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Severe Fatigue During the Palliative Treatment Phase of Cancer: An Exploratory Study

Peters, Marlies E. W. J. MSc, RN; Goedendorp, Martine M. PhD; Verhagen, Constans A. H. H. V. M. MD, PhD; van der Graaf, Winette T. A. MD, PhD; Bleijenberg, Gijs PhD

doi: 10.1097/NCC.0b013e318291bd2d

Background: Because of a rise in incidence and more effective treatments, the prevalence of patients with metastatic cancer is increasing fast. When palliative treatment is aimed at maintaining or improving patients’ quality of life, knowledge about severe fatigue is clinically relevant because of its debilitating effect, but at present this information is lacking.

Objective: This study investigated the prevalence of severe fatigue in patients with various incurable cancers and whether severe fatigue increased with further treatment lines and differed between various cancers and treatment modalities. In addition, a relationship between severe fatigue and other symptoms was examined.

Methods: Patients were asked to fill in the Checklist Individual Strength, European Organization of Research and Treatment of Cancer–Quality of Life Questionnaire C30, and the McGill Pain Questionnaire during palliative anticancer treatment, and hemoglobin levels were collected.

Results: Of all participating patients (n = 137), 47% were severely fatigued. Patients who received first line of treatment were significantly less often severely fatigued (40%) compared with patients who received further lines (60%). Significantly more severe fatigue was observed when patients had more pain, dyspnea, appetite loss, nausea, vomiting, and constipation.

Conclusions: During the phase of palliative anticancer treatment, fatigue was the most common symptom, nearly half of the patients had severe fatigue increasing with further treatment lines. Various treatment-related symptoms were related to more severe fatigue.

Implications for Practice: As severe fatigue is significantly related to other symptoms of cancer and its treatment, the screening and treatment of these cancer-related symptoms should be more stringent, as they might negatively influence each other.

Author Affiliations: Department of Medical Oncology (Ms Peters and Drs Verhagen and van der Graaf) and Expert Centre Chronic Fatigue (Drs Goedendorp and Bleijenberg), Radboud University Nijmegen, Medical Centre, the Netherlands; and Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen (Dr Goedendorp), the Netherlands.

Financial support was obtained from the Paul Speth Foundation.

The authors have no conflicts of interest to disclose.

Correspondence: Marlies E. W. J. Peters, MSc, RN, Department of Medical Oncology (452), Radboud University Nijmegen, Medical Centre, PO Box 9101, 6500 HB Nijmegen, the Netherlands (

Accepted for publication March 9, 2013.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins