Introduction Cancer-related fatigue is a common symptom whose pathophysiology may involve dysfunction of cardiac muscle & autonomic nervous system (ANS).
Aim Assess feasibility of objective measurement of fatigue, cardiac muscle & ANS function in a palliative population.
Methods Consecutive participants with cancer recruited from palliative outpatient clinic. Fatigue measured subjectively (brief fatigue inventory [BFI]) & objectively (grip strength, timed-up-and-go [TUG], sit-to-stand [STS]).
A 2D transthoracic echocardiogram assessed cardiac function (systolic: ejection fraction [EF]; diastolic: isovolumic relaxation time [IVRT], LV filling velocities [E/A]. Myocardial strain analysed using EchoPAC software.
Heart rate variability (HRV) recorded for five minutes each of spontaneous & paced breathing. SDNN: standard deviation of RR intervals; RMSSD: Root mean square of successive differences. Active stand identified postural hypotension. Participants completed an acceptability questionnaire.
Results 10 participants, 7 female. Mean age: 66 years (57–71). Cancer types: Lung, colorectal, breast, gastric, ovarian. Metastatic disease: n=10. BFI ≥3 (indicating fatigue): n=7
Median (Range) BFI 4.2 (0–8.9). Grip strength (kg force) 18 (9–39). TUG (s) 9 (7–23). STS (no. in 30s) 10 (0–15)
Ejection fraction normal 67.5%. Grade I diastolic dysfunction present (E/A 0.8, IVRT 96ms).
HRV reduced SDNN & RMSSD very low: 21.3, 11.5ms spont; 27.2, 19.2ms paced, normal >50, >42 respectively
Strain significantly different (19.1, 24.3, p=0.02) in groups with/without fatigue.
BFI correlated with HRV, TUG with Strain (0.875, p=0.001), & HRV.
All found study acceptable No participant withdrew. One participant each:
• unable to complete STS
• felt echo interfered with privacy
• found paced breathing ‘bothersome’
Conclusions 1. Objective assessment of fatigue, cardiac muscle & ANS feasible, acceptable & warranted in palliative populations
2. Majority of participants fatigued subjectively & objectively
3. Significant diastolic dysfunction & loss of HRV present
4. Correlations between subjective & objective fatigue, myocardial strain & HRV
5. These bedside tests can be used in palliative populations to guide symptom management
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.