Urologic Oncology: Seminars and Original Investigations
Original articleA cross-sectional investigation of fatigue in advanced renal cell carcinoma treatment: Results from the FAMOUS study
Introduction
Renal cell carcinoma (RCC) represents approximately 4% of adult malignancies [1] but displays the highest mortality rate of all urologic tumors with 40% of patients dying from the disease [1]. As RCC does not immediately lead to clinical symptoms, many of the patients present with advanced or metastatic disease (mRCC) at diagnosis [2]. An increasing number of treatment options for patients have become available. Beside effectiveness and safety, quality of life has gained importance when deciding on the type of treatment. However, perception and assessment of various aspects concerning this area can differ among health care workers, treating physicians, and patients [3], [4]. Physicians appear to underestimate pain, but rate emotional problems higher compared with patients [4].
Fatigue is a complex and cumulative condition of patients treated for advanced RCC, and it considerably affects patient's quality of life. It is anticipated that fatigue is highly prevalent in these patients, and that the frequency of reporting as well as assessment of severity may differ between physicians and patients. However, a direct comparison in a blinded manner was not executed till date. Thus, objective data like the presented attempt—despite all methodological implications—are rare. Therefore, this work was initiated to compare assessment of fatigue as evaluated by physicians and patients with mRCC. Furthermore, possible influences of fatigue on quality of life were analyzed. We focused on the assessment of fatigue, as it is one of the most common ailments affecting patients with cancer. It is also a common side effect of mRCC treatments [5], [6], [7].
The term fatigue can be defined as a sense of exhaustion above normal [8]. Causes of fatigue are difficult to determine and multiple factors may be influential. First, functional factors exist such as tumor burden, anticancer treatment, and low hemoglobin levels leading to anemia with fatigue as a symptom. Secondly, sociopsychological effects are noted as being responsible for fatigue. Fatigue is associated with a decrease in patients' activities, which in turn can result in loneliness, isolation, and depression [8].
Section snippets
Patients and methods
One hundred German oncology and urology outpatient centers are currently participating in the collection of data for the multicentre, prospective, noninterventional clinical mRCC Registry (study number in ClinicalTrials.gov registry: NCT00610012). Since starting in December 2007, 1,000 patients are intended to be recruited by the end of 2012. Among other information, the registry documents data on the medical history and all systemic therapies for a maximum of 3 years for each patient.
For this
Patient characteristics
Overall, 271 questionnaires were sent to 72 physicians. Of them, 167 questionnaires were returned by the physicians (response rate, 62%). Subsequently, 98 questionnaires were returned by corresponding patients (response rate, 59%) and analyzed. Table 1 presents the patient characteristics; 72% of patients were male. This ratio reflects patient characteristics of the mRCC Registry [12] and coincides with published data [13]. At the time of questionnaire completion, 64.3% of patients (n = 63)
Discussion
With limited available data on quality of life of patients with mRCC receiving systemic treatment, the aim of this study was to evaluate the perception of fatigue by physicians and patients. In addition, possible effects of fatigue on quality of life were examined.
Fatigue was reported for and by almost all patients in this study. The incidence of fatigue was independent of treatment line. In general, patients judged fatigue to be more severe than their physicians. Several studies comparing
Acknowledgments
The authors thank all outpatient centers and patients participating in the mRCC registry. They also thank the Arbeitskreis Klinische Studien in onkologischen und hämatologischen Praxen e.V. as well as the Bund der Urologen e.G. for supporting the registry. The authors would like to thank Victoria Smith-Machnow and Martina Jänicke for the support in preparing the article.
The mRCC registry is funded by iOMEDICO AG. The FAMOUS project was supported by GlaxoSmithKline GmbH & Co. KG.
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