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On-line version ISSN 1677-6119
Int. braz j urol. vol.37 no.6 Rio de Janeiro Nov./Dec. 2011
Clinically relevant fatigue in men with hormone-sensitive prostate cancer on long-term androgen deprivation therapy
Storey DJ; McLaren DB; Atkinson MA; Butcher I; Frew LC; Smyth JF; Sharpe M
Edinburgh Cancer Research UK Centre, University of Edinburgh, Edinburgh
Ann Oncol. 2011; 17. [Epub ahead of print]
BACKGROUND: The purpose of the study was to determine the prevalence and associations of clinically relevant fatigue (CRF) in men with biochemically controlled prostate cancer on long-term androgen deprivation therapy (ADT).
PATIENTS AND METHODS: One hundred and ninety-eight men were surveyed and the prevalence of CRF (Brief Fatigue Inventory score > 3) determined. Associations with other measures (Hospital Anxiety and Depression Scale; International Prostate Symptom Score; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire; Brief Pain Inventory worst pain; clinical and demographic information) were explored in univariate and multivariate analyses.
RESULTS: Eight-one per cent (160 of 198) of questionnaires were analysable. CRF prevalence was 43% (68 of 160). CRF associations included moderate/severe urinary symptoms, anxiety and medical co-morbidities; the strongest associations were depression [odds ratio (OR) 9.8, 95% confidence interval (CI) 4.3-22.8] and pain (OR 9.2, 95% CI 4.0-21.5). After controlling for other factors, the independent associations were depression (OR 4.7, 95% CI 1.6-14.0) and pain (OR 3.1, 95% CI 1.0-8.9). There was no association with age, disease burden or treatment duration.
CONCLUSIONS: Two-fifths of men with biochemically controlled prostate cancer on long-term ADT report CRF that interferes with function. Management aimed at improving CRF should address depression and pain.
This study though based on a cross-sectional survey with small patient numbers restraining its power, adds to the limited literature concerning clinically relevant fatigue (CRF) in men with biochemically controlled prostate cancer on long term GnRH-based ADT.
The main findings were as follows:
- CRF prevalence in the sample was 43% (95% CI 35% to 50%) and the difference in scores between those with and without CRF far exceeded the 20 points described as a 'large' clinically significant;
- CRF was associated with moderate/severe pain, depression, anxiety, concurrent co-morbidities and moderate/severe urinary symptoms but the only independent associations of CRF were depression and pain.
Fatigue may be attenuated optimizing depression and pain treatments.
Dr. Leonardo Oliveira Reis
Assistant Professor of Urology
University of Campinas, Unicamp
Campinas, São Paulo, Brazil