Fatigue and Its Risk Factors in Cancer Patients Who Seek Emergency Care

Abstract

Cancer patients visiting the emergency center (EC) are seldom assessed or treated for severe fatigue, a common symptom in sick patients due to acute medical conditions arising from cancer and cancer treatment. We provide a profile of cancer-related fatigue within the EC setting. Using a single-item screening tool derived from the Brief Fatigue Inventory, 928 patients (636 with solid tumors, 292 with hematological malignancies) triaged in the EC of a tertiary cancer center rated their fatigue at its worst in the last 24 hours. Patient demographic and clinical factors were retrospectively reviewed from medical records. The chief complaints of patients seeking emergency care included fever, pain, gastrointestinal symptoms, dyspnea, fatigue, and bleeding. More than half (54%) reported severe fatigue (seven or higher on a 0-10 scale) upon EC admission. Moderate to severe pain was highly associated with fatigue severity. Patients with severe fatigue were more likely to be unstable and unable to go home after EC care. In multivariate logistic regression analysis for severe fatigue, the significant risk factors for patients with solid tumors included dizziness (odds ratio [OR]=3.59), severe pain (OR=1.98), poor performance status (OR=1.81), and being female (OR=1.56). Dyspnea was significantly associated with severe fatigue in patients with hematological malignancies (OR=4.74). Although fatigue was not the major reason for an ER visit, single-item fatigue-severity screening demonstrated highly prevalent severe fatigue in sicker EC cancer patients and in those patients who also suffered from other symptoms.

Single Center Experience on Causes of Cancer Patients Visiting the Emergency Department in Southwest Turkey

“…Previous studies have shown applied to the emergency room with the most common cause of pain approximately in 34% of the patients (Swenson et al, 1995;Escalente et al, 2008;Bozdemir et al, 2009). It keeps track of nausea, vomiting and shortness of breath, respectively (Bozdemir et al, 2009;Yates and Barrett, 2010;Mayer et al, 2011;Kraft-Rovere et al, 2012;Yucel et al, 2012).…”

Predictors of significant worsening of patient‐reported fatigue over a 1‐month timeframe in ambulatory patients with common solid tumors

“…In the existing fatigue literature, from a variety of different cohorts, predictors of fatigue have included most prominently co-existing psychological symptoms and mental health factors (including the tendency toward catastrophizing) 29, 30, 32–35 , co-existing pain 36, 37 , duration of cancer treatment 38 , primary disease site 39 , comorbidity 32, 40–42 , and a variety of other factors. As shown in Table 2, we found that the worsening in fatigue levels varied according to baseline levels of fatigue, and our model of fatigue worsening included baseline fatigue as a significant predictor.…”

Emergency department visits for symptoms experienced by oncology patients: a systematic review

“…The 18 included studies were published between 1995 and 2011 in seven countries: USA (n09), Taiwan (n03), France (n 02), Japan (n 01), Italy (n 01), Australia (n 01), and Argentina (n01) (see Table 4) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Seventeen studies were published in English and one in French.…”

“…Although definitions were provided for 16 of the 28 Febrile neutropenia a)Fever (temp >38°C) and profound thrombocytopenia (<20×10 9 /l) [2] b)Absolute granulocyte count <500/mm 3 [5] c)Temperature >38.3°C and suspected neutropenia [12] d)Temp >38°C and absolute neutrophil count <1,000/mm 3 [14] e)Fever ≥100.4°F (in last 24 h) and ANC ≤500 cells/ml [15] f)White blood cell count <1,000/μl (or neutrophils <500/μl) with a core temperature above 38.3°C (or >38°C on 2 consecutive occasions) [16] Sepsis a) Blood: detection of microbial CO 2 by automated method of continuous blood culturing monitoring or urine: >50,000 colony-forming units of pathologic organisms/ml [15] b) Blood lactate >4 mmol/l or low BP (SBP <90 mmHg or 40 mmHg below usual) before fluid challenge or 1+ organ dysfunction (SpO 2 <95 % with fraction of inspired air O 2 >0.5, Cr >176 μmol/l or oliguria, international normalized ratio >2, Bili >78 μmol/l, Glasgow coma scale <15) [ c) Specific to abdominal pain [9] d) Generalized abdominal pain/tenderness, rebounding pain, tenderness localized in the R lower quadrant [17] e) All types of pain [7] Fatigue a) Weakness [5] b) Self-reported on 0-10 scale (severe07-10, non-severe00-6) [ [5] c) Glasgow coma scale score ≤12 [9] Dyspnea a) Shortness of breath [5,13] b) Subjective awareness of difficulty in breathing [11] Skin reactions a) All types of rash, blisters, vesicles, purpura [1] Anemia a) Hb 5.5 g/dl [2] b) Hemoglobin <8 g/dl [11] Infection a) Microbial documentation [2] b) No definition provided, but states 'confirmed' [14] Respiratory failure a) PaO 2 <60 mmHg & RR >30 breaths/min (necessitating mech. vent.)…”

“…vent.) [9] Anxiety a) Having nervousness, crying, apprehension, uncertainty, or fear without cause (noted in RN/MD notes) [11] Eight studies focused on multiple symptoms, reporting a median of five symptoms (range [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Eleven of these symptoms (44 %) were defined in one of six studies, while two studies provided no definitions.…”