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IAHPC Hospice and Palliative Care Newsletter


2005; Volume 6, No 4, April


Article of the Month

Carla Ripamonti, MD

Many ways to help support palliative care.

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Message from the Chair & Executive Director:
Kathleen M. Foley, MD
Liliana De Lima, MHA

Article of the Month:
Dr. Ripamonti

The Terri Shiavo Case in the US

Reports: The 6th Asia Pacific Hospice Conference

2nd Global Summit of National Hospice and Palliative Care Associations

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Roger Woodruff, MD

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Asia Report
India Report of the Training the Trainers Course

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Dr. William Farr

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Palliative Care in the Developing World: Principles and Practice

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The correlation between fatigue, physical function, the systemic inflammatory response, and psychological distress in patients with advanced lung cancer

Author(s): Brown D.J.F, McMillan DC , Milroy R.

Abstract:  Cancer 2005; 103: 377-82

Fatigue is a frequent and devastating symptom in advanced cancer patients with a negative impact on their basic daily life activities.

Little is known about the mechanism that determines the intensity of the symptom and it is not yet clear if there is a correlation between fatigue, objective physical function and psychological distress.

The aim of this study was to evaluate the relationship between fatigue, physical function, the systemic inflammatory response, and psychological distress in patients with metastatic or locally advanced lung cancer.

38 patients were assessed (18 with metastatic disease and 20 with locally advanced cancer) recruited from two specialist palliative care centers and an associated hospital. The control group was composed of 15 age-matched and gender matched healthy volunteers. Patients were excluded if they had received surgery or had undergone chemo or radiotherapy in the previous month or if they had an active connective tissue disease.

The patients and the control group were assessed for:

  • fatigue by means of FACIT-Fatigue (FACIT-F), and 3-item Fatigue subscale of the EORTC QLQ-30
  • weakness by means of a 10-cm visual analogue scale
  • anthropometry, body composition: height and weight, body mass index (BMI), triceps skin-fold thickness and thigh skin-fold thickness, midarm and midthigh circumferences
  • physical function: functional ability was assessed by means of the Karnofsky performance status (KPS), hand-grip strength in the dominant hand with a grip dynamometer, the chair-rise time was measured on a hand-held digital stopwatch
  • psychological distress by means of the Hospital Anxiety and Depression (HAD) scale
  • type of drugs taken (opioids, benzodiazepines, antidepressants, NSAIDs, corticosteroids)
  • white blood cell count, haemoglobin, creatininekinase, albumin, and C-reactive protein


With respect to the control group, cancer patients had higher levels of fatigue, weakness and psychological distress (p<0.001). Moreover cancer patients were thinner, had lower levels of haemoglobin and creatinekinase and higher CRP levels, lower KPS, lesser grip strength, longer chair-rise times, higher HAD scale scores (all p<0.01). Significant correlations (all p< 0.001) were found in the cancer patients between FACIT-F and the Fatigue subscale of the EORTC and between the KPS and the chair-rise time. The correlation between fatigue and the use of drugs involved only those patients on benzodiazepines who reported greater fatigue compared to those who were not taking such drugs (p<0.01).

As fatigue increased, there were lower KPS, higher weakness and higher HAD scores (p<0.001) and slower chair-rise times (p<0.01). In a multiple regression analysis, only KPS, weakness and HAD scores were correlated independently with fatigue (p<0.001).

Why I chose this article

The results of this study, even though carried out on a small number of advanced cancer patients, demonstrate that fatigue is correlated with KPS and psychological distress. Weight loss or anaemia is not principally the causes of fatigue, contrary to the results of other studies. Moreover, this study points out that both fatigue and performance statuses are related to a simple evaluation of a physical function such as the time taken to rise from a chair.

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC

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