The Level of Distress From Fatigue Reported in the Final Two Months of Life by a Palliative Care Population: An Australian National Prospective, Consecutive Case Series

Ingham, Gemma; Urban, Katalin; Allingham, Samuel F; Blanchard, Megan B; Marston, Celia; Currow, David C.

doi:10.1016/j.jpainsymman.2020.10.031

Cited by 4 publications

(9 citation statements)

References 25 publications

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“…Our study supports previous findings that patients dying at home show poorer performance and need more assistance. Patients with life-limiting illnesses often suffer from multiple discomfort symptoms that reduce quality of life [ 23 ], including breathlessness, bowel problems, fatigue, and pain [ 18 , 22 , 31 ]. It has been reported that fatigue was a common symptom although it is underrecognized frequently [ 28 ], and one third of patients may experience significant breathlessness [ 29 ], or suffer from at least some degree of bowel problems [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Death place and palliative outcome indicators in patients under palliative home care service: an observational study

et al. 2023

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Background Dying at home accompanied by loved-ones is regarded favorably and brings good luck in Taiwan. This study aimed to examine the relevant factors affecting whether an individual dies at home or not in a group of terminal patients receiving palliative home care service. Methods The patients who were admitted to a palliative home care service at a hospital-affiliated home health care agency were consecutively enrolled between March 1, 2021 and March 31, 2022. During the period of care, the instruments of the palliative care outcomes collaboration was used to assess patients in each home visit twice a week, including symptom assessment scale, palliative care problem severity score, Australia-modified Karnofsky performance status, resource utilization groups-activities of daily living, and palliative care phase. Results There were 56 participants (53.6% female) with a median age of 73.0 years (interquartile range (IQR) 61.3–80.3 y/o), of whom 51 (91.1%) patients were diagnosed with cancer and 49 (96.1%) had metastasis. The number of home visits was 3.5 (IQR 2.0–5.0) and the average number of days under palliative home care service was 31 (IQR 16.3–51.5) before their death. After the end of the study, there was a significant deterioration of sleeping, appetite, and breathing problems in the home-death group, and appetite problems in the non-home death patients. However, physician-reported psychological/spiritual problems improved in the home-death group, and pain improved in the non-home death patients. Physical performance deteriorated in both groups, and more resource utilization of palliative care was needed. The 44 patients who died at home had greater cancer disease severity, fewer admissions, and the proportion of families desiring a home death for the patient was higher. Conclusions Although the differences in palliative outcome indicators were minor between patients who died at home and those who died in the hospital, understanding the determinants and change of indicators after palliative care service at different death places may be helpful for improving the quality of end-of-life care.

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Section: Discussionmentioning

confidence: 99%

Death place and palliative outcome indicators in patients under palliative home care service: an observational study

et al. 2023

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“…Similarly, Al Maqbali et al noted the highest frequency of CRF in patients with advanced disease [12]. In a nationwide Australian study on routinely collected data from more than 116,000 subjects, 80% of cancer patients reported fatigue during the last 60 days of life, and 50% assessed fatigue level to be moderate or severe [26].…”

Section: Epidemiology Of Cancer Related Fatigue With Focus On Patients In Palliative Carementioning

confidence: 91%

Fatigue in Cancer Patients in Palliative Care—A Review on Pharmacological Interventions

Klasson

Frankling

Hagelin

et al. 2021

Cancers

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Fatigue is one of the most distressing symptoms experienced by cancer patients. The suggested biological mechanism for cancer related fatigue (CRF) includes immune activation triggered by tumor tissue or by anticancer treatment but other mechanisms have also been proposed. Previous large meta-analysis of interventions on fatigue focuses mostly on patients early in the disease trajectory, with only one tenth of included studies performed in palliative cohorts. The aim of this narrative review is therefore to present a background on CRF with focus on the palliative setting. A summary of recent randomized, controlled trials on pharmacological interventions on CRF in palliative care is presented, including studies on psychostimulants, corticosteroids, testosterone and melatonin. Interestingly, in several of these studies there was a positive and similar effect on fatigue in both the intervention and the placebo arm—indicating an important placebo effect for any pharmacological treatment. In addition, studies on dietary supplements and on pharmacological complementary medicines are discussed. To conclude, the evidence is still weak for using pharmacological treatments on CRF in palliative care patients—although methylphenidate and corticosteroids might be considered.

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“…Fatigue is a common and distressing symptom in patients with advanced or metastatic cancer that affects their quality of life (QoL) negatively [1][2][3]. A recent metaanalysis indicated that approximately 60% of patients with advanced cancer suffer from fatigue [4].…”

Section: Introductionmentioning

confidence: 99%

Sex Differences in the Effect of Vitamin D on Fatigue in Palliative Cancer Care—A Post Hoc Analysis of the Randomized, Controlled Trial ‘Palliative-D’

Klasson

Frankling

Warnqvist

et al. 2022

Cancers

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In the randomized, placebo-controlled, double-blind trial ‘Palliative-D’, vitamin D treatment of 4000 IE/day for 12 weeks reduced opioid use and fatigue in vitamin-D-deficient cancer patients. In screening data from this trial, lower levels of vitamin D were associated with more fatigue in men but not in women. The aim of the present study was to investigate possible sex differences in the effect of vitamin D in patients with advanced cancer, with a specific focus on fatigue. A post hoc analysis of sex differences in patients completing the Palliative-D study (n = 150) was performed. Fatigue assessed with the Edmonton Symptom Assessment Scale (ESAS) was reduced in vitamin-D-treated men;−1.50 ESAS points (95%CI −2.57 to −0.43; p = 0.007) but not in women;−0.75 (95%CI −1.85 to 0.36; p = 0.18). Fatigue measured with EORTC QLQ-C15-PAL had a borderline significant effect in men (−0.33 (95%CI −0.67 to 0.03; p = 0.05)) but not in women (p = 0.55). The effect on fatigue measured with ESAS in men remained the same after adjustment for opioid doses (p = 0.01). In conclusion, the positive effect of the correction of vitamin D deficiency on fatigue may be more pronounced in men than in women. However, studies focused on analyzing sex differences in this context must be performed before firm conclusions can be drawn.

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The Level of Distress From Fatigue Reported in the Final Two Months of Life by a Palliative Care Population: An Australian National Prospective, Consecutive Case Series

Cited by 4 publications

References 25 publications

Death place and palliative outcome indicators in patients under palliative home care service: an observational study

Death place and palliative outcome indicators in patients under palliative home care service: an observational study

Fatigue in Cancer Patients in Palliative Care—A Review on Pharmacological Interventions

Sex Differences in the Effect of Vitamin D on Fatigue in Palliative Cancer Care—A Post Hoc Analysis of the Randomized, Controlled Trial ‘Palliative-D’

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