Fatigue and Associated Symptoms in Patients with a Primary Brain Tumor

Julia Day,Rooney A,Erridge S,Gillespie D,Grant R,Berntzen B,Tuck S,Peoples S

doi:10.31487/j.aco.2019.03.04

Abstract

Purpose: To determine the prevalence and predictors of fatigue in clinically stable primary brain tumor patients, we used objective and subjective measures and a cross-sectional design. Methods: Eighty-five brain tumor patients completed self-report measures of fatigue, sleep disturbance, mood and growth hormone deficiency. Objective measures of sleep, cognition and neurological function were carried out. Comparisons were made between patients with no-mild, moderate and severe fatigue. Results: Sixty-seven per cent of patients (n=57) were experiencing moderate or severe fatigue at the time of assessment. Statistically significant differences between no-mild, moderate and severe fatigue groups were found when examining percentage daytime activity (p=0.035), processing speed (p = 0.0006), anxiety (p=0.008), depression (p<0.0001), neurological function (p<0.0001), growth hormone deficiency (p<0.0001) and epileptic drug type (p=0.011). Memory, executive function and verbal fluency were not found to significantly differ across groups. Sleep duration and efficiency were not correlated with fatigue. Using regression analysis, anxiety and neurological function predictors were independently found to be associated with fatigue (p=0.017 and p=0.0003 respectively). Conclusions: Findings suggest neurological function and anxiety independently contribute to fatigue in stable brain tumor patients. A ‘neurological model’ may offer a better understanding of fatigue in the brain tumor population than a ‘cancer model’. This study supports the recommendation of a core data set for assessing fatigue that includes a measure of neurological function, alongside patient perceptions of causation (physical and mental fatigue). This may potentially be helpful in selecting treatment options or in interpretation of drug trials of fatigue.

Highlights

Fatigue is the most common symptom reported in patients living with a brain tumor [1,2,3,4,5]
Future research may help to prevent this by reducing the numbers of measures in order to complete data collection at one time. This exploratory study highlights the role of physical impairment and symptoms of depression as significant predictors of fatigue severity
Multiple regression revealed that both depression and disability were significant predictors of fatigue, together accounting for approximately 23% of the variance in patients' self-reported fatigue measure

Summary

Introduction

Fatigue is the most common symptom reported in patients living with a brain tumor [1,2,3,4,5] It can be associated with primary factors related to the disease process and treatment (e.g. surgery, radiotherapy) and secondary factors including sleep disturbance, depression, endocrine changes, and medication side-effects [2,3, 6,7,8,9,10,11]. Researchers have proposed a core set of assessments for all brain tumor patients to identify symptoms of fatigue, distress (anxiety and depression), drowsiness, difficulty remembering, and difficulty with sleeping [12]. These are often cooccurring and related symptoms that may be contributing to poor quality of life, and offer avenues for treatment. A neurological-related fatigue model, common in patients with multiple sclerosis (MS), stroke, traumatic brain injury and epilepsy, may offer a better understanding of fatigue in brain tumor patients, that incorporates impairment and disability associated with the nervous system [15,16,17,18,19]

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