Skip to main content

Advertisement

SpringerLink
Log in

Possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion in advanced cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goals

In this theoretical paper, we present the Edmonton Fatigue Framework (EFF), a new framework for the study of tiredness, fatigue, and exhaustion in advanced cancer.

Materials and methods

The Fatigue Adaptation Model (FAM), the starting point for the EFF, was drawn from a literature review pertaining to fatigue in depression, chronic fatigue syndrome, cancer, shift workers, and athletes published in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), PubMed, PsychINFO, SPORTdiscus, and CancerLit between 1995 and 2004, and from seven qualitative studies conducted by our group. The EFF, an elaboration of the FAM, was constructed after an expansion of our literature review to 2006 and team discussion. The EFF provides new insights into possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion as they occur in both ill and non-ill states. In this paper, however, we consider only possible links in advanced cancer.

Conclusions

We propose that stressors associated with advanced cancer and its supportive treatment trigger declines in four systems—cognitive function, sleep quality, nutrition, and muscle endurance—and that these declines reduce one’s ability to adapt. While these systems each likely has its own effect on adaptation, we propose that the most important and serious effects arise from interactions among declines in cognitive function, sleep quality, nutrition, and muscle endurance.

Conclusions

Interventions for fatigue have been limited by a lack of understanding about its etiology. Hypotheses arising from the EFF` suggest a new direction for further study that focuses on interactions among cognitive function, sleep quality, nutrition, and muscle endurance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Aistars J (1987) Fatigue in the cancer patient: a conceptual approach to a clinical problem. Oncol Nurs Forum 14 (6):25–29

    PubMed  CAS  Google Scholar 

  2. Ancoli-Israel S, Liu L, Marler M, Parker B, Jones B, Sadler G et al (2006) Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer 14:201–209

    Article  PubMed  Google Scholar 

  3. Argiles J, Costelli P, Carbo N, Pallares-Trujillo J, Lopez-Soriano F (1999) Tumor growth and nitrogen metabolism in the host. Int J Oncol 14:479–486

    PubMed  CAS  Google Scholar 

  4. Barber M, Ross J, Voss A, Tisdale M, Fearon K (1999) The effect of an oral nutritional supplement enriched with fish oil on weight loss in patients with pancreatic cancer. Br J Cancer 81:80–86

    Article  PubMed  CAS  Google Scholar 

  5. Bartlett F (1953) Psychological criteria of fatigue. In: Floyd W, Welford A (eds) Symposium on fatigue. H. K. Lewis, London, pp 1–5

    Google Scholar 

  6. Baumgartner R (2000) Body composition in healthy aging. Ann NY Acad Sci 904:437–448

    Article  PubMed  CAS  Google Scholar 

  7. Baumgartner R, Koehler K, Gallagher D, Romero L, Heymsfield S, Ross R et al (1998) Epidemiology of sarcopenia among the elderly in New Mexico. Am J Epidemiol 147:755–763

    PubMed  CAS  Google Scholar 

  8. Baumgartner R, Wayne S, Waters D, Janssen I, Gallagher D, Morley J (2004) Sarcopenic obesity predicts instrumental activities of daily living disability in the elderly. Obes Res 12:1995–2004

    Article  PubMed  Google Scholar 

  9. Beck S, Schwartz A (2000) Unrelieved pain contributes to fatigue and insomnia. Podium presentation at the Oncology Nursing Society’s 25th Congress, San Antonio, TX

  10. Bohlius J, Wilson J, Seidenfeld J, Piper M, Schwarzer G, Sandercock J et al (2006) Recombinant human erythropoietins and cancer patients: updated meta-analysis of 57 studies including 9353 patients. J Natl Cancer Inst 98:708–714

    Article  PubMed  CAS  Google Scholar 

  11. Bosaeus I, Daneryd P, Svanberg E, Lundholm K (2001) Dietary intake and resting energy expenditure in relation to weight loss in unselected cancer patients. Int J Cancer 93:380–383

    Article  PubMed  CAS  Google Scholar 

  12. Bower J, Ganz P, Aziz N (2005) Altered cortisol response to psychologic stress in breast cancer survivors with persistent fatigue. Psychosom Med 67(2):277–280

    Article  PubMed  Google Scholar 

  13. Bower J, Ganz P, Aziz N, Fahey J, Cole S (2003) T-cell homeostasis in breast cancer survivors with persistent fatigue. J Natl Cancer Inst 95:1165–1168

    Article  PubMed  Google Scholar 

  14. Bozcik H, Dalmis B, Ozdogan M, Artac M, Savas B (2006) Quality of life in patients with advanced non-small cell lung cancer. Cancer Nurs 29(2):104–110

    Article  Google Scholar 

  15. Brown D, McMillan D, Milroy R (2005) The correlation between fatigue, physical function, the systemic inflammatory response and psychological distress in patients with advanced cancer. Cancer 103:377–382

    Article  PubMed  Google Scholar 

  16. Cameron C (1997) A theory of fatigue. Ergonomics 16(5):633–648

    Article  Google Scholar 

  17. Clearfield M (2005) C-reactive protein: a new risk assessment tool for cardiovascular disease. J Am Osteopath Assoc 105:409–416

    PubMed  Google Scholar 

  18. Cleeland C, Bennett G, Dantzer R, Dougherty P, Dunn A, Meyers C et al (2003) Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms. Cancer 97:2919–2925

    Article  PubMed  Google Scholar 

  19. Dallman P (1982) Manifestations of iron deficiency. Semin Hematol 19:19–30

    PubMed  CAS  Google Scholar 

  20. Dallman P (1986) Biochemical basis for the manifestations of iron deficiency. Annu Rev Nutr 6:13–40

    Article  PubMed  CAS  Google Scholar 

  21. Dantzer R (2001) Cytokine-induced sickness behaviour: where do we stand? Brain Behav Immun 15:7–24

    Article  PubMed  CAS  Google Scholar 

  22. Dantzer R, Bluthe R, Laye S, Bret-Dibat J, Parnet P, Kelley K (1998) Cytokines and sickness behavior. Ann NY Acad Sci 840:586–590

    Article  PubMed  CAS  Google Scholar 

  23. di Carlo E, Iezzi M, Pannellini T, Zaccardi F, Modesti A, Forni G et al (2001) Neutrophils in anti-cancer immunological strategies: old players in new games. J Hematother Stem Cell Res 10:739–748

    Article  PubMed  Google Scholar 

  24. Dodd M, Miaskowski C, Paul S (2001) Symptom clusters and their effect on the functional status of patients with cancer. Oncol Nurs Forum 28(1):465–470

    PubMed  CAS  Google Scholar 

  25. Fayad L, Keating M, Reuben J, O’Brien S, Lee B, Lerner S, Kurzrock R (2001) Interleukin-6 and interleukin-10 levels in chronic lymphocytic leukemia:correlation with phenotypic characteristics and outcome. Blood 97:256–263

    Article  PubMed  CAS  Google Scholar 

  26. Fearon K, von Meyenfeldt M, Moses A, Van Geenen R, Gouma D, Giacosa A et al (2003) Effect of a protein and energy dense n-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia: a randomised double blind trial. Gut 52(10):1479–1486

    Article  PubMed  CAS  Google Scholar 

  27. Field C, Johnson I, Schley P (2002) Nutrients and their role in host resistance to infection. J Leukoc Biol 71:16–32

    PubMed  CAS  Google Scholar 

  28. Gardener G, Edgerton B, Senwiratne B, Barnard R, Chira Y (1977) Physical work capacity and metabolic stress in subjects with iron deficiency anemia. Am J Clin Nutr 30:910–917

    Google Scholar 

  29. Glaus A (1998) Fatigue in patients with cancer. Springer, Berlin

    Google Scholar 

  30. Grandjean E (1968) Fatigue: its physiological and psychological significance. Ergonomics 11(5):427–436

    Article  PubMed  CAS  Google Scholar 

  31. Horne R, Picard R (1979) Psychosocial risk factors for lung cancer. Psychosom Med 41:503–514

    PubMed  CAS  Google Scholar 

  32. Jansen C, Miaskowski C, Dodd M, Dowling G, Kramer J (2005) Potential mechanisms for chemotherapy-induced impairments in cognitive function. Oncol Nurs Forum 32(6):1151–1161

    Article  PubMed  Google Scholar 

  33. Janssen I, Baumgartner R, Ross R, Rosenberg I, Roubenoff R (2004) Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol 159(4):413–421

    Article  PubMed  Google Scholar 

  34. Kennedy G, Spence V, Underwood C, Belch J (2004) Increased neutrophil apoptosis in chronic fatigue syndrome. J Clin Pathol 57:891–893

    Article  PubMed  CAS  Google Scholar 

  35. Krueger J, Majde J, Obale F (2003) Sleep in host defense. Brain Behav Immun 17:S41–S47

    Article  PubMed  CAS  Google Scholar 

  36. Krueger J, Obal F, Fang J, Kubota T, Taishi P (2001) The role of cytokines in physiological sleep regulation. Ann NY Acad Sci 933:211–221

    Article  PubMed  CAS  Google Scholar 

  37. Kuzrock R (2001) The role of cytokines in cancer-related fatigue. Cancer 92(s6):1684–1688

    Article  Google Scholar 

  38. Lee K, Cho M, Miaskowski C, Dodd M (2004) Impaired sleep and rhythms in persons with cancer. Sleep Med Rev 8:199–212

    Article  PubMed  Google Scholar 

  39. LeShan L, Worthington R (1956) Some recurrent life history patterns observed in patients with malignant disease. J Nerv Ment Dis 124:460–465

    Article  PubMed  CAS  Google Scholar 

  40. Lundholm K, Daneryd P, Bosaeus I, Korner U, Lindholm E (2004) Palliative nutritional intervention in addition to cyclooxygenase and erythropoietin treatment for patients with malignant disease: effects on survival, metabolism, and function—A randomized prospective study. Cancer 100:1967–1977

    Article  PubMed  CAS  Google Scholar 

  41. Lundstrom S, Furst C (2003) Symptoms in advanced cancer: relationship to endogenous cortisol levels. Palliat Med 17(6):503–508

    Article  PubMed  Google Scholar 

  42. Mazhar D, Gillmore R, Waxman J (2005) COX and cancer. QJM 98:711–718

    Article  PubMed  CAS  Google Scholar 

  43. Molassiotis A (1999) A correlational evaluation of tiredness and lack of energy in survivors of haematological malignancies. Eur J Cancer Care 8:19–25

    Article  CAS  Google Scholar 

  44. Molle I, Steffensen R, Thiel S, Peterslund N (2006) Chemotherapy-related infections in patients with multiple myeloma: associations with mannan-binding lectin genotypes. Eur J Haematol 77:19–26

    Article  PubMed  CAS  Google Scholar 

  45. Moore P, Dimsdale J (2002) Opioids, sleep, and cancer-related fatigue. Med Hypotheses 58(1):77–82

    Article  PubMed  CAS  Google Scholar 

  46. Morrow G, Shelke A, Roscoe J, Hickok J, Mustian K (2005) Management of cancer-related fatigue. Cancer Investig 23:229–239

    Article  Google Scholar 

  47. Morse JM, Mitcham C, Hupcey JE, Tason MC (1996) Criteria for concept evaluation. J Adv Nurs 24:385–390

    Article  PubMed  CAS  Google Scholar 

  48. National Comprehensive Cancer Network (2006) Clinical practice guidelines in oncology: cancer-related fatigue, version 1. http://www.nccn.org/professionals/physician_gls/default.asp. Retrieved on Sept. 2, 2006

  49. Olson K (2007) A new way of thinking about fatigue: A reconceptualization. Oncol Nurs Forum 34(1):93–99

    Article  PubMed  Google Scholar 

  50. Olson K, Morse JM (2005) Delineating the concept of fatigue using a pragmatic utility approach. In: Cutcliff J, McKenna H (eds) The essential concepts of nursing. Elsevier Science, Oxford, pp 141–159

    Google Scholar 

  51. Olson K, Krawchuk A, Qudussi T (2007) Fatigue in individuals with advanced cancer in active treatment and palliative settings. Cancer Nurs 30(6):1–10

    Article  Google Scholar 

  52. Olson K, Tom B, Hewitt J, Whittingham J, Buchanan L, Ganton G (2002) Evolving routines: managing fatigue associated with lung and colorectal cancer. Qual Health Res 5:655–670

    Article  Google Scholar 

  53. Olson K, Morse J, Smith J, Mayan M, Hammond D (2001) Linking the trajectories of illness and dying. Omega, J Death and Dying 42(4):293–308

    Article  Google Scholar 

  54. Persson C, Glimelius B (2002) The relevance of weight loss for survival and quality of life in patients with advanced gastrointestinal cancer treated with palliative chemotherapy. Anticancer Res 22(6B):3661–3668

    PubMed  Google Scholar 

  55. Pratt V, Watanabe S, Bruera E, Mackey J, Clandinin M, Baracos B, Field C (2002) Plasma and neutrophil fatty acid composition in advanced cancer patients and response to fish oil supplementation. Br J Cancer 87:1370–1378

    Article  PubMed  CAS  Google Scholar 

  56. Pugh C, Kumagawa K, Fleshner M, Watkins L, Maier S, Rudy J (1998) Selective effects of peripheral lipopolysaccharide administration on contextual and auditory-cue fear conditioning. Brain Behav Immun 12:212–229

    Article  PubMed  CAS  Google Scholar 

  57. Rhoten D (1982) Fatigue and the postsurgical patient. In: Norris C (ed) Concept clarification in nursing. Aspen, Rockville, MD, pp 277–300

    Google Scholar 

  58. Rich T, Innominato P, Boerner J, Mormont C, Iacobelli S, Baron B et al (2005) Elevated serum cytokines correlated with altered behaviour, serum cortisol rhythm, and dampened 24-hour rest–activity patterns in patients with metastatic colorectal cancer. Clin Cancer Res 11:1757–1764

    Article  PubMed  CAS  Google Scholar 

  59. Sateia M, Silberfarb P (1998) Sleep. In: Doyle D, Hanks G, MacDonald N (eds) Oxford textbook of palliative medicine. Oxford University Press, Oxford, pp 751–767

    Google Scholar 

  60. Savard J, Laroche L, Simard S, Ivers H, Morin C (2003) Chronic insomnia and immune function. Psychosom Med 65:211–221

    Article  PubMed  Google Scholar 

  61. Savard J, Morin C (2004) Insomnia in the context of cancer: a review of a neglected problem. J Clin Oncol 19(3):895–908

    Google Scholar 

  62. Scott H, McMillan D, Forrest L, Brown D, McArdle C, Milroy R (2002) The systemic inflammatory response, weight loss, performance status and survival in patients with inoperable non-small cell lung cancer. Br J Cancer 87:264–267

    Article  PubMed  CAS  Google Scholar 

  63. Sela R, Watanabe S, Nekolaichuk C (2005) Sleep disturbances in palliative cancer patients attending a pain and symptom control clinic. Palliat Support Care 3:23–31

    Article  PubMed  Google Scholar 

  64. Selye H (1952) The story of the adaptation syndrome. Acta, Montreal

    Google Scholar 

  65. Selye H (1956) The stress of life. McGraw Hill, New York

    Google Scholar 

  66. Selye H (1971) Hormones and resistance: part 1. Springer, New York

    Google Scholar 

  67. Stark M, Cimprich B (2003) Promoting attentional health: Importance to women’s lives. Health Care Women Int 24(2):93–102

    PubMed  Google Scholar 

  68. Tisdale M (1999) Wasting in cancer. J Nutr 129(suppl 1):S243–S246

    Google Scholar 

  69. Tisdale M (2004) Cancer cachexia. Langebeck’s Arch Surg 389:299–305

    Google Scholar 

  70. Turner R, Anglin P, Burkes R, Couture F, Evans W, Goss G et al (2001) Epoetin Alfa in cancer patients. J Pain Symptom Manag 22(5):954–965

    Article  CAS  Google Scholar 

  71. Viteri F, Torun B (1974) Anemia and physical work capacity. In: Garby L (ed) Clinics in haematology, vol 3. W. B. Saunders, London, pp 609–626

    Google Scholar 

  72. Witzig T, Silberstein P, Loprinzi C, Sloan J, Novotny P, Mailliard J, Rowland K, Alberts S, Krook J, Levitt R, Morton R (2005) Phase III, randomized, double blind study of epoetin alfa compared with placebo in anemic patients receiving chemotherapy. J Clin Oncol 23(12):2606–2617

    Article  PubMed  CAS  Google Scholar 

  73. Woods L, Nail L, Gilster A, Winters K, Elsea C (2006) Cancer chemotherapy-related symptoms: Evidence to suggest a role for proinflammatory cytokines. Oncol Nurs Forum 33(3):535–542

    Article  Google Scholar 

Download references

Acknowledgments

Financial support was provided by the Alberta Heritage Foundation for Medical Research, the Canadian Institutes for Health Research, and the Alberta Palliative Care Research Initiative.

Author information

Authors and Affiliations

  1. Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada

    Karin Olson & Marilyn Cree

  2. Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

    A. Robert Turner

  3. Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada

    Kerry S. Courneya

  4. Faculty of Agriculture, Food, and Nutritional Science, University of Alberta, Edmonton, Canada

    Catherine Field

  5. Department of Pulmonary Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

    Godfrey Man

  6. Population Health and Information, Cross Cancer Institute, Edmonton, Alberta, Canada

    John Hanson

  7. Faculty of Nursing, University Extension Centre, 6-10 8303 112 St., Edmonton, Alberta, T6G 2T4, Canada

    Karin Olson

Authors
  1. Karin Olson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Robert Turner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kerry S. Courneya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Catherine Field
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Godfrey Man
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marilyn Cree
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John Hanson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karin Olson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Olson, K., Turner, A.R., Courneya, K.S. et al. Possible links between behavioral and physiological indices of tiredness, fatigue, and exhaustion in advanced cancer. Support Care Cancer 16, 241–249 (2008). https://doi.org/10.1007/s00520-007-0298-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-007-0298-8

Keywords

Search

Navigation