Comprehensively understanding fatigue in patients with myeloproliferative neoplasms

Cancer. 2016 Feb 1;122(3):477-85. doi: 10.1002/cncr.29753. Epub 2015 Dec 15.


Background: Patients with myeloproliferative neoplasms (MPNs) experience a high persistence, prevalence, and severity of fatigue. There is currently only limited information regarding factors that contribute to fatigue in patients with MPNs.

Methods: A 70-item, Internet-based survey regarding fatigue was developed by MPN investigators and patients/advocates and hosted by the Mayo Clinic Survey Research Center.

Results: Fatigue was found to be prevalent and severe among international survey respondents (1788 respondents). Higher body mass index (P<.001), current use of alcohol (P<.001), and current tobacco use (P = .0025) were found to be significantly associated with greater fatigue. Moderate/severe fatigue was present more frequently in those individuals who did not exercise compared with those who reported exercising at least once per week (P<.001). Medical comorbidities found to be significantly associated with greater fatigue included restless leg syndrome (P = .006), diabetes mellitus (P = .045), fibromyalgia (P < 0.001), chronic fatigue syndrome (P = .006), and chronic kidney disease (P = .02). Current use of antidepressants (P<.001), antihistamines (P = .0276), antianxiety medications (P = .0357), and prescription pain medications (P<.001) were found to be associated with worsened fatigue. Nearly 25% of respondents scored > 2 on the Patient Health Questionnaire, indicating a high probability of depression. Higher Brief Fatigue Inventory score, Myeloproliferative Neoplasm Total Symptom Score, and individual symptom items were all associated with a higher likelihood of depressive symptoms (P<.0001).

Conclusions: The management of fatigue should be multifactorial, with a comprehensive assessment and treatment plan to address all modifiable fatigue etiologies. Patients with MPNs likely have a higher prevalence of mood disturbances compared with the general population, suggesting the need to assess and intervene in this domain.

Keywords: essential thrombocythemia; fatigue; myelofibrosis; polycythemia vera; quality of life.

MeSH terms

  • Adult
  • Aged
  • Anxiety / complications
  • Anxiety / therapy
  • Bone Marrow Neoplasms / complications*
  • Chronic Disease / epidemiology
  • Comorbidity
  • Depression / complications
  • Depression / therapy
  • Diabetes Complications / epidemiology
  • Diabetes Complications / prevention & control
  • Fatigue / etiology*
  • Fatigue / prevention & control*
  • Fatigue / psychology
  • Fatigue Syndrome, Chronic / complications
  • Fatigue Syndrome, Chronic / epidemiology
  • Female
  • Fibromyalgia / complications
  • Fibromyalgia / epidemiology
  • Humans
  • Internet
  • Male
  • Middle Aged
  • Mood Disorders / complications*
  • Mood Disorders / epidemiology
  • Mood Disorders / therapy*
  • Quality of Life
  • Restless Legs Syndrome / complications
  • Restless Legs Syndrome / epidemiology
  • Risk Factors
  • Risk Reduction Behavior
  • Self Report
  • Severity of Illness Index