Descriptive study on burden and communication of fatigue among castration-resistant prostate cancer patients in Japan

Figures & data

Table 1. Questions using the Brief Fatigue Inventory assessing severity of fatigue and impact of cancer treatment-related fatigue on daily function.

Item	Question	Description
1	Fatigue right now	Fatigue as currently experienced by the patient, evaluated on a scale from 0 to 10, with 0 meaning ‘no fatigue’ and 10 meaning ‘fatigue at its most severe for you form’.
2	Usual level of fatigue in past 24 h
3	Worst level of fatigue in past 24 h
4	General activity	Interference of fatigue during the past 24 h in the different aspects of the patient’s life, evaluated on a scale from 0 to 10, with zero meaning ‘fatigue does not interfere’ and 10 meaning ‘maximum interference’.
5	Mood
6	Walking ability
7	Normal work
8	Relations with other people
9	Enjoyment of life

Note: A global fatigue score ranging from 0 to 10 was evaluated upon completion of the study.

Table 2. Clinical characteristics.

Characteristic/Parameter	N = 22
Age (years), mean (min-max)	71.1 (55–85)
Duration of disease, median (min-max)	10 years 9 months (3 months − 21 years and 4 months)
History of androgen deprivation therapy	n	(%)
Surgical orchiectomy	4	18.2
Leuprorelin	9	40.9
Goserelin	5	22.7
Degarelix acetate	8	36.4
Injected (Unknown drug name, per month)	1	4.5
Injected (Unknown drug name, every 3 months)	3	13.6
History of first-generation androgen receptor blockers (Yes)	n	(%)
Bicalutamide	16	72.7
Flutamide	10	45.5
Current treatment by novel androgen receptor blockers (Yes)	n	(%)
Enzalutamide	12	54.5
≤6 months	4	33.3
≤1 year	1	8.3
≥1 year	7	58.3
Abiraterone acetate	10	45.5
≤6 months	2	16.7
≤1 year	3	25.0
≥1 year	5	41.7
Prostate-specific antigen (PSA) level (ng/mL)
At enzalutamide initiation (12 patients)
Mean (SD)	8.09 (6.10)
Median (min, max)	5.60 (0.93, 24)
Interquartile range, 25–75%	2.50–7.80
At abiraterone acetate initiation (10 patients)
Mean (SD)	6.21 (7.20)
Median (min, max)	2.70 (0.15, 23.40)
Interquartile range, 25–75%	1–8.60
At the time of answering the questionnaire (22 patients)
Mean (SD)	1.45 (3.10)
Median (min, max)	0.10 (0, 12)
Interquartile range, 25–75%	0.01–1
Patient-reported metastatic status	n	(%)
No metastasis	9	41
Bone	10	46
Lymph node	6	27

Table 3. Symptoms reported by the patients.

Symptoms	Number of patients who reported symptoms, N = 22
	Mild	Moderate	Severe	Extreme severity
	n (%)	n (%)	n (%)	n (%)
Tiredness	8 (36.4)	3 (13.6)	1 (4.5)	0
Back pain	2 (9.1)	0	1 (4.5)	0
Constipation	5 (22.7)	0	0	0
Arthralgia	6 (27.3)	0	1 (4.5)	0
Hypertension	6 (27.3)	3 (13.6)	0	0
Loss of appetite	4 (18.2)	1 (4.5)	0	0
Weight loss	3 (13.6)	2 (9.1)	1 (4.5)	0
Nausea	1 (4.5)	0	0	0
Hot flashes	7 (31.8)	3 (13.6)	3 (13.6)	1 (4.5)
Lethargy	8 (36.4)	2 (9.1)	0	0
Foot swelling	3 (13.6)	1 (4.5)	0	0
Palpitations/shortness of breath	5 (22.7)	0	0	2 (9.1)
Dizziness	5 (22.7)	0	0	0

Table 4. Previous and current hormone therapies were reported by the patients.

Previous hormone therapy		Current hormone therapy
Hormone therapy	Number of patients (n)	Hormone therapy	Number of patients (n)
Bicalutamide and flutamide	8	enzalutamide	4
		abiraterone acetate	4
Bicalutamide alone	8	enzalutamide	5
		abiraterone acetate	3
Flutamide alone	2	enzalutamide	1
		abiraterone acetate	1
Neither bicalutamide nor flutamide	4	enzalutamide	2
		abiraterone acetate	2

Table 5. Brief Fatigue Inventory scores based on the patients’ responses.

Brief Fatigue Inventory (BFI) items	Number of patients who responded (N = 22)
	BFI score 1–3	BFI score 4–6	BFI score 7–9
	Mild	Moderate	Severe
	n (%)	n (%)	n (%)
Fatigue right NOW	14 (63.6)	7 (31.8)	1 (4.6)
USUAL level of fatigue in past 24 h	18 (81.8)	3 (13.6)	1 (4.56)
WORST level of fatigue in past 24 h	14 (63.6)	7 (31.8)	1 (4.6)
Circle the one number that describes how, during the past 24 h, fatigue has interfered with your:
General activity	19 (86.4)	2 (9.1)	1 (4.6)
Mood	17 (77.3)	3 (13.6)	2 (9.1)
Walking ability	19 (86.4)	2 (9.1)	1 (4.6)
Normal work in the last week	19 (86.4)	2 (9.1)	1 (4.6)
Relations with others	20 (90.9)	1 (4.6)	1 (4.6)
Ability to enjoy life	20 (90.9)	2 (9.1)	0

Table 6. Fatigue right NOW in BFI by patient background stratification.

			BFI score 1–3	BFI score 4–6	BFI score 7–9
			Mild	Moderate	Severe
		N	n (%)	n (%)	n (%)
Age: >70	Yes	12	8 (66.7)	3 (25.0)	1 (8.3)
	No	10	6 (60.0)	4 (20.0)	0 (0.0)
History of surgical orchiectomy	Yes	4	2 (50.0)	2 (50.0)	0 (0.0)
	No	18	12 (66.7)	5 (27.8)	1 (5.6)
History of leuprorelin	Yes	9	7 (77.8)	1 (11.1)	1 (11.1)
	No	13	7 (53.8)	6 (46.2)	0 (0.0)
History of goserelin	Yes	5	4 (80.0)	1 (20.0)	0 (0.0)
	No	17	10 (58.8)	6 (35.3)	1 (5.9)
History of degarelix acetate	Yes	8	6 (75.0)	2 (25.0)	0 (0.0)
	No	14	8 (57.1)	5 (35.7)	1 (7.1)
History of bicalutamide	Yes	16	11 (68.8)	4 (25.0)	1 (6.3)
	No	6	3 (50.0)	3 (50.0)	0 (0.0)
History of flutamide	Yes	10	5 (50.0)	4 (40.0)	1 (10.0)
	No	12	9 (75.0)	3 (25.0)	0 (0.0)

Table 7. Healthcare professionals’ responses to patients’ communication of fatigue as reported by patients.

Comments	Patient number
Patients’ comments for each BFI domain
“If it wasn’t for fatigue, I would have been able to continue my job.”	3
“Going out has become troublesome. For example, I have a lot of gatherings like alumni meetings, work activities. I have stopped going to those completely. I don’t even want to go outside anymore”	3
“When fatigue kicks in, I stop the car and make sure I rest, but I think it might be dangerous to drive. That’s how I feel”	4
“I can’t do chores and work at home like gardening. There is a lack of motivation.”	5
Healthcare professional’s response as described by a patient
“I can’t sleep, so I asked about herbal and Chinese medicine because I heard it works. The doctor said there was nothing he (or she) could do.”	1
“I do. I take medications, the doctor said that it cannot be helped.”	3
“I had an honest discussion with my primary care physician back then, this physician was very understanding and wrote me a referral letter to a hospital. The referral was addressed to that doctor.”	4
“The doctor said that drug has such adverse effect (but the discussion doesn’t go as far as to reduce the drug)”	5
“I did tell them. But it didn’t seem like the physician cared.”	8
Communication with HCPs
“It can be difficult to discuss this with the physician, because of the atmosphere. I think that even if I have said anything, they wouldn’t be listening to me. They are always looking at their computer monitor.”	6
Regarding treatment satisfaction
“The doctor might be too busy. I wait for 1 h and only get 3–4 min of time with the doctor. I feel that the cancer center doesn’t give the atmosphere to sit down and discuss calmly.”	5
“The side effects bother me like I have mentioned before. I think due to the side effects it’s a 4.”	2