8571 Background: Palliative care seeks to minimize distress at the end of life. Fatigue significantly diminishes quality of life (QOL) in this population. Are there potentially modifiable factors that influence fatigue and QOL? Methods: This analysis focuses on a subset of 198 patients from a larger 2×2×2 factorial randomized trial of pain education and care coordination conducted in South Australia. Selected participants were adults referred to a community palliative care service with pain in the preceding 3 months and a hemoglobin assessment within 14 days of enrollment. Pain, other symptoms, and Australia-modified Karnofsky Performance Status (AKPS) were recorded at enrollment. Predictors considered were anxiety, depression, dyspnea, constipation, pain, AKPS, hemoglobin, age, and gender. Dependent variables were global QOL from the McGill QOL Questionnaire and fatigue. Using forward stepwise linear regression, multivariate models predicting fatigue and QOL were constructed from significant univariate variables. Results: Mean age was 69 (standard deviation (SD) 13); 97% had cancer. Most frequent diagnoses were lung (18%), hematological (15%), and colorectal (15%) malignancies. Mean hemoglobin was 11.4 gm/dL (SD 1.9); median AKPS 60%; mean worst pain 4.0 (SD 3.4; 0–10 scale). Distressing symptoms (3–4 on 0–4 scales) included dyspnea (22%), constipation (13%), anxiety (11%), and depression (6%). Mean QOL was 5.9 (SD 2.0) on a 0–10 scale; mean fatigue was 2.3 (SD 1.0) on a 0–4 scale. The final multivariate model predicting fatigue included AKPS (p<0.01), constipation (p=0.02), and dyspnea (p=0.06). Hemoglobin was not predictive of fatigue (univariate p=0.7069). QOL was significantly influenced by fatigue (p=0.03), anxiety (p< 0.01), and AKPS (p= 0.01). Conclusions: Fatigue was driven by performance status, constipation, and dyspnea. In contrast to an oncology population, hemoglobin was not a significant contributor to fatigue in this population, consistent with other palliative care cohorts. QOL was driven by fatigue, anxiety, and performance status. This analysis of a prospectively collected population suggests that performance status, constipation, dyspnea, and anxiety are potentially modifiable variables impacting fatigue and QOL in the palliative care setting. No significant financial relationships to disclose.
The Relationship among a Palliative Care Service, Patient’s Factors, and Quality of Life of Post Treatment Cervical Cancer Patients: a Causal Model Approach
