Journal of Pain and Symptom Management
Volume 38, Issue 4 , Pages 587-596 , October 2009

Cancer-Related Fatigue: Central or Peripheral?

  • Tugba Yavuzsen, MD

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Mellar P. Davis, MD, FCCP

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Vinoth K. Ranganathan, MSE, MBA

      Affiliations

    • Neural Control Laboratory, Department of Biomedical Engineering, The Lerner Research Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Department of Physical Medicine and Rehabilitation, Rehabilitation Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Declan Walsh, MSc, FACP, FRCP

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, The Cleveland Clinic, Cleveland, Ohio, USA
    • Corresponding Author InformationAddress correspondence to: Declan Walsh, MSc, FACP, FRCP, The Harry R. Horvitz Center for Palliative Medicine, The Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, M76, Cleveland, OH 44195, USA.
    • ,
  • Vlodek Siemionow, PhD

      Affiliations

    • Neural Control Laboratory, Department of Biomedical Engineering, The Lerner Research Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Department of Physical Medicine and Rehabilitation, Rehabilitation Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Jordanka Kirkova, MD

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Dilara Khoshknabi, MD

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Ruth Lagman, MD, MPH

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Susan LeGrand, MD, FACP

      Affiliations

    • The Harry R. Horvitz Center for Palliative Medicine, Taussig Cancer Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, The Cleveland Clinic, Cleveland, Ohio, USA
    • ,
  • Guang H. Yue, PhD

      Affiliations

    • Neural Control Laboratory, Department of Biomedical Engineering, The Lerner Research Institute, The Cleveland Clinic, Cleveland, Ohio, USA
    • Department of Physical Medicine and Rehabilitation, Rehabilitation Institute, The Cleveland Clinic, Cleveland, Ohio, USA

,Accepted 2 January 2009.

  • Image Result

    Schematic diagram for subject positioning, and recording force, electromyogram (EMG), and electroencephalogram (EEG).

    Schematic diagram for subject positioning, and recording force, electromyogram (EMG), and electroencephalogram (EEG).

  • Image Result

    Mean intensity of the BFI score (0–10) for each question in CRF group and control group (P<0.001) (means±standard deviation). Question 1—please rate your fatigue (weariness, tiredness) by circling

    Mean intensity of the BFI score (0–10) for each question in CRF group and control group (P<0.001) (means±standard deviation). Question 1—please rate your fatigue (weariness, tiredness) by circling the one number that best describes your fatigue right now; Question 2—please rate your fatigue (weariness, tiredness) by circling the one number that best describes your usual level of fatigue during the past 24 hours; Question 3—please rate your fatigue (weariness, tiredness) by circling the one number that best describes your worst level of fatigue during the past 24 hours; Question 4—circle the one number that describes how, during the past 24 hours, fatigue has interfered with your: 4a—general activity, 4b—mood, 4c—walking ability, 4d—normal work (includes both work outside the home and daily chores), 4e—relations with other people, 4f—enjoyment of life.

  • Image Result
    Normalized TF (mean±standard deviation) at rest (TFrest) and after SC (TFfatigue).

    Normalized TF (mean±standard deviation) at rest (TFrest) and after SC (TFfatigue).

  • Image Result
    The ratio (%) of TF to voluntary force during SC (TFSC) to the rest TF before SC (TFrest).

    The ratio (%) of TF to voluntary force during SC (TFSC) to the rest TF before SC (TFrest).

 The Harry R. Horvitz Center for Palliative Medicine is a World Health Organization Demonstration Project in Palliative Medicine.This study was supported in part by a Cleveland Clinic internal grant (RPC6700) and a Department of Defense grant (DAMD17-01-1-0665).A version of this article was presented at the Fourth Research Forum of the European Association for Palliative Care, Venice, Italy, May 25–27, 2006.

PII: S0885-3924(09)00450-3

doi: 10.1016/j.jpainsymman.2008.12.003

Journal of Pain and Symptom Management
Volume 38, Issue 4 , Pages 587-596 , October 2009

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