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Clinical Factors Associated With Cancer-Related Fatigue in Patients Being Treated for Leukemia and Non-Hodgkin’s Lymphoma

From the Department of Symptom Research, Division of Anesthesiology and Critical Care, Hematology, Division of Medical Oncology, and Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

Address reprint requests to Xin Shelley Wang, MD, Department of Symptom Research, Box 221, The University of Texas M.D. Anderson Cancer Center, 1100 Holcombe Blvd, Houston, TX 77030; email: swong@ mdanderson.org.

PURPOSE: To describe fatigue severity, fatigue interference, and associated factors in hematologic malignancies.

PATIENTS AND METHODS: Patients being treated for leukemia and non-Hodgkin’s lymphoma (n = 228) completed the Brief Fatigue Inventory to rate fatigue severity and functional interference caused by fatigue. Data on patient demographics, Eastern Cooperative Oncology Group performance status, other physical symptoms, current treatments, and laboratory values were also collected. Descriptive statistics, bivariate correlation, and logistic regression were used for data analysis.

RESULTS: Fifty percent of the sample reported severe fatigue, which was defined as a "fatigue worst" rating of 7 or greater. More patients with acute leukemia (61%) reported severe fatigue compared with those with chronic leukemia (47%) and non-Hodgkin’s lymphoma (46%). Increased fatigue severity significantly compromised patients’ general activity, work, enjoyment of life, mood, walking, and relationships with others. Fatigue severity was strongly associated with performance status, use of opioids, blood transfusions, gastrointestinal symptoms, and sleep disturbance items, as well as with low serum hemoglobin and albumin levels. Regression analysis indicated that nausea was the significant clinical predictor of severe fatigue (odds ratio, 13), and low serum albumin was the significant laboratory value predictor (odds ratio, 3.8).

CONCLUSION: Disabling fatigue occurs with high frequency in hematologic malignancy, supporting a need to develop better methods of fatigue management. Better control of gastrointestinal and other symptoms may be of benefit. The mechanism and relationship between low albumin and severe fatigue needs to be investigated further, and longitudinal studies of the effects of treatment, host factors, and other symptoms are needed.

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