OBJECTIVE: Fatigue is the most frequently occurring and distressing symptom in 
patients with advanced cancer, caused by multiple factors. Neither a specific 
histological diagnosis of malignancy nor the type of anticancer treatment seem 
to be strongly related to fatigue, which support the idea that other factors may 
play a role. This study investigated to what extent the model of 
fatigue-perpetuating factors that is known for cancer survivors was applicable 
for patients with advanced cancer.
METHODS: Patients on active treatment for various incurable cancers were asked 
to complete the Checklist Individual Strength, subscale fatigue severity and 
physical activity, the Acceptance scale of the Illness Cognition Questionnaire, 
the Hospital Anxiety and Depression Scale, the Fatigue Catastrophizing Scale, 
the Symptom Checklist subscale sleep, and the van Sonderen Social Support 
List-Discrepancies.
RESULTS: The questionnaires were filled in by 137 patients. Inappropriate 
coping, fear of progression, fatigue catastrophizing, discrepancies in social 
support, depressive mood, self reported physical activity, and sleeping problems 
were all related to fatigue severity in univariate analyses, of which the latter 
two were significant in a multivariate linear regression analysis.
CONCLUSION: This study tested fatigue-perpetuating factors known to be of 
relevance in cancer survivors, for their relation with fatigue severity in 
palliative patients. We demonstrated that these factors were also relevant for 
patients on palliative treatment. On the basis of our results, we suggest 
clinicians confronted with palliative patients with serious fatigue to address 
sleeping problems and promote physical activity. In case of persistent fatigue, 
personalized cognitive behavioral therapy can be considered.