Cancer-related fatigue: Inevitable, unimportant and untreatable? Results of a multi-centre patient survey

Objectives: To investigate cancer patients' experience of fatigue and their perceptions about the causes, management and impact of this symptom. Design: Cross-sectional, questionnaire-based survey. Settings: Three regional cancer centres; Glasgow, Birmingham and Southampton. Participants: One thousand three hundred seven outpatients with cancer attending the three units over a 30-day period. Main outcome measures: Investigator designed questionnaire and the fatigue sub-scale of the Functional Assessment of Cancer Therapy - Fatigue (FACT-F) questionnaire. Results: The response rate was 576 of 1307 (44%). Fatigue was reported to affect 58% of patients 'somewhat or very much'. The comparable figures for pain and nausea/vomiting were 22% and 18%, respectively. Fatigue had never been reported to the hospital doctor by 52% (281 of 538) of patients with this symptom. Only 75 patients (14%) had received treatment or advice about the management of their fatigue. Fatigue was reported to be not well-managed by 33% (180 of 538) of patients with this symptom. The comparable figures for pain and nausea/vomiting were 9% (46 of 538) and 7% (37 of 538), respectively. The median FACT-F score was 18 (range 0-52). On multivariate analysis 54% of the variation in FACT-F scores could be explained by the combination of quality of life, depression, dyspnoea, weight loss/anorexia and use of analgesics in the previous month. Conclusions: Fatigue has been identified as an important problem by patients with cancer. It affects more patients for more of the time than any other symptom and is regarded by patients as being more important than either pain or nausea/vomiting. Research into the aetiology and management of this symptom should be regarded as a priority.