Prevalence, predictors, and prognostic impact of fatigue among Brazilian outpatients with advanced cancers

Purposes

The purposes of this study are to evaluate the impact of cancer-related fatigue (CRF) on quality of life (QoL), and to identify its clinical predictors. In addition, the authors investigated the prognostic impact of CRF and its relationship with the inflammatory marker C-reactive protein.

Method

Data regarding patient characteristics, symptom scores, and QoL indices were collected at the initial evaluation. At the same time, blood samples were collected in order to evaluate some laboratorial markers. Patients were followed by telephone interviews every 15 days until death. CRF was defined as ≥66.67 points on EORTC QLQ-C30 fatigue subscale.

Results

The examined patients had a median age of 61 years (range, 21–86 years) and 50.7 % were male. Median Karnofsky performance score (KPS) was 75.5 (SD, 15.1). The prevalence of CRF was 25 % (55 out of 221). Overall, patients with CRF presented higher symptom burden and also worst QoL scores. The following variables were independently associated with CRF: nausea (OR 1.22, p?=?0.009), dyspnea (OR 1.33, p?=?0.002), KPS (OR 0.96, p?=?0.009), body mass index (OR 0.93, p?=?0.046), and C-reactive protein (OR 1.08, p?=?0.004). The median overall survival (OS) was lower in CRF patients (p?<?0.0001). Only KPS (HR?=?0.96, p?<?0.001) and C-reactive protein (HR?=?1.07, p?<?0.001) were independent prognostic factors for OS.

Conclusions

Advanced cancer patients (ACP) with CRF had a higher burden of symptoms and impaired QoL. Our findings support the hypothesis that chronic inflammatory state (CIS) could play a role in the pathogenesis of fatigue in ACP. Moreover, CIS seems to have greater prognostic impact than the associated fatigue.