The association between anemia and fatigue in patients with advanced cancer receiving palliative care

Background: Fatigue has been reported to be associated with anemia in patients receiving cancer treatment. Treatment of anemia such as erythropoietin has been reported to decrease fatigue in these patients. Objective: To investigate the correlation between anemia and fatigue intensity in patients with advanced cancer receiving palliative care. Methods: We reviewed medical charts of 177 consecutive outpatients seen by our palliative care specialists. Information of fatigue intensity and hemoglobin level was collected. Results: Among 147 (83%) evaluable patients, the median hemoglobin level was 11.6 g/dL (range, 7.5-16.1). Eighty-two (56%) patients had a hemoglobin level 12 g/dL or less, whereas 125 (85%) had 10 g/dL or more. The median fatigue score in patients with a hemoglobin level 10 g/dL or more and 10 g/dL or less was 6 (range, 4-8) and 7 (range, 5-8), respectively (p = 0.048). The median fatigue score in patients with a hemoglobin level 12 g/dL or more and 12 g/dL or less was 6 (range, 4-7) and 6 (range, 4-8), respectively (p > 0.5). Spearman's rank correlation coefficient showed a significant association only between the hemoglobin level and the albumin level (r = 0.52, p < 0.0001). Hemoglobin level did not show a significant correlation with fatigue although there was a trend (p = 0.09). In a multivariate regression analysis of the intensity of fatigue and other clinical variables, three variables remained significant in the reverse elimination analysis: depression (p = 0.0067), albumin level (p = 0.0079), and sensation of well-being (p = 0.0569). The overall explained variance for this model was 0.22. Conclusion: Our findings suggest that anemia is not one of the major contributors to fatigue in patients with cancer receiving palliative care.