Factors associated with the severity and improvement of fatigue in patients with advanced cancer presenting to an outpatient palliative care clinic

We reviewed the records of consecutive patients with advanced cancer presenting to OPC. Edmonton Symptom Assessment System (ESAS) scores were obtained at the initial and subsequent visits between January 2003 and December 2008. All patients received interdisciplinary care led by palliative medicine specialists following an institutional protocol. Fatigue improvement was defined as a reduction of ≥2 points in ESAS score relative to the baseline. Descriptive statistics were used to summarize patient characterstics. Univariate analyses were performed and only significant variables were included in multivariate regression analysis to determine factors associated with severity and improvement in CRF.A total of 1778 evaluable patients were analyzed (median age, 59？years; 52% male). The median time between visits was 15？days. Median fatigue scores on the ESAS were 6 at baseline and 5 at follow-up. Severity of all ESAS items and low serum albumin were associated with fatigue at baseline (p？<？0.0001). The improvement of fatigue was observed in 586 patients (33%). The hierarchical model showed that fatigue improved over time (b？=？？0.009; p？=？0.0009). low appetite (odds ratio [OR]？=？1.09 per point; p？=？0.0113) and genitourinary cancer (OR？=？1.74 per point; p？=？0.0458) were significantly associated with improvement of fatigue.CRF is strongly associated with physical and emotional symptoms. Genitourinary cancer and low appetite at baseline were associated with successful improvement of fatigue.Previous research has shown that patients with advanced cancer develop severe physical and psychosocial symptoms as a result of cancer and treatments [1,2]. Among cancer-related symptoms, cancer-related fatigue (CRF) is the most common chronic and distressing [2], with a frequency of 60-90% [1]. Since CRF is more severe in advanced stages than in early stages of disease, CRF can prevent patients with advanced cancer from receiving effective cancer therapy [2]. The National Comprehensive Ca