title: An investigation of weakness, fatigue, strength, function and quality of life in patients with advanced cancer
Creators: name: Brown, Duncan J. F.
Publisher: name: University of Glasgow
Year: 2001
Subjects: subject: Cancer, patients, fatigue, quality of life, asthenia.

description: Weakness and fatigue are the commonest symptoms in patients with advanced cancer. They are symptoms which have largely eluded precise definition, but have been reported to seriously affect quality of life and ability to perform basic daily activities. Reduced muscle bulk due to cancer cachexia and alteration in intrinsic muscle function have been suggested as causes of both reduced muscle strength and subjective weakness and fatigue. It has been reported that anxiety/depression, anaemia, deranged biochemistry and the inflammatory response may contribute to weakness and fatigue. However, the relationship between subjective weakness and fatigue and objective strength in cancer patients is not clear. To date, such relationships have not been studied in cancer patients. The aims of the present work were twofold. First, to investigate the importance of weight loss, altered body composition, the inflammatory response, haematological and biochemical parameters in the experience of weakness and fatigue in patients with advanced cancer. The second aim of this work was to examine the relationships between objective tests of strength and function and measures of weakness and fatigue and patient-related quality of life in patients with advanced cancer. In chapter 5, a typical hospice population was studied retrospectively, to provide a background and baseline to the prospective studies. A heterogeneous group of 229 cancer patients, who had died in the preceding 6 months, was described. Of these patients, more than half had the presence of weight loss documented in the casenotes. Weakness, fatigue and tiredness were documented as important symptoms in some patients, but not as frequently as in previous prospective studies. Many patients had increased difficulty in performing the activities of daily living. The difficulties of establishing symptom prevalence retrospectively from casenotes is discussed. Many of the patients were taking drugs implicated in the aetiology of weakness and fatigue, such as opioids, benzodiazepines, antidepressants and corticosteroids. In chapter 6, a group of patients with advanced cancer was compared with an age, sex and healthy body mass index matched healthy control group. The cancer group were clearly more unwell, having lost weight including both fat and muscle. The cancer patients also had a lower performance status and had significantly more weakness and fatigue. The correlations obtained between the weakness scale and the two fatigue scales suggested that weakness and fatigue tend to co-exist and that patients tend to use the terms weakness and fatigue synonymously. The cancer patients were more anaemic and had evidence of an inflammatory response. Correlations with the weakness and fatigue scales suggest that anaemia and the inflammatory response may be aetiological factors in the pathogenesis of weakness and fatigue. It was of interest that patients taking benzodiazepine drugs had higher fatigue scores than those not receiving such drugs. Those cancer patients who had lost greater than 5% of their body weight were compared with those who were weight-stable. The weight-losers had lost muscle mass, had more weakness and fatigue and reported greater difficulty in carrying out activity than the weight-stable patients. The weight-losers had a more marked inflammatory response, suggesting that the inflammatory response is involved in ongoing weight loss in patients with advanced cancer. In chapter 7, it was observed that in addition to having more weakness and fatigue, the cancer patients had lost physical strength, compared with the healthy controls, as well as performing less well in the chair, stair and walking functional tests. The cancer group also had poorer levels of self-rated functioning, an increased symptom burden and poorer quality of life. Although there was no apparent relationship between the weakness score and the strength measures, multivariate analysis suggested that muscle bulk may be an important factor in determining muscle strength. The fatigue and weakness scale scores in the cancer group were related to objective function, and handgrip strength was related to chair stand time. The relationship between strength and function was not as striking as in previous work in the healthy elderly. However, it was clear that cancer patients were a more rapidly changing group than the healthy elderly. (Abstract shortened by ProQuest.).