to assess criterion validity, and known-group method was used along with factor analysis to establish construct validity. Cronbach's α for the total scale was 0.89. Convergent and discriminant validities were also established. Correlations between the MFI and the health-related quality of life scales were significant (p < .01). The scale differentiated between subgroups of persons with the hepatitis B infection in terms of age, gender, employment, education, disease duration, and stage of disease. Factor analysis indicated a four-factor solution for the scale that explained 60% of the variance. The MFI is a valid and reliable instrument to identify fatigue in Iranians with hepatitis B.
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Dornonville de la Cour FL, Forchhammer BH, Mogensen J, Norup A. On the relation between dimensions of fatigue and depression in adolescents and young adults with acquired brain injury. Neuropsychol Rehabil 2018; 30:872-887. [DOI: 10.1080/09602011.2018.1517368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Frederik L. Dornonville de la Cour
- National study of young brain injury survivors, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- The Unit for Cognitive Neuroscience (UCN), Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Brain Injury Center BOMI, Roskilde, Denmark
| | - Birgitte H. Forchhammer
- National study of young brain injury survivors, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Mogensen
- The Unit for Cognitive Neuroscience (UCN), Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Anne Norup
- National study of young brain injury survivors, Department of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Wiskemann J, Hummler S, Diepold C, Keil M, Abel U, Steindorf K, Beckhove P, Ulrich CM, Steins M, Thomas M. POSITIVE study: physical exercise program in non-operable lung cancer patients undergoing palliative treatment. BMC Cancer 2016; 16:499. [PMID: 27430336 PMCID: PMC4949758 DOI: 10.1186/s12885-016-2561-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background Patients with advanced stage non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC) often experience multidimensional impairments, affecting quality of life during their course of disease. In lung cancer patients with operable disease, several studies have shown that exercise has a positive impact on quality of life and physical functioning. There is limited evidence regarding efficacy for advanced lung cancer patients undergoing palliative treatment. Therefore, the POSITIVE study aims to evaluate the benefit of a 24-week exercise intervention during palliative treatment in a randomized controlled setting. Methods/design The POSITIVE study is a randomized, controlled trial investigating the effects of a 24-week exercise intervention during palliative treatment on quality of life, physical performance and immune function in advanced, non-operable lung cancer patients. 250 patients will be recruited in the Clinic for Thoracic Diseases in Heidelberg, enrolment begun in November 2013. Main inclusion criterion is histologically confirmed NSCLC (stage IIIa, IIIb, IV) or SCLC (Limited Disease-SCLC, Extensive Disease-SCLC) not amenable to surgery. Patients are randomized into two groups. Both groups receive weekly care management phone calls (CMPCs) with the goal to assess symptoms and side effects. Additionally, one group receives a combined resistance and endurance training (3x/week). Primary endpoints are quality of life assessed by the Functional Assessment of Cancer Therapy for patients with lung cancer (FACT-L, subcategory Physical Well-Being) and General Fatigue measured by the Multidimensional Fatigue Inventory (MFI-20). Secondary endpoints are physical performance (maximal voluntary isometric contraction, 6-min walk distance), psychosocial (depression and anxiety) and immunological parameters and overall survival. Discussion The aim of the POSITIVE trial is the evaluation of effects of a 24-week structured and guided exercise intervention during palliative treatment stages. Analysis of various outcomes (such as quality of life, physical performance, self-efficacy, psychosocial and immunological parameters) will contribute to a better understanding of the potential of exercise in advanced lung cancer patients. In contrast to other studies with advanced oncological patients the POSITIVE trial provides weekly phone calls to support patients both in the intervention and control group and to segregate the impact of physical activity on quality of life. Trial registration ClinicalTrials.gov NCT02055508 (Date: December 12, 2013)
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Affiliation(s)
- Joachim Wiskemann
- Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and University Clinic Heidelberg, Heidelberg, Germany. .,National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany.
| | - Simone Hummler
- Clinic for Thoracic Diseases, Department of Oncology, Thoraxklinik am Universitätsklinikum, Heidelberg, Germany.,Clinic for Thoracic Diseases, Department of Pneumology and Intensive Care Unit, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Christina Diepold
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | - Melanie Keil
- Immune Monitoring Unit (G808), National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,CCU Neuroimmunology and Brain Tumor Immunology, National Center for Tumor Diseases, (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Abel
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | - Karen Steindorf
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | - Philipp Beckhove
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | | | - Martin Steins
- Clinic for Thoracic Diseases, Department of Oncology, Thoraxklinik am Universitätsklinikum, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Thomas
- Clinic for Thoracic Diseases, Department of Oncology, Thoraxklinik am Universitätsklinikum, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
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11
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Colloca G, Venturino A, Governato I, Checcaglini F. Incidence and Correlates of Fatigue in Metastatic Castration-Resistant Prostate Cancer: A Systematic Review. Clin Genitourin Cancer 2016; 14:5-11. [DOI: 10.1016/j.clgc.2015.07.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 07/30/2015] [Indexed: 11/30/2022]
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12
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Wirken L, van Middendorp H, Hooghof CW, Rovers MM, Hoitsma AJ, Hilbrands LB, Evers AWM. The Course and Predictors of Health-Related Quality of Life in Living Kidney Donors: A Systematic Review and Meta-Analysis. Am J Transplant 2015; 15:3041-54. [PMID: 26414703 DOI: 10.1111/ajt.13453] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 01/25/2023]
Abstract
A better understanding of the course and risk factors for impaired long-term health-related quality of life (HRQoL; ie, physical, psychological, and social-relational functioning) after kidney donation might help clinicians improve the care of live kidney donors. This systematic review and meta-analysis summarizes prospective studies about the course and predictors of HRQoL in living kidney donors. Studies indicate that shortly after donation, donors have lower HRQoL, with minor to moderate changes in psychological and social-relational functioning and major changes in physical functioning. At 3-12 months after donation, HRQoL returned to baseline or was slightly reduced, particularly for fatigue, but scores were still comparable to general population norms. Results were mainly robust across surgery techniques. A limited number of studies examined risk factors for impaired HRQoL, with low psychological functioning before donation as the most consistent predictor. Based on these results, clinicians can inform potential donors that, on average, kidney donors have high long-term HRQoL; however, donors with low psychological functioning at baseline are those most at risk of impaired long-term HRQoL. Future studies should focus on other potentially relevant predictors of postdonation HRQoL, including donor eligibility criteria and donor-recipient relationships, to optimize screening and interventions for donors at risk.
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Affiliation(s)
- L Wirken
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - H van Middendorp
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - C W Hooghof
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - M M Rovers
- Radboud Institute of Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - A J Hoitsma
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - L B Hilbrands
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - A W M Evers
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
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Rasoulzadeh Y, Bazazan A, Safaiyan A, Dianat I. Fatigue and Psychological Distress: A Case Study Among Shift Workers of an Iranian Petrochemical Plant, During 2013, in Bushehr. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 17:e28021. [PMID: 26568862 PMCID: PMC4636754 DOI: 10.5812/ircmj.28021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 06/28/2015] [Accepted: 07/21/2015] [Indexed: 11/25/2022]
Abstract
Background: Shift work is a well-recognized occupational health hazard in both industrialized and industrially developing countries. Prolonged working time, day/night shift rotation, circadian rhythm and sleep disorders, family and social problems are the most important features of shift working, which have serious complications. Objectives: The present study evaluated the fatigue and psychological distress and their relationship among shift workers, in a petrochemical plant (Southern Pars gas field) in Southwest Iran. Materials and Methods: In this cross-sectional field study, 400 shift workers from a plant were involved, with participation rate of 72.5% (290 persons). The multidimensional fatigue inventory (MFI-20) and general health questionnaire (GHQ-28) were used to evaluate the level of fatigue and psychological distress, respectively. Results: The results showed that the fatigue and psychological distress (particularly social dysfunction, anxiety and insomnia) are frequent among 12-hour shift workers (the total MFI and total GHQ scores were 42.68 ± 17.88 and 34.66 ± 18.56). A relatively strong positive correlation was found between fatigue and psychological distress (r = 0.62). The results of the stepwise regression model indicated that the psychological distress was significantly related only to general fatigue, mental fatigue and reduced motivation, whereas it was not to the physical fatigue and reduced activity. Conclusions: The study findings highlight the importance of the mental aspect of fatigue in this working group. These results have possible implications for workers’ health and well-being and for the design of shift work systems, for industrial workers.
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Affiliation(s)
- Yahya Rasoulzadeh
- Department of Occupational Health and Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Ahmad Bazazan
- Department of Occupational Health and Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Abdolrasoul Safaiyan
- Department of Vital Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, IR Iran
| | - Iman Dianat
- Department of Occupational Health and Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, IR Iran
- Corresponding Author: Iman Dianat, Department of Occupational Health and Ergonomics, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-4113357580, Fax: +98-4113340634, E-mail:
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Toward a systematic approach to assessment and care planning in palliative care: A practical review of clinical tools. Palliat Support Care 2015; 14:161-73. [DOI: 10.1017/s1478951515000565] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
ABSTRACTObjective:Ensuring a consistent and systematic approach to the delivery of care for people with advanced disease is a priority for palliative care services worldwide. Many clinical tools are available to aid in this process; however, they are often used sporadically, and implementation of a routine set of clinical tools to guide care planning in the specialist palliative care sector in Australia has not been achieved. This study sought to recommend key clinical tools that may assist with the assessment and care planning of specialist palliative care provision for patients and family caregivers admitted to specialist palliative care settings (home, hospital, and hospice).Method:A mixed-methods sequential approach over four phases was employed, involving: (1) a palliative care sector survey, (2) a systematic literature review, (3) an appraisal of identified clinical tools, and (4) a focus group with an expert panel who critiqued and endorsed a final suite of clinical tools recommended for specialist palliative care.Results:Twelve tools with practical relevance were recommended for use across settings of care.Significance of Results:Palliative services should review current practices and seek to implement this recommended suite of tools to enhance assessment and guide care delivery across care settings. Subsequent evaluation should also occur.
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Mikula P, Nagyova I, Krokavcova M, Vitkova M, Rosenberger J, Szilasiova J, Gdovinova Z, Groothoff JW, van Dijk JP. The mediating effect of coping on the association between fatigue and quality of life in patients with multiple sclerosis. PSYCHOL HEALTH MED 2015; 20:653-61. [DOI: 10.1080/13548506.2015.1032310] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Madsen UR, Groenvold M, Petersen MA, Johnsen AT. Comparing three different approaches to the measurement of needs concerning fatigue in patients with advanced cancer. Qual Life Res 2015; 24:2231-8. [DOI: 10.1007/s11136-015-0962-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 11/30/2022]
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17
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Torres MEU, Rodríguez JNR, Ramos JLS, Gómez FA. Transfusion in Palliative Cancer Patients: A Review of the Literature. J Palliat Med 2014; 17:88-104. [DOI: 10.1089/jpm.2013.0387] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Prevalence and contributors to fatigue in individuals hospitalized with advanced cancer: A prospective, observational study. Int J Nurs Stud 2012; 49:1146-54. [DOI: 10.1016/j.ijnurstu.2012.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 02/25/2012] [Accepted: 03/12/2012] [Indexed: 11/20/2022]
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19
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de Raaf PJ, Sleijfer S, Lamers CHJ, Jager A, Gratama JW, van der Rijt CCD. Inflammation and fatigue dimensions in advanced cancer patients and cancer survivors: an explorative study. Cancer 2012; 118:6005-11. [PMID: 22736424 DOI: 10.1002/cncr.27613] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 03/05/2012] [Accepted: 03/27/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND Inflammation may underlie cancer-related fatigue; however, there are no studies that assess the relation between fatigue and cytokines in patients with advanced disease versus patients without disease activity. Furthermore, the relation between cytokines and the separate dimensions of fatigue is unknown. Here, association of plasma levels of inflammatory markers with physical fatigue and mental fatigue was explored in advanced cancer patients and cancer survivors. METHODS A total of 45 advanced cancer patients and 47 cancer survivors completed the subscales Physical Fatigue and Mental Fatigue of the Multidimensional Fatigue Inventory. Plasma concentrations of C-reactive protein (CRP), interleukin-1 receptor antagonist (IL-1-ra), interleukin-6 (IL-6), interleukin-8 (IL-8), and neopterin were measured. Nonparametric tests were used to assess differences in fatigue intensity and levels of inflammatory markers and to determine correlation coefficients between the fatigue dimensions and inflammatory markers. RESULTS Compared with cancer survivors, patients with advanced cancer had higher levels of physical fatigue (median 16 vs 9, P < .001) and mental fatigue (median 11 vs 6, P = .01). They also had higher levels of all cytokines (P < .01). In advanced cancer, CRP (r = 0.49, P = .001), IL-6 (r = 0.43, P = .003), IL-1-ra (r = 0.32, P = .03), and neopterin (r = 0.25, P = .10) were correlated with physical but not with mental fatigue. In cancer survivors, only IL-1-ra was related to both physical fatigue (r = 0.24, P = .10) and mental fatigue (r = 0.35, P = .02). CONCLUSIONS In advanced cancer, inflammation seems to be associated with physical fatigue, but not to mental fatigue. In cancer survivors, there was no convincing evidence that inflammation plays a major role in fatigue.
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Affiliation(s)
- Pleun J de Raaf
- Department of Medical Oncology, Erasmus MC Daniel den Hoed Cancer Center, Rotterdam, the Netherlands.
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20
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Depression, fatigue, and health-related quality of life in head and neck cancer patients: a prospective pilot study. Support Care Cancer 2012; 20:2705-11. [DOI: 10.1007/s00520-012-1390-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 01/17/2012] [Indexed: 10/14/2022]
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21
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Validation of the Chinese version of Multidimensional Fatigue Inventory-20 in Chinese patients with cancer. Support Care Cancer 2011; 20:2379-83. [PMID: 22198167 DOI: 10.1007/s00520-011-1357-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Accepted: 12/12/2011] [Indexed: 01/24/2023]
Abstract
GOALS OF WORK The purpose of this research is to study the validation of the Chinese version of Multidimensional Fatigue Inventory-20 in measuring fatigue status of the patients with cancer in China. MATERIALS AND METHODS The original English version of the Multidimensional Fatigue Inventory-20 was translated into a Chinese version, which was applied to measure the fatigue status of cancer patients prior to commencing chemotherapy and during the last week of chemotherapy, respectively. The reliability and criterion-related validity of the Chinese version of the Multidimensional Fatigue Inventory-20 were assessed by calculating Cronbach's α and Pearson correlation coefficients. The construct validity was analyzed by employing factor analysis. MAIN RESULTS There were three dimensions in the Chinese version of the MFI-20, which measures the physical, mental, and spiritual fatigue of patients with cancer. All of the correlation coefficients between EORTC QLQ-C30V3.0 and MFI-20 were statistically significant (P < 0.0001). The Cronbach's α coefficient was more than 0.8 and 0.7 for total MFI-20 and for the three dimensions of the Chinese version of the MFI-20, respectively. CONCLUSIONS The Chinese version of the MFI-20 is a reliable and valid instrument to assess fatigue in Chinese patients with cancer.
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Abstract
In recent years, as treatment options for cancer sufferers have become more successful but also more exhausting, fatigue has become increasingly distressing and extreme for these patients. Despite this, the assessment and management of fatigue is frequently overlooked by health-care professionals. This article will focus on the assessment and management of cancer-related fatigue in patients with advanced cancer, assessing the evidence base in order to guide practice in a subject that poses a particular challenge to palliative care practitioners.
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Affiliation(s)
- Maureen Hawthorn
- Wirral Wide Nursing Services, Bromborough, Wirral, Chesire, United Kingdom.
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Abstract
Palliative care is an interdisciplinary and holistic approach aimed at alleviating suffering from physical, psychosocial, and spiritual issues in progressive, advanced disease. Progressive fatigue and anorexia-cachexia syndrome can contribute to loss of physical function in the palliative cancer patient, to the detriment of overall quality of life. Physical activity is one potential intervention, which may address these needs in the palliative cancer patient. There is preliminary evidence that at least some palliative cancer patients are willing and able to tolerate physical activity interventions, with some patients demonstrating improvement in select supportive care outcomes postintervention. Methodologically rigorous studies and consensus on common definitions are required to advance this area of research.
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Affiliation(s)
- Sonya S Lowe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, 11560 University Drive NW, Edmonton, T6G 1Z2, Alberta, Canada.
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Abstract
Many different words are used to describe fatigue. It is unclear whether these word descriptors represent the same cancer symptom or dimension. The objective of this study was to identify clinical associations of three fatigue word descriptors (FWDs): 'easy fatigue', 'weakness', and 'lack of energy' (LOE). One thousand consecutive palliative medicine patients completed a 38-item symptom checklist. The prevalence of the three FWDs alone and in combination was calculated. Spearman correlations assessed associations between FWDs. Logistic regression analysis identified univariable and multivariable predictors for each FWD. Survival was estimated using the Kaplan-Meier method, individually and for 0-1 versus 2-3 FWDs, and compared using log-rank tests. The prevalence of easy fatigue was 69%, weakness 66%, and LOE 61%. Correlations between the FWDs were high (0.65-0.79). In multivariable models, clinical associations (particularly neuro-psychiatric symptoms and performance status) of the FWDs were variable. Weakness was associated with performance status, but not anxiety or depression. LOE was associated with anxiety and depression, but not performance status. Fatigue was associated with depression, but not anxiety or performance status. All FWDs were associated with dry mouth, early satiety, sleep problems, and weight loss. The worst survival was associated with two or three reported FWDs compared with none or one (P < 0.001). Weakness and LOE had distinct clinical associations that differed from fatigue. Evaluation of fatigue should use multiple descriptors (particularly weakness), as they are not synonymous. Further research is necessary to identify biological associations for discrete FWDs.
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Affiliation(s)
- Katherine Hauser
- The Harry R. Horvitz Center for Palliative Medicine, Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Institute, USA
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Alsén P, Brink E, Brändström Y, Karlson BW, Persson LO. Fatigue after myocardial infarction: Relationships with indices of emotional distress, and sociodemographic and clinical variables. Int J Nurs Pract 2010; 16:326-34. [DOI: 10.1111/j.1440-172x.2010.01848.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Purcell A, Fleming J, Bennett S, McGuane K, Burmeister B, Haines T. A multidimensional examination of correlates of fatigue during radiotherapy. Cancer 2010; 116:529-37. [PMID: 19921735 DOI: 10.1002/cncr.24731] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Cancer-related fatigue can be measured as both a unidimensional and a multidimensional construct. Unidimensional fatigue and its symptom correlates have undergone some previous investigation; however, minimal research has considered the differential effect of correlates on individual dimensions of fatigue. The objective of the current study was to investigate cancer-related fatigue in a radiotherapy sample using a multidimensional conceptualization to determine whether correlates of fatigue are consistent across all dimensions or whether each fatigue dimension has its own unique pattern of correlates. METHODS The study used a prospective cohort design with data collected from radiotherapy patients at 3 time points; before, after, and 6 weeks after radiotherapy treatment. RESULTS A total of 210 participants were enrolled in the study. Results indicated the following relations. Increased general fatigue was found to be associated with lower performance status, being in a de facto relationship, depression, having treatment to the brain, and reduced vigorous physical activity. Increased physical fatigue was associated with lower performance status, depression, reduced physical activity, reduced productive hours, and nausea. Higher levels of reduced activity were associated with depression, decreased participation in activities of daily living, decreased number of productive hours, and lower performance status. Higher levels of reduced motivation were associated with radiotherapy to the brain, reduced moderate physical activity, and depression. Increased mental fatigue was associated with diagnosis of a brain tumor, anxiety, depression, and sleep problems. CONCLUSIONS The results of the current study support the recognition of multiple dimensions of fatigue, because each dimension examined had various correlates. These findings further develop our understanding of fatigue and may help clinicians provide more targeted information to people with cancer-related fatigue. Furthermore, these results can guide the development of group or individually tailored interventions that ultimately may reduce the impact of this distressing symptom on people with cancer.
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Affiliation(s)
- Amanda Purcell
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Brisbane, Queensland 4067, Australia.
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Prue G, Allen J, Gracey J, Rankin J, Cramp F. Fatigue in gynecological cancer patients during and after anticancer treatment. J Pain Symptom Manage 2010; 39:197-210. [PMID: 19995675 DOI: 10.1016/j.jpainsymman.2009.06.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2008] [Revised: 06/01/2009] [Accepted: 07/13/2009] [Indexed: 11/18/2022]
Abstract
CONTEXT Research has indicated that individuals with gynecological cancer experience severe fatigue. OBJECTIVES This longitudinal survey aimed to analyze the fatigue experienced over the course of one year by a gynecological cancer population, to determine if the fatigue was more severe than that reported by females without cancer, and to identify variables associated with cancer-related fatigue (CRF). METHODS Data were collected over a 12-month period before, during, and after anticancer treatment. Fatigue was assessed using the Multidimensional Fatigue Symptom Inventory-Short Form. Participants with cancer also completed the Rotterdam Symptom Checklist. RESULTS Sixty-five cancer patients (mean age = 57.4 years, standard deviation [SD] = 13.9) and 60 control subjects (mean age = 55.4 years, SD = 13.6) participated. Descriptive analysis and repeated measurements modeling indicated that the cancer participants reported worse fatigue than the noncancer individuals before, during, and after anticancer treatment (P < 0.001) and that the level of fatigue in persons with cancer changed with time (P = 0.02). A forward stepwise regression demonstrated that psychological distress level was the only independent predictor of CRF during anticancer 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. CONCLUSION Psychological distress level is an important indicator of CRF in gynecological cancer. Interventions focused on the reduction of psychological distress may help alleviate CRF.
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Affiliation(s)
- Gillian Prue
- Institute of Nursing Research, University of Ulster, Newtownabbey, Co. Antrim, BT37 0QB, United Kingdom.
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Brown LF, Kroenke K. Cancer-related fatigue and its associations with depression and anxiety: a systematic review. PSYCHOSOMATICS 2010; 50:440-7. [PMID: 19855028 DOI: 10.1176/appi.psy.50.5.440] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Fatigue is an important symptom in cancer and has been shown to be associated with psychological distress. OBJECTIVE This review assesses evidence regarding associations of cancer-related fatigue with depression and anxiety. METHOD Database searches yielded 59 studies reporting correlation coefficients or odds ratios. RESULTS The combined sample size was 12,103. Almost all studies showed a correlation of fatigue with depression and with anxiety. However, 31 different instruments were used to assess fatigue, suggesting a lack of consensus on measurement. CONCLUSION This review confirms the association of fatigue with depression and anxiety. Directionality needs to be better delineated in longitudinal studies.
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Affiliation(s)
- Linda F Brown
- Psychology Department, Indiana University Purdue University, Indianapolis, IN 46202, USA.
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Mota DDCDF, Pimenta CADM, Fitch MI. Pictograma de Fadiga: uma alternativa para avaliação da intensidade e impacto da fadiga. Rev Esc Enferm USP 2009. [DOI: 10.1590/s0080-62342009000500012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo foi validar o Fatigue Pictogram para uso no Brasil. Os dados foram coletados em quatro ambulatórios de oncologia de São Paulo (SP) e na Escola de Enfermagem da USP. A amostra de conveniência envolveu 584 pacientes com câncer, 184 acompanhantes e 189 estudantes de graduação enfermagem, que responderam ao Pictograma de Fadiga, ao Inventário de Depressão de Beck (IDB) e Escala de Karnofsky (KPS). Foram feitos testes de validade e confiabilidade. O Teste-reteste mostrou que o instrumento tem boa estabilidade. O primeiro item do Pictograma de Fadiga discriminou estudantes de cuidadores de pacientes, mas não pacientes de cuidadores. O segundo item discriminou todos os grupos. Observou-se adequada validade convergente (fadiga e depressão) e divergente (fadiga e Karnofsky). O Pictograma de Fadiga é válido, confiável e fácil de usar para avaliar fadiga em câncer, mas necessita ajustes para uso em pessoas saudáveis.
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Wasteson E, Brenne E, Higginson IJ, Hotopf M, Lloyd-Williams M, Kaasa S, Loge JH. Depression assessment and classification in palliative cancer patients: a systematic literature review. Palliat Med 2009; 23:739-53. [PMID: 19825894 DOI: 10.1177/0269216309106978] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The objective of this study was to review the literature on depression in palliative cancer care in order to identify which assessment methods and classification systems have been used in studies of depression. Extensive electronic database searches in PubMed, CancerLit, CINAHL, PsychINFO, EMBASE and AgeLine as well as hand search were carried out. In the 202 included papers, 106 different assessment methods were used. Sixty-five of these were only used once. All together, the Hospital Anxiety and Depression Scale (HADS) was the most commonly used assessment method. However, there were regional differences and while the HADS dominated in Europe it was quite seldom used in Canada or in the USA. Few prevalence and intervention studies used assessment methods with an explicit reference to a diagnostic system. There were in total few case definitions of depression. Among these, the classifications were in general based on cut-off scores (77%) and not according to diagnostic systems. The full range of the DSM-IV diagnostic criteria was seldom assessed, i.e. less than one-third of the assessments in the review took into account the duration of symptoms and 18% assessed consequences and impact upon patient functioning. A diversity of assessment methods had been used. Few studies classified depression by referring to a diagnostic system or by using cut-off scores. Evidently, there is a need for a consensus on how to assess and conceptualize depression and related conditions in palliative care.
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Affiliation(s)
- Elisabet Wasteson
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), N-7006 Trondheim, Norway.
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Lowe SS, Watanabe SM, Baracos VE, Courneya KS. Associations between physical activity and quality of life in cancer patients receiving palliative care: a pilot survey. J Pain Symptom Manage 2009; 38:785-96. [PMID: 19775864 DOI: 10.1016/j.jpainsymman.2009.03.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 03/18/2009] [Accepted: 04/01/2009] [Indexed: 11/28/2022]
Abstract
The primary aim of this study was to examine the association between physical activity and quality of life (QoL) in cancer patients receiving palliative care. Fifty advanced cancer patients aged 18 years or older with clinician-estimated life expectancy of 3-12 months and Palliative Performance Status Scale scores greater than 30% were recruited from an outpatient palliative care clinic and palliative home care. Participants completed a cross-sectional survey by means of face-to-face interview assessing self-reported QoL (McGill Quality of Life Questionnaire [MQOL]), self-reported physical function (Late-Life Function and Disability Instrument), symptoms (Edmonton Symptom Assessment System), and physical activity behavior. Seventy-six percent (38 of 50) of the participants were deceased at the time of data analysis, with a median survival of 104 days from time of survey to time of death. Walking was the most common reported physical activity. Analyses of variance indicated that participants who reported walking more than 30 minutes per day also reported higher existential subscores (+/-0.8 [95% CI, 0.0-1.5]; P=0.045), support subscores (+/-0.7 [95% CI, 0.1-1.4]; P=0.027), and total scores (+/-0.5 [95% CI, 0.0-0.9]; P=0.046) on the MQOL. There were no significant differences for self-reported physical function or symptoms. Our findings show a significant positive association between physical activity and QoL scores in this sample of patients with advanced cancer. A pilot intervention trial testing the causal effects of physical activity on QoL in cancer patients receiving palliative care is warranted.
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Affiliation(s)
- Sonya S Lowe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, Alberta, Canada.
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Brown LF, Kroenke K. Cancer-related fatigue and its associations with depression and anxiety: a systematic review. PSYCHOSOMATICS 2009. [PMID: 19855028 DOI: 10.1176/appi.psy.50.5.440.] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fatigue is an important symptom in cancer and has been shown to be associated with psychological distress. OBJECTIVE This review assesses evidence regarding associations of cancer-related fatigue with depression and anxiety. METHOD Database searches yielded 59 studies reporting correlation coefficients or odds ratios. RESULTS The combined sample size was 12,103. Almost all studies showed a correlation of fatigue with depression and with anxiety. However, 31 different instruments were used to assess fatigue, suggesting a lack of consensus on measurement. CONCLUSION This review confirms the association of fatigue with depression and anxiety. Directionality needs to be better delineated in longitudinal studies.
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Affiliation(s)
- Linda F Brown
- Psychology Department, Indiana University Purdue University, Indianapolis, IN 46202, USA.
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Brown LF, Kroenke K. Cancer-Related Fatigue and Its Associations With Depression and Anxiety: A Systematic Review. PSYCHOSOMATICS 2009. [DOI: 10.1016/s0033-3182(09)70835-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Kirkova J, Walsh D, Russel M, Hauser K, Lasheen W. Symptom Assessment in Palliative Medicine: Complexities and Challenges. Am J Hosp Palliat Care 2009; 27:75-83. [DOI: 10.1177/1049909109339619] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Symptoms are important patient-reported outcomes (PRO), which help to evaluate the impact of diseases and treatments and assess quality of care. Thorough symptom assessment is a challenge, as patients in palliative settings are often polysymptomatic and easily fatigued. There is no consensus about standardization of symptom assessment in palliative medicine. The available research provides some methodological guidance, but the psychometric properties of structured multisymptom assessments are largely understudied. New approaches may improve the efficacy of clinical assessment and create instruments with greater clinical utility. In this article, we discuss current methodological concepts of symptom assessment in clinical practice, specifically with reference to symptom questionnaires appropriate for palliative medicine.
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Affiliation(s)
- Jordanka Kirkova
- Harry R. Horvitz Center for Palliative Medicine, the Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Declan Walsh
- The Harry R. Horvitz Chair in Palliative Medicine, Cleveland, Ohio,
| | - Mitchell Russel
- Harry R. Horvitz Center for Palliative Medicine, the Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Katherine Hauser
- Harry R. Horvitz Center for Palliative Medicine, the Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
| | - Wael Lasheen
- Harry R. Horvitz Center for Palliative Medicine, the Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
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Hagelin CL, Wengström Y, Ahsberg E, Fürst CJ. Fatigue dimensions in patients with advanced cancer in relation to time of survival and quality of life. Palliat Med 2009; 23:171-8. [PMID: 18952749 DOI: 10.1177/0269216308098794] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To understand the relation between fatigue and patients emotional situation at the end of life, this cross-sectional study aimed to explore the association between multidimensional aspects of fatigue, emotional functioning and quality of life (QoL) in patients with advanced cancer at the end of life. Patients with advanced cancer answered fatigue related measurements (Borg Category Ratio-10 scale, Multidimensional Fatigue Inventory-20, Swedish Occupational Fatigue Inventory and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30), when admitted for specialised palliative care. A total of 228 patients with a median length of survival of 63 days were included. In relation to time of survival, fatigue increased closer to death, in both global and multidimensional aspects, as well as the patient's experience of being sleepy. Marital status was found to affect the experience of fatigue in both global and multidimensional ratings of fatigue. The association between the experience of fatigue and feelings of being tense, worried, irritable or depressed and rated QoL decreased and was not evident closer to death. Fatigue in all dimensions increased, as patients got closer to death. The association between fatigue and both QoL and negative emotions faded away during the last days and weeks of life.
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Affiliation(s)
- C Lundh Hagelin
- Research & Development unit, Stockholms Sjukhem Foundation, Stockholm, Sweden.
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Lundh Hagelin C, Wengström Y, Fürst CJ. Patterns of fatigue related to advanced disease and radiotherapy in patients with cancer-a comparative cross-sectional study of fatigue intensity and characteristics. Support Care Cancer 2008; 17:519-26. [PMID: 18791747 DOI: 10.1007/s00520-008-0502-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 08/22/2008] [Indexed: 10/21/2022]
Abstract
GOALS OF WORK This cross-sectional comparative study was designed to explore and describe the prevalence and patterns of cancer-related fatigue in patients with advanced cancer as well as patients undergoing curative radiotherapy. Another aim was to explore the association of anxiety and depression with fatigue. MATERIALS AND METHODS Patients with an advanced stage of disease (n = 228) and patients receiving radiotherapy (n = 81) completed the Borg Category Ratio Scale, the Multidimensional Fatigue Inventory and the Hospital Anxiety and Depression Scale. MAIN RESULTS Patients with advanced disease had an increased probability of experiencing all aspects of fatigue except for mental fatigue as compared to patients undergoing radiation, e.g., odds ratio 11.5 (CI 5.8-22.7) for physical fatigue. Higher scores for depression than for anxiety were reported when patients had high levels of fatigue, with 23% of the patients classified as anxious and 39% depressed. CONCLUSIONS The present study was carried out in order to address a gap in research by comparing the multidimensional aspects of fatigue in different groups of cancer patients. It is the intensity of fatigue that seems to be related to the underlying exposure to radiation or to the level of disease burden rather than the different fatigue profiles, such as the relation between physical and mental aspects.
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Affiliation(s)
- Carina Lundh Hagelin
- Research & Development Unit, Stockholms Sjukhem Foundation, Mariebergsgatan 22, Stockholm 112 35, Sweden.
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Thombs BD, Bassel M, McGuire L, Smith MT, Hudson M, Haythornthwaite JA. A systematic comparison of fatigue levels in systemic sclerosis with general population, cancer and rheumatic disease samples. Rheumatology (Oxford) 2008; 47:1559-63. [PMID: 18701538 DOI: 10.1093/rheumatology/ken331] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES There are no studies of fatigue levels in patients with SSc. The objective of this study was to compare fatigue in SSc to general population samples and patients with rheumatic diseases and cancer, where fatigue has been researched extensively. METHODS SSc patients completed the General Fatigue Index (GFI) of the Multidimensional Fatigue Inventory. A systematic review was conducted to select comparison samples. Mean GFI scores from SSc patients were compared with mean scores from comparison samples with t-tests and Bonferroni corrections (family-wise P < 0.05). RESULTS A total of 106 SSc patients were sampled (97 females; 28 diffuse SSc; 11.9 +/- 7.9 yrs since diagnosis). Based on comparisons from the systematic review, mean GFI scores in SSc (13.3 +/- 4.6) were significantly higher (greater fatigue; P < 0.05) than in two large population samples (8.7 and 9.6) and than in two samples of cancer patients in remission (9.4 and 10.0). Scores for the SSc sample were significantly lower (less fatigue) compared with two samples of cancer patients in palliative care (16.8 and 17.0). SSc GFI scores were similar to scores from patients with RA (13.4), AS (13.0) and SLE (13.1) and to scores from six studies of cancer patients in active treatment (11.1-13.5). CONCLUSIONS The high levels of fatigue reported in SSc were similar to patients with varying types and treatment stages of cancer and patients with other rheumatic diseases when assessed with the GFI, demonstrating that fatigue warrants greater attention in SSc.
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Affiliation(s)
- B D Thombs
- Department of Psychiatry, McGill University and Sir Mortimer B. Davis - Jewish General Hospital, Montreal, Quebec, Canada.
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Abstract
It was suggested that fatigue is one of characteristics of panic disorder. Fatigue was assessed in 360 patients with panic disorder using the Japanese version of the Multidimensional Fatigue Inventory (MFI-J). The scores for general fatigue and reduced activity were significantly higher in the patients than in the controls. These tendencies were also observed in men when the subject group was differentiated according to sex, but not in women. In contrast, the trend for higher score for physical fatigue was observed only in the female patients. Thus, the present study suggests that the characteristics of fatigue vary with sex in panic disorder.
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Affiliation(s)
- Hisanobu Kaiya
- Outpatient Clinic for Anxiety Disorders, Akasaka Mental Clinic, Tokyo, Japan
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Echteld MA, Passchier J, Teunissen S, Claessen S, de Wit R, van der Rijt CCD. Multidimensional fatigue and its correlates in hospitalised advanced cancer patients. Eur J Cancer 2007; 43:1030-6. [PMID: 17336052 DOI: 10.1016/j.ejca.2007.01.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Revised: 01/12/2007] [Accepted: 01/22/2007] [Indexed: 11/19/2022]
Abstract
Although fatigue is a multidimensional concept, multidimensional fatigue is rarely investigated in hospitalised cancer patients. We determined the levels and correlates of multidimensional fatigue in 100 advanced cancer patients admitted for symptom control. Fatigue dimensions were general fatigue (GF), physical fatigue (PF), reduced activity (RA), reduced motivation (RM) and mental fatigue (MF). Investigated correlates were tumour load, prior anti-tumour treatment, medication use, haemoglobin levels, serum biochemical variables, physical symptoms and mood. Median GF, PF and RA scores were very high; median RM and MF scores were moderate, and differed from the GF, PF and RA scores. Multiple regression analyses showed that symptoms and mood correlated with all fatigue dimensions. Each fatigue dimension had different relationships with other factors. Hospitalised advanced cancer patients differ in fatigue levels depending on the fatigue dimension, and each fatigue dimension has different correlates. The results confirm that fatigue should be regarded as a multidimensional concept.
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Affiliation(s)
- Michael A Echteld
- VU University Medical Centre, Institute for Research in Extramural Medicine, Department of Public and Occupational Health, Amsterdam, The Netherlands.
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