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The latest evidence for practice

How do cancer symptoms link with cancer-related fatigue?

Fatigue is a very common problem for patients diagnosed with cancer, regardless of the type of cancer or the treatment. Cancer-related fatigue differs from the fatigue experienced by healthy people in that it is not relieved by rest. Unsurprisingly, cancer-related fatigue can have a major impact on quality of life, but it is unclear how various cancer-related symptoms are linked with cancer-related fatigue.

This systematic review sought to determine the links between cancer symptoms, psychological distress and cancer-related fatigue in order to map how these factors are linked. Thirty studies were identified as relevant and included in the review.

The review found that although all the reported symptoms (such as pain, nausea, dyspnoea, psychological distress, etc) had associations with cancer-related fatigue, there were much stronger links between psychological distress and cancer-related fatigue than between physical symptoms and cancer-related fatigue. However, there was also a stronger link between nausea/vomiting and cancer-related fatigue than there was between other physical symptoms and cancer-related fatigue.   

A commentary notes that this review is strengthened by its focus on both individual symptoms and symptom clusters. It commends the study for bringing attention to the strong link between psychological distress and cancer-related fatigue, and notes that the review suggests that addressing issues around nausea may also be particularly useful in relation to cancer-related fatigue.

Overall, this review provides useful groundwork for developing clinical approaches for patients suffering from cancer-related fatigue.  

Oh HS, Seo WS. Systematic review and meta-analysis of the correlates of
cancer related fatigue. Worldviews Evid Based Nurs 2011;8:191-201.

Fitch MI. Systematic review and meta-analysis of the correlates of
cancer-related fatigue. Evid Based Nurs 2012;15(4):108.


What is the link between red meat consumption and mortality?

In westernised diets, there is typically a high intake of red meat and processed meat and a low intake of fruit and vegetables. Research has suggested that there is a link between red and processed meat intake, various cancers and some chronic diseases. However, it is unclear whether there is also a link between red meat intake and an increased risk of premature death.

This study collected data from two large US cohort studies, which had gathered data from 37,698 men and 83,644 women, who had no known cardiovascular disease or cancer when they entered the study. These people were asked to complete dietary questionnaires every four years until death, and data was gathered from medical records and death certificates. The participants were followed for up to 28 years.

The study found that the participants who had the largest intake of red meat had a 23% increased risk of mortality compared to those with the lowest intake of red meat. In particular, there was an increased risk of mortality due to cardiovascular disease and cancers. The increased risk applied to both men and women.

A commentary notes that this study is strengthened by its size, length of follow-up and its use of prospective data. The results support the findings of other studies in this area and suggest that people should be encouraged to reduce their red meat consumption.

Pan A, Sun Q, Bernstein AM, et al. Red meat consumption and mortality:
results from 2 prospective cohort studies. Arch Intern Med 2012;172:

Cross AJ. Higher red meat consumption is associated with increased risk
of all-cause, cardiovascular, and cancer mortality. Evid Based Nurs