Causal attributions for fatigue by older adults with advanced cancer

Fatigue is a prevalent, debilitating, and often disruptive symptom for cancer patients. Yet, it remains inadequately understood and managed, especially among late middle-aged and older patients with advanced disease. Few studies have explored fatigue qualitatively, and almost none have focused on patients' attributions for this subjective and multidimensional symptom.

Our objectives were to 1) examine the attributions patients aged 55 years or older with advanced cancer made for their fatigue and how they arrived at these attributions and 2) understand how patients' attributions affect how they contend with fatigue, including communication with health care providers.

We conducted qualitative in-depth interviews with 35 patients aged 55 years or older on their experiences with fatigue. Patients had a variety of cancers and were at stages IV or late III of the disease. Interviews were thematically coded and analyzed.

Two main themes emerged: 1) Cancer-related treatment was the master and often the sole attribution patients made for their fatigue. Patients making this attribution expressed certainty about its accuracy and seemed less distressed about the symptom. 2) Multiple causes of fatigue, typically a combination of cancer, treatment, and nonthreatening causes (e.g., older age, overexertion, or anemia), also were offered by some. Patients seemed to resist identifying disease severity as a cause and appeared motivated to normalize and minimize the symptom, thus decreasing its threatening impact.

Patients' causal attributions for fatigue had a profound effect on their physical and psychological well-being, their communication with providers, and their integration of the symptom into their lives.