Associations between multiple chronic conditions and cancer-related fatigue: an integrative review.

PROBLEM IDENTIFICATION: To summarize the current state of nursing knowledge related to the association of multiple chronic conditions (MCCs) and cancer-related fatigue (CRF) in patients with solid tumors during chemotherapy. LITERATURE SEARCH: A systematic literature search of PubMed, CINAHL®, EMBASE, Cochrane, and ProQuest Dissertations and Theses for primary nursing research from January 2000 to June 2012 that examined the prevalence and/or severity of CRF with MCCs or a single comorbidity.Data Evaluation: The studies were appraised for the clarity and focus of the research question and the appropriateness of the method and research design. A 13-item quality criteria checklist evaluated the data from each article on a 0-2 scale (0 = poor, 1 = fair, 2 = good). DATA ANALYSIS: Of 329 abstracts, 21 studies were included in the analysis. The association of MCC and CRF was mostly reported in aggregate, with a mean of three MCCs per patient.Presentation of Findings: Having one or more other comorbidities was significantly associated with the prevalence and severity of CRF. Specifically, arthritis, hypertension, and cardiac disease, although not consistently or clinically defined across studies, are associated with an increased prevalence and severity of CRF. The association of MCC and CRF prevalence and severity was inconsistent because of the variability in the measures used and the time span identified to measure changes. IMPLICATIONS FOR NURSING PRACTICE: Awareness of the prevalence of MCCs is essential to support patients experiencing CRF. Holistic nursing assessment of the patient's symptoms-with an awareness of MCCs-would help improve symptom management to limit the effect of CRF.