Correlations between Self-Rated Fatigue with Quality of Life, and Social Participation in Viennese Outpatients Suffering from Advanced Cancer During Palliative Chemotherapy

Zusammenfassung

Fragestellung: Das Symptom krebsassoziiertes Fatiguesyndrom („Fatigue”) wird in der Literatur als ein allgemeines, persistierendes und subjektives Gefühl der Erschöpfung beschrieben, welches in Zusammenhang mit der Krebserkrankung oder deren Behandlung steht und die betroffenen Patienten in ihrer Leistungsfähigkeit und ihren täglichen Verrichtungen behindert, was wiederum zu einer Einschränkung der Lebensqualität (QOL) und der „Sozialen Partizipation” führen kann. Die vorliegende Querschnittsuntersuchung hatte das Ziel, Zusammenhänge zwischen dem Symptom „Fatigue” mit der QOL und mit der „Sozialen Partizipation” an Wiener Karzinompatienten unter ambulanter palliativer Chemotherapie zu untersuchen. Material und Methode: 98 konsekutive Patienten (Durchschnittsalter 56 ± 8 Jahre) mit fortgeschrittener Karzinomerkrankung und infauster Prognose wurden in die Studie eingeschlossen. Alle Studienteilnehmer lebten zu Hause und erhielten an der Abteilung für Onkologie des Wiener Allgemeinen Krankenhauses als ambulante Patienten palliative Chemotherapien. Die Zielparameter „Fatigue” und „Soziale Partizipation” wurden anhand visueller Analogskalen (VAS) registriert und dokumentiert. Die Erfassung der Lebensqualität erfolgte mittels der deutschen Version des „SF-36 Health Survey” (SF-36). Mittels statischer Analysen (Spearman-Korrelation) wurden Korrelationen zwischen „Fatigue” und QOL sowie „Fatigue” und „Sozialer Partizipation” untersucht. Ergebnisse: Es wurde keine signifikante Korrelation zwischen „Fatigue” mit der QOL-Domäne „Körperlicher Schmerz” gefunden. Dagegen ergaben sich signifikante negative Korrelationen zwischen „Fatigue” mit den QOL-Domänen „Körperliche Funktionsfähigkeit” (p < 0,0001, r = - 0,56), „Körperliche Rollenfunktion” (p < 0,0001, r = - 0,60), „Mentale Gesundheit” (p = 0,0003, r = - 0,36), „Emotionelle Rollenfunktion” (p < 0,0001, r = - 0,42), „Vitalität” (p < 0,0001, r = - 0,67), „Allgemeiner Gesundheitszustand” (p = 0,0016, r = - 0,32) und „Soziale Kompetenz” (p = 0,0006, r = - 0,34). Zusätzlich zeigte sich eine signifikante negative Korrelation zwischen dem Symptom „Fatigue” mit der von den Patienten angegebenen „Sozialen Partizipation” (p < 0,0001, r = - 0,44). Schlussfolgerung: Die Ergebnisse dieser Studie an ambulanten Wiener Patienten weisen auf einen negativen Einfluss des Symptoms „Fatigue” auf die meisten Domänen der QOL und auf die „Soziale Partizipation” bei Karzinompatienten unter palliativer Chemotherapie hin. Zusätzlich unterstreichen sie die klinische Relevanz dem aktivitäts- und funktionslimitierenden Symptom „Fatigue” in der Rehabilitation solcher Patienten suffizient entgegenzuwirken.

Abstract

Purpose: Cancer-related fatigue has been described as a common, persistent, and subjective sense of tiredness related to cancer or to treatment for cancer that interferes with usual functioning, and to impair the patient's ability to carry out daily activities, which may influence quality of life (QOL) and social participation („Social Participation”). This cross-sectional study aimed to evaluate correlations between „Fatigue” with QOL and „Social Participation” in Viennese outpatients suffering from advanced cancer during palliative chemotherapy. Materials and methods: A total of 98 (56 ± 8 years of age) consecutive patients were included in the study. All participants were suffering from advanced cancer with poor prognosis, and receiving palliative chemotherapy as outpatients at the Department of Oncology in the General Hospital of Vienna. „Fatigue” and „Social Participation” were registered on visual analog scales. QOL was evaluated using the German version of the SF-36 Health Survey. A statistical analysis using Spearman correlation coefficients was performed to detect correlations between „Fatigue” with „Quality of Life”, and „Social Participation”. Results: No significant correlation was found between „Fatigue” with the QOL-scale „Bodily pain”. „Fatigue” showed a significant negative correlation with the QOL-scales „Physical functioning” (p < 0.0001, r = - 0.56), „Role-physical” (p < 0.0001, r = - 0.60), „Mental Health” (p = 0.0003, r = - 0.36), „Role-emotional” (p < 0.0001, r = - 0.42), „Vitality” (p < 0.0001, r = - 0.67), „General Health” (p = 0.0016, r = - 0.32), and „Social functioning” (p = 0.0006, r = - 0.34). Furthermore, a significant negative correlation was identified between „Fatigue” with „Social Participation” (p < 0.0001, r = - 0.44). Conclusions: These findings indicate a negative impact of „Fatigue” on QOL, and „Social Participation” in Viennese outpatients suffering from advanced cancer and receiving palliative chemotherapy. Furthermore, they underline the importance of fatigue management to counteract this activity-limiting symptom as rehabilitation goal in this patient group.

Schlüsselwörter

Fatigue - Lebensqualität - Partizipation - fortgeschrittener Krebs - palliative Chemotherapie

Key words

Fatigue - quality of life - participation - advanced cancer - palliative chemotherapy

References

• 1 Aistars J. Fatigue in the cancer patient: a conceptual approach to a clinical problem.  Oncol Nurs Forum. 1987;  14 25-30
• 2 Maughan T S, James R D, Kerr D J, Ledermann J A, McArdle C, Seymour M T, Cohen D, Hopwood P, Johnston C, Stephens R J. British MRC Colorectal Cancer Working Party . Comparison of survival, palliation, and quality of life with three chemotherapy regimen in metastatic colorectal cancer: a multicenter randomised trial.  Lancet. 2002;  359 1555-1563
• 3 Mock V, Atkinson A, Barsevick A, Cella D, Cimprich B, Cleeland C, Donnelly J, Eisenberger M A, Escalante C, Hinds P, Jacobsen P B, Kaldor P, Knight S J, Peterman A, Piper B F, Rugo H, Sabbatini P, Stahl C. National Comprehensive Cancer Network . National Comprehensive Cancer Network. NCNN practice guidelines for cancer-related fatigue.  Oncology. 2000;  14 151-161
• 4 Morrow G R, Andrews P L, Hickok J T, Roscoe J A, Matteson S. Fatigue associated with cancer and its treatment.  Support Care Cancer. 2002;  10 389-398
• 5 Smets E M, Garssen B, Schuster-Uitterhöve A L, Haes J C de. Fatigue in cancer patients.  Br J Cancer. 1993;  68 220-224
• 6 Stasi R, Abriani L, Beccaglia P, Terzoli E, Amadori S. Cancer-related fatigue. Evolving concepts in evaluation and treatment.  Cancer. 2003;  98 1786-1801
• 7 Stone P, Richards M, Hardy J. Fatigue in patients with cancer.  Eur J Cancer. 1998;  34 1670-1677
• 8 Vogelzang N J, Breitbart W, Cella D, Curt G A, Groopman J E, Horning S J, Itri L M, Johnson D H, Scherr S L, Portenoy R K. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey.  Semin Hematol. 1997;  34 4-12
• 9 Chan C W, Molassiotis A. The impact of fatigue on Chinese cancer patients in Hong Kong.  Support Care Cancer. 2001;  9 18-24
• 10 Coates A. Quality of life and supportive care.  Support Care Cancer. 1997;  5 435-438
• 11 Glaus A. Assessment of fatigue in cancer and non-cancer patients and healthy individuals.  Support Care Cancer. 1993;  1 285-286
• 12 Glaus A, Crow R, Hammond S. A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals.  Support Care Cancer. 1996;  4 82-96
• 13 Glaus A. Measuring fatigue of cancer patients in the German-speking region: development of the Fatigue Assessment Questionnaire.  Pflege. 2001;  14 161-170
• 14 Kassa S, Loge J H. Quality of life in palliative care: principles and practice.  Palliat Med. 2003;  17 11-20
• 15 Knobel H, Loge J H, Brenne E, Fayers P, Hjermstad M J, Kaasa S. The validity of EORTC-QLQ-C30 fatigue scale in advanced cancer patients and cancer survivors.  Palliat Med. 2003;  17 664-672
• 16 Potter J. Fatigue experience in advanced cancer: a phenomenological approach.  Int J Palliat Nurs. 2004;  10 15-23
• 17 Richardson A. Measuring fatigue in cancer patients.  Support Care Cancer. 1998;  6 94-100
• 18 Walsh D, Donnelly S, Rybicki L. The symptoms of advanced cancer: relationship to age, gender, and performance status in 1000 patients.  Support Care Cancer. 2000;  8 175-179
• 19 Visser M R, Smets E M. Fatigue, depression and quality of life in cancer patients: how are they related?.  Support Care Cancer. 1998;  2 101-108
• 20 Dimeo F, Schwartz S, Fietz T, Wanjura T, Boning T, Thiel E. Effects of endurance training on the physical performance of patients with hematological malignancies during chemotherapy.  Support Care Cancer. 2003;  11 623-628
• 21 Dimeo F, Rumberger B G, Keul J. Aerobic exercise as therapy for cancer fatigue.  Med Sci Sports Exerc. 1998;  30 475-478
• 22 Dimeo F, Stieglitz R D, Novelli-Fischer U, Fetscher S, Keul J. Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy.  Cancer. 1999;  85 2273-2277
• 23 Osoba D. Health-related quality-of-life assessment in clinical trials of supportive care in oncology.  Support Care Cancer. 2000;  8 84-88
• 24 Felleiter P, Gustorff B, Lierz P, Hornykewycz S, Kress H G. Use of the World Health Organization guidelines on cancer pain relief before referral to a specialized pain service. Schmerz 2004 (Epub ahead of print)
• 25 Crevenna R, Schneider B, Mittermaier C, Keilani M, Zöch C, Nuhr M, Wolzt M, Quittan M, Bigenzahn W, Fialka-Moser V. Implementation of the Vienna hydrotherapy group for laryngectomees - a pilot study.  Supportive Care in Cancer. 2003;  11 735-738
• 26 Huskisson E. Visual analog scales. In: Melzack R (ed) Pain measurement and assessment. New York; Raven press 1983: 33-37
• 27 Kleinman L, Zodet M W, Hakim Z, Aledort J, Barker C, Chan K, Krupp L, Revicki D. Psychometric evaluation of the fatigue severity scale for use in chronic hepatitis V.  Qual Life Res. 2000;  9 499-508
• 28 Lee K A, Hicks G, Nino-Murcia G. Validity and reliability of a scale to assess fatigue.  Psychiatry Res. 1991;  36 291-298
• 29 Bullinger M, Kirchberger I, Ware J. Der deutsche SF-36 health survey.  Z Gesundheitswiss. 1995;  3 21-26
• 30 Fisch M J, Titzer M L, Kristeller J L, Shen J, Loehrer P J, Jung S H, Passik S D, Einhorn L H. Assessment of quality of life in outpatients with advanced cancer: the accuracy of clinician estimations and the relevance of spiritual well-being - a Hoosier Oncology Group study.  J Clin Oncol. 2003;  21 2754-2759
• 31 Crevenna R, Schmidinger M, Keilani M, Fialka-Moser V, Zettinig G, Quittan M. Aerobic exercise for a patient suffering from metastatic bone disease.  Supportive Care in Cancer. 2003;  11 120-122
• 32 Crevenna R, Schmidinger M, Keilani M, Nuhr M, Nur H, Fialka-Moser V, Quittan M. Aerobic exercise as additive palliative treatment for a patient with advanced hepatocellular cancer.  Wien Med Wochenschr. 2003;  153 237-240
• 33 Crevenna R, Fialka-Moser V, Keilani M Y, Schmidinger M, Marosi C, Quittan M. Aerobic exercise for a patient suffering from relapsed inflammatory breast cancer.  Wien Med Wochenschr. 2002;  152 581-584
• 34 Cella D. FACIT Manual: Manual of the Functional Assessment of Chronic Illness Therapy (FACIT) Scales version 4. Evanston, Illinois; Evanston Northwestern Healthcare and Northwestern University 1997
• 35 Cella D. The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue.  Semin Hematol. 1997;  34, 3, Suppl 2 13-19
• 36 Mendoza T R, Wang X S, Cleeland C S, Morrissey M, Johnson B A, Wendt J K, Huber S L. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory.  Cancer. 1999;  85 1186-1196
• 37 Okuyama T, Akechi T, Kugaya A, Okamura H, Shima Y, Maruguchi M, Hosaka T, Uchitomi Y. Development and validation of the cancer fatigue scale: a brief, three-dimensional, self-rating scale for assessment of fatigue in cancer patients.  J Pain Symptom Manage. 2000;  19 5-14
• 38 Piper B F, Dibble S L, Dodd M J, Weiss M C, Slaughter R E, Paul S M. The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer.  Oncol Nurs Forum. 1998;  25 677-684
• 39 Schwartz A L. The Schwartz Cancer Fatigue Scale: testing reliability and validity.  Oncol Nurs Forum. 1998;  25 711-717
• 40 Martikainen P, Lahelma E, Marmot M, Sekine M, Nishi N, Kagamimori S. A comparison of socio-economic differences in physical functioning and perceived health among male and female employees in Britain, Finland and Japan.  Social Science and Medicine. 2004;  59 1287-1295
• 41 Baker F, Haffer S C, Denniston M. Health-related quality of life of cancer and noncancer patients in medicare managed care.  Cancer. 2003;  97 674-681
• 42 Crevenna R, Zettinig G, Keilani M, Posch M, Schmidinger M, Pirich C, Nuhr M, Wolzt M, Quittan M, Fialka-Moser V, Dudczak R. Quality of life in patients with non-metastatic differentiated thyroid cancer under thyroxine supplementation therapy.  Supportive Care in Cancer. 2003;  11 597-603
• 43 Perenboom R J, Chorus A M. Measuring participation according to the International Classification of Functioning, Disability and Health (ICF).  Disabil Rehabil. 2003;  25 577-587
• 44 So W K, Dodgson J, Tai J W. Fatigue and Quality of life among Chinese patients with hematologic maignancy after bone marow transplantation.  Cancer Nurs. 2003;  26 211-219
• 45 Hayes J R. Depression and chronic fatigue in cancer patients.  Prim Care. 1991;  18 327-339
• 46 Glaus A. Fatigue in patients with cancer. Analysis and assessment.  Recent Results Cancer Res. 1998;  145 1-172
• 47 Akechi T, Kugaya A, Okamura H, Yamawaki S, Uchitomi Y. Fatigue and its associated factors in ambulatory cancer patients: a preliminary study.  J Pain Symptom Manage. 1999;  17 42-48
• 48 Williamson R J, Purcell S, Sterne A, Wessely S, Hotopf M, Farmer A, Sham P C. The relationsship of Fatigue to mental and physical health in a community sample.  Soc Psychiatry Psychiatr Epidemiol. 2005;  40 126-132
• 49 Jacobsen P B, Donovan K A, Weitzner M A. Distinguishing fatigue and depression in patients with cancer.  Semin Clin Neuropsychiatry. 2003;  4 229-240
• 50 Crevenna R, Schmidinger M, Keilani M Y, Nuhr M J, Wiesinger G F, Korpan M, Marosi C, Fialka-Moser V, Quittan M. Aerobic exercise for breast cancer patients receiving adjuvant oncological treatment - results of the first Austrian outpatient group.  Phys Med Rehab Kuror. 2002;  12 25-30