Impact of symptom control on fatigue improvement in patients with advanced cancer: A prospective observational study

Abstract

Background Fatigue is one of the most common symptoms found in patients with advanced cancer. There is interplay between fatigue and other symptoms.

AimTo examine the factors associated with fatigue in patients with advanced cancer and the impact of symptom control on improvement in fatigue.

Design Prospective observational study. Patients were assessed for symptom burden using the Edmonton Symptom Assessment Scale (ESAS). All the study patients received standard palliative care. They were followed up 15–30 days after the first consult. Analysis of the results was performed using descriptive statistics, correlation, multiple linear regressions and logistic regression of fatigue with other variables. CTRI registration number REF/2014/02/006537.

Setting/participantsPalliative Care clinic of a tertiary cancer care hospital, from January to June 2014. Patients had advanced cancer, were registered with the clinic, had ECOG ≤ 3, and ESAS fatigue score ≥ 1.

Results 500 subjects enrolled at baseline. 402 completed the planned follow-up (median age, 52 years; 51.6% male). Significant improvement in the fatigue score was observed (p < 0.001) at follow-up. Haemoglobin, albumin levels, type of cancer, sites of metastasis, ECOG score, body weight, all items on ESAS scale (except drowsiness) were found to be significantly associated with fatigue at baseline (p < 0.05). The logistic regression model showed that improvement in haemoglobin and albumin levels and in severity of pain and dyspnoea, significantly improved fatigue scores at follow up.

Conclusions Fatigue improved with the standard palliative care delivered at our specialty Palliative Care clinic. Certain clinical, biochemical factors and symptoms were associated with fatigue severity at baseline, improvement of which lead to lesser fatigue at follow up.

Keywords:

• Advanced cancer
• ESAS
• ECOG
• Fatigue
• Indian cancer centre
• Outpatient
• Palliative care
• Symptom control

Acknowledgements

We thank all staff members of the Department of Palliative Medicine at Tata Memorial Centre who have contributed to the materialization of this work. We would also like to thank the patients and caregivers who gave us their consent, valuable time and energy in carrying out the study. Special thanks go to Dr. Janet L. Abrahm, MD, who very kindly agreed to read the entire manuscript and made many invaluable suggestions.

Disclaimer statements

Contributors The corresponding author of this manuscript is Dr M.A. Muckaden, MD (Radiation Oncology), Master of Science (Palliative Medicine), Professor and Head, Department of Palliative Medicine, MB G 75, Tata Memorial Centre, Dr E Borges’ Road, Parel, Mumbai 400012.

Email id: [email protected]

The first author is Dr A Ghoshal, MD (Palliative Medicine), Senior Resident, Department of Palliative Medicine, Tata Memorial Centre, Mumbai 400012.

The co-authors are as follows:

Dr Naveen Salins, MD (Gen Med) Dip Pall Med (Clin) Clinical Fellowship (Pall Med), Associate Professor, Department of Palliative Medicine, Tata Memorial Centre, Mumbai 400012.

Dr Jayita Deodhar, MD (Psy), D.P.M., DNB (Psy), DMH (UK), MRCPsych, CCST in Gen Adult Psychiatry (UK), Associate Professor, Department of Palliative Medicine, Tata Memorial Centre, Mumbai 400012.

Dr Anuja Damani, MD (Pall Med), Senior Resident, Department of Palliative Medicine, Tata Memorial Centre, Mumbai 400012.

Funding None.

Conflicts of interest There are no conflicts-of-interest.

Ethics approval The Institutional Review Board of the hospital approved the study (Project No: 1181) and it was registered with clinical trials registry of India (CTRI REF/2014/02/006537).

ORCiD

Arunangshu Ghoshal http://orcid.org/0000-0001-9975-2568