Pain, depression, and fatigue as a symptom cluster in advanced cancer

Barry J. A. Laird (Lead / Corresponding author), Angela C. Scott, Lesley A. Colvin, Amy Louise McKeon, Gordon D. Murray, Kenneth C. H. Fearon, Marie T. Fallon

Research output: Contribution to journalArticlepeer-review

123 Citations (Scopus)


Context: Pain, depression, and fatigue are common symptoms in cancer populations. They often coexist and have been suggested as a specific symptom cluster. Systemic inflammation (SI) may be a possible common mechanism.

Objective: This study examined whether pain, depression, and fatigue exist as a symptom cluster in advanced cancer patients with cachexia and might be related to the presence of SI.

Methods: Secondary data analysis was undertaken of two clinical trials in patients with cancer cachexia (n = 654). Pain, depression, and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. Plasma C-reactive protein (CRP) was measured as a marker of SI in a subgroup (n = 436). Multivariate analysis and a series of regression analyses were undertaken relating pain, depression, fatigue, and CRP.

Results: Pain, depression, and fatigue clustered, with between two and four times as many patients having all three symptoms as would be expected if the symptoms only coexist by chance (P < 0.001). CRP was not related to the symptom cluster. There was a strong relationship between the pattern of symptoms and physical functioning (P < 0.001).

Conclusion: Pain, depression, and fatigue is an identifiable symptom cluster in a cohort of cachexic cancer patients and is associated with reduced physical functioning.

Original languageEnglish
Pages (from-to)1-11
Number of pages11
JournalJournal of Pain and Symptom Management
Issue number1
Early online date12 Mar 2011
Publication statusPublished - Jul 2011


  • cancer
  • cluster
  • depression
  • fatigue
  • inflammation
  • Pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • General Nursing


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