Fatigue, depression and quality of life in cancer patients: how are they related?

Abstract

In a study concerning a group of cancer patients undergoing radiotherapy three research questions were addressed. (1) Is fatigue a valid criterion for depression in these somatically ill patients? (2) What is the 'cause-andeffect' relation between fatigue and depression? (3) To what extent are fatigue and depression related to patients' quality of life. A heterogeneous sample of cancer patients (n p 250) were interviewed before treatment, 2 weeks after treatment and 9 months later. Fatigue was measured using the MFI, a self-report instrument covering five dimensions of fatigue. Depression was assessed with the non-somatic items of the CES-D. Quality of life had to be indicated on a Cantrill ladder. Fatigue and depression do not follow the same course over time. Just after radiotherapy, fatigue had either increased or remained stable, depending on the dimension under consideration. Depression, in contrast, decreased. Nine months later fatigue had decreased, whereas levels of depression remained stable. Concurrent relations between fatigue and depression were mostly moderate. There was no strong evidence for a cause-and-effect relationship between depression and fatigue. Depression showed highest concurrent relationships with quality of life, especially before treatment. Prospectively, depression and the dimension of physical fatigue were the main predictors for quality of life. Fatigue is not a valid criterion for depression in these patients. Nor is there a strong cause-and-effect relationship. Both depression and physical fatigue are relevant to patients' quality of life.

Psychological aspects of prostate cancer: a clinical review

“…25 QOL studies have found few prostate treatment variables associated with depression. 26 Rather, major findings from these studies indicate that being older, being married, having high social support, being optimistic and having less impairment in physical functioning are associated with decreased risk of depression. 27 --30 The profile of risk factors associated with depression in men with prostate cancer is highly consistent with the profile of factors empirically shown to be associated with risk of depression in general cancer populations.…”

Fatigue in ovarian carcinoma patients

“…A relation between fatigue and low QOL has also been reported for other groups of cancer patients. 45 Ovarian carcinoma patients with fatigue also differ from nonfatigue patients in several other respects, with the former showing more anxiety and depression as well as an increased helpless coping behavior. In addition, this group reported significantly lower social support and higher social stress.…”

Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer

“…Although many cancer studies have examined fatigue during and after chemotherapy, only a small number evaluated fatigue before chemotherapy. These studies found that younger age, female gender, presence of metastases, sleep problems, mood disturbance, lower cognitive function, and poorer performance were all associated with more severe pretreatment fatigue among cancer patients [16,26,34,43]. Studies examining the relationship between sleep and fatigue have primarily found that, during chemotherapy, the two are associated.…”

“…Miaskowski and Lee [32], in a study of patients with bone metastasis, found that these patients reported only moderate fatigue but significant sleep disturbance. Several investigators found that fatigue was also related to depression, anxiety, and/or pain in patients undergoing chemotherapy [36,43] and after the end of chemotherapy [9,43]. Three studies examined the relationship between fatigue and reports of sleep disruption before treatment [16,26,34], but no studies examined fatigue and objectively recorded sleep before treatment.…”