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

TY - JOUR

T1 - Pain, depression, and fatigue as a symptom cluster in advanced cancer

AU - Laird, Barry J. A.

AU - Scott, Angela C.

AU - Colvin, Lesley A.

AU - McKeon, Amy Louise

AU - Murray, Gordon D.

AU - Fearon, Kenneth C. H.

AU - Fallon, Marie T.

PY - 2011/7

Y1 - 2011/7

N2 - 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.

AB - 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.

KW - cancer

KW - cluster

KW - depression

KW - fatigue

KW - inflammation

KW - Pain

UR - https://www.scopus.com/pages/publications/79960144637

U2 - 10.1016/j.jpainsymman.2010.10.261

DO - 10.1016/j.jpainsymman.2010.10.261

M3 - Article

C2 - 21402467

AN - SCOPUS:79960144637

SN - 0885-3924

VL - 42

SP - 1

EP - 11

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

IS - 1

ER -