Fatigue has been known to be a common complaint of patients with ITP. If you go to a patient organisation and do a study, as has been published by Dr Cooper called the I-WISh study, fatigue was a common complaint of these patients. Now, the problem is that most patients who belong to patient groups are a little bit biased in terms of they’re the ones who have more trouble with ITP than the general ITP patients. So we did a prospective study to assess a number of things in ITP patients, these were patients who had ITP on average for ten years and had entered the study. We looked at about 100 patients, we did cognitive function tests to see if their cognitive function was changed and we’ll come to that topic in a second. We also did a fatigue score, or several fatigue scores, in patients to assess in a prospective fashion using an organised instrument that measures fatigue whether fatigue was a common problem.
What was the study design?
The study design is quite simple – we enlisted patients in our practices who had ITP for more than a year. They had chronic ITP, not acute ITP or persistent ITP which is disease for under a year. These patients with chronic ITP were asked to participate in the study. We did blood tests which have not yet been analysed, we did cognitive function testing and we did questionnaires of several different types to assess the level of fatigue these patients had.
What were the key results?
The results of the study were interesting. We found that about a quarter of all patients had significant cognitive dysfunction, that is presented in abstract at this meeting by Dr Cooper, and that validates prior studies showing that cognition is changed in ITP patients, the mechanism of which we don’t yet know. My part of the study was to assess fatigue and 27% of the patients with ITP had significant fatigue, that’s a FACIT-Fatigue score below 30 that correlates with fatigue scores that are seen in patients with cancer, rheumatoid arthritis and diabetes.
This tells us that about 27% of patients with ITP have significant fatigue that’s comparable to patients with cancer. It validates prior findings that the percentage of those with fatigue is actually less than in patient groups studies where you just pull patients at random.
What could be the clinical significance of these results?
The clinical significance is not yet understood. The main issue with fatigue is that patients know they have it and, indeed, do have it. It’s not all in their minds as a sign of depression which many doctors write this off. The major impact of the study is to tell physicians that treat ITP patients fatigue is real, it can be quantified and what I think ought to happen in the future is we ought to be doing fatigue scores on all of our patients to assess this as a clinical variable in addition to the platelet count, in addition to assessing their bleeding risk.
I think what’s important is for physicians or nurses hearing this discussion, fatigue is real in ITP patients, it ought to be assessed in a prospective fashion in all the patients and we need to develop easier scoring schemes for patients so a patient can go to a doctor and say, ‘Yes, my platelet count is good but I still have fatigue.’
