The impact of hemoglobin levels on fatigue and quality of life in cancer patients

Ann Oncol. 2002 Jun;13(6):965-73. doi: 10.1093/annonc/mdf122.


Background: Although fatigue is a commonly reported symptom in cancer patients its etiology is still poorly understood. The objective of the present study was to investigate the relationship between hemoglobin (Hb) levels and the subjective experience of fatigue and quality of life in cancer patients with mild or no anemia undergoing chemotherapy.

Patients and methods: Sixty-eight cancer patients (25 colorectal, 26 lung and 17 ovarian cancer) presently undergoing chemotherapy participated in the study. Fatigue was measured with the Multidimesional Fatigue Inventory (MFI-20), quality of life with The European Organization for Research and Treatment of Cancer QLQ-C30. In order to provide normative data for fatigue levels, the MFI-20 was also completed by a sex- and age-matched sample of 120 healthy controls.

Results: Compared with healthy subjects, cancer patients experienced significantly higher levels of subjective fatigue. Correlations between Hb values and subscales of the MFI-20 were moderate with a tendency to increase during chemotherapy. Hb values alone, however, do not fully account for the observed fatigue. Other symptoms, especially pain, dyspnea and sleep disturbances, also showed an association with perceived fatigue.

Conclusions: Despite significant correlations, these results indicate that Hb values only partially explain subjectively experienced fatigue and quality of life in cancer patients. It is suggested therefore that the treatment of fatigue must be multidimensional and involve all areas which contribute to the syndrome.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anemia / diagnosis
  • Anemia / etiology
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Case-Control Studies
  • Cohort Studies
  • Colorectal Neoplasms / drug therapy
  • Colorectal Neoplasms / physiopathology
  • Colorectal Neoplasms / psychology
  • Fatigue / diagnosis*
  • Fatigue / etiology
  • Female
  • Hemoglobins / analysis*
  • Humans
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / physiopathology
  • Lung Neoplasms / psychology
  • Male
  • Middle Aged
  • Neoplasms / drug therapy*
  • Neoplasms / physiopathology
  • Neoplasms / psychology*
  • Ovarian Neoplasms / drug therapy
  • Ovarian Neoplasms / physiopathology
  • Ovarian Neoplasms / psychology
  • Probability
  • Prognosis
  • Quality of Life*
  • Reference Values
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Surveys and Questionnaires


  • Hemoglobins