Annals of Oncology Advance Access originally published online on September 5, 2007
Annals of Oncology 2007 18(11):1861-1869; doi:10.1093/annonc/mdm349
© 2007 European Society for Medical Oncology
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Clinically relevant fatigue in cancer outpatients: the Edinburgh Cancer Centre symptom study
1 Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
2 Centre for Statistics in Medicine, Wolfson College Annexe, Oxford, UK
3 University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
4 Centre for Integrated Healthcare Research, Queen Margaret University College, Edinburgh, UK
5 SAS, Whittington House, Medmenham, Buckinghamshire, UK
6 School of Molecular and Clinical Medicine, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh, UK
* Correspondance to: Dr D. Storey, Edinburgh Cancer Centre, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU. Tel: +44 (0)131 537 1000; Fax: +44 (0) 131 537 3914; E-mail: drdjs{at}talk21.com
Background: Fatigue is associated with cancer and its treatment but we know little about how many and which patients suffer fatigue of clinical severity. We aimed to determine the prevalence of clinically relevant fatigue (CRF) and its associations in outpatients with various cancer diagnoses.
Patients and methods: A survey of outpatients with colorectal, breast, gynaecological, genitourinary, sarcoma, melanoma and miscellaneous tumours at a regional cancer centre. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) fatigue subscale and the Hospital Anxiety and Depression Scale (HADS). These self-report data were linked to demographic and clinical variables. Data were available on 2867 outpatients.
Results: The prevalence of CRF (EORTC fatigue subscale 
40) was 32% (95% confidence interval 31–34%). The variables independently associated with CRF were primary cancer site, having disease present, type of cancer treatment and emotional distress (total HADS score 15). Emotional distress had the strongest association with fatigue but half the cases of CRF were not distressed.
Conclusion: CRF is common in cancer outpatients and is associated with type of disease and treatment, as well as with emotional distress. The association between CRF and emotional distress is strong but they are not equivalent conditions.
Key words: associations, cancer, fatigue, predictors, prevalence, treatment
Received for publication February 6, 2007. Revision received June 8, 2007. Accepted for publication June 8, 2007.
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