Background: Although fatigue affects over 75% of patients with advanced cancer, changes over time in symptoms and antecedents have not been described in the acute care setting.
Objectives: To determine the prevalence, in patients with advanced cancer, of fatigue and anaemia on admission, describe strategies used to treat anaemia, observe changes in fatigue over ten days, and determine factors associated with fatigue.
Design: Prospective, observational study.
Settings and participants: In two Swiss tertiary care hospitals, a convenience sample of patients (N=103) was recruited at admission and followed up at days six (n=76) and ten (n=53). Patients were admitted because of new and/or worsening symptoms, deteriorating health status, or complications. They received measures aimed at symptom control and disease modifying interventions.
Methods: Clinical and sociodemographic data were collected on selected patients who were able to complete a test battery of validated measures. Assessment was undertaken on hospital admission and on days six and ten post-admission.
Findings: At admission, according to the suggested cut-off score of 43 for the FACIT-Fatigue scale, 87% of participants were experiencing cancer-related fatigue. Fatigue varied greatly within and among patients. Data on anaemia were available for 100 patients, of whom 62% were anaemic on admission. Severe and life threatening anaemia were mostly treated with red blood cell transfusions. Over time, fatigue decreased for patients who improved enough to be discharged (p<0.001) but not for those who withdrew from the study, most of whom did so due to worsening health. In multiple regression analysis, younger patients and patients with lower functional status, higher scores for depression, and more other anaemia-related symptoms experienced more fatigue. The variables examined explained 62% of variance in fatigue.
Conclusions: Fatigue was common in hospitalized patients with advanced cancer and the majority were anaemic. Based on these data, monitoring and treating fatigue and anaemia over a ten-day hospital stay seem to be supported. The variable trajectories call for interventions carefully tailored to individual patients. The results should be considered as a first step to exploring fatigue in these patients.
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