Cancer-related fatigue
Cancer-related fatigue is a
Among patients receiving
Fatigue may be a symptom of the cancer, or it may be the result of treatments for the cancer.
Pathophysiology
The pathophysiology of cancer-related fatigue is poorly understood. It may be caused by the cancer or the effects it has on the body, by the body's response to the cancer, or by the cancer treatments.
Fatigue is a common
Some fatigue is caused by cancer treatments. This may show a characteristic pattern. For example, people on many chemotherapy regimens often feel more fatigue in the week after treatments, and less fatigue as they recover from that round of medications. People receiving radiation therapy, by contrast, often find their fatigue steadily increases until the end of treatment.[2]
Proposed mechanisms by which cancer can cause fatigue include an increase in
Screening
The
typically involves a simple question, like "On a scale of one to ten, how tired have you felt during the last week?"More detailed information may be collected in a
Diagnosis
Some causes of cancer-related fatigue are treatable, and evaluation is directed towards identifying these treatable causes. Treatable causes of cancer-related fatigue include:
Definition
The National Comprehensive Cancer Network defines cancer-related fatigue as "a distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning".[1]
Cancer-related fatigue is a
Management
Treatment depends on the patient's overall situation. A patient who is in active treatment may have different priorities than a person who has completed treatment, or who is at the end of life.
Some management strategies may help all patients and could be supported by the work of an
Patients who are not at the end of life may benefit from physical exercise or physical therapy. Engaging in physical activity may reduce fatigue.[1][4][5][6]Forms of exercise that have been proven to be most effective are more aerobic exercise such as walking, running, cycling, and swimming. These forms of activity can be done at various levels of intensity and have been proven as an effective way of improving QOL for cancer patients.[7]
While
At the end of life, fatigue is usually associated with other symptoms, especially anemia, side effects from many medications and previous treatments, and poor nutritional status.
Addressing specific causes
If the fatigue is caused or exacerbated by a specific medical condition, such as anemia, then treatment of that medical condition should reduce the fatigue.
- Anemia: Loss of oxygen-carrying red blood cells is a common cause of fatigue. Medications to improve blood production or blood transfusions frequently reduce fatigue.
- Pain: A variety of approaches to managing cancer pain may be used, particularly analgesic medications.
- restless leg syndrome, by pain, by anxiety, or by other medical conditions, like obstructive sleep apnea or menopause. Practicing good sleep hygienemay reduce fatigue by improving sleep quality.
- Nutritional disturbances: Patients may have difficulty eating, may not be absorbing food well, or may have chosen an extreme diet as an
- Lack of physical activity: Decreased physical activity can make fatigue worse by reducing endurance and muscle strength. Participating in regular aerobic[6] and muscle-strengthening[12] physical activity both during and after cancer treatment may reduce cancer-related fatigue. Current physical activity guidelines recommend adults with cancer to engage in at least 150 minutes per week of moderate- intensity or 75 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination. It is also recommended to perform muscle-strengthening physical activity two to three times a week, although there are studies showing that aerobic training is better at mitigating symptoms of cancer-related fatigue and reduces the risk of post exercise malaise.[13] Physical activities should be tailored to individual needs and physical abilities.[14]
- Side effects from medications: Fatigue and sleepiness are known side effects with some kinds of medications. Sometimes a change of medication, the dose, or the timing of the medication may result in less fatigue. For example, an antihistamine might be taken shortly before sleep, rather than in the middle of the day.
- marijuana, and many other drugscan produce fatigue as a side effect.
- Other medical conditions: Cancer and its treatment usually put intense physical stress on the body, which can exacerbate other medical conditions. Additionally, fatigue may result from an infection.[2]
Prognosis
Fatigue caused by the cancer or its treatment often resolves if treatment is successful. However, some patients experience long-term or chronic fatigue. When strict definitions are used, about 20% of long-term, disease-free
Experiencing fatigue before treatment, being depressed or anxious, getting too little exercise, and having other medical conditions are all associated with higher levels of fatigue in post-treatment cancer survivors.[1] Receiving multiple types of treatments, such as chemotherapy and radiation, is associated with more fatigue.[2] Older adults have a higher risk of long-term fatigue.[2]
Cancer-related fatigue has consistently been found to be one of the most prevalent and distressing symptoms in childhood cancer survivors.[15] The International Late Effects of Childhood Cancer Guidelines Harmonization Group (IGHG) has published recommendations regarding the surveillance of fatigue in survivors of childhood cancer. [16] These recommendations include regular screenings of fatigue in survivors of childhood cancer. Survivors of pediatric brain tumors report more fatigue after end of treatment than survivors of acute lymphoblastic leukemia, but both groups experience more fatigue than healthy children and adolescents.[17] While considered a long-term effect of the treatment, children and adolescents experience fatigue already during the treatment for acute lymphoblastic leukemia and this side-effect of treatment remains in some patients after the treatment has ended.[18] Fatigue after treatment for pediatric brain tumors does not automatically resolve itself, but requires surveillance and interventions.[19]
References
- ^ a b c d e f g h i j k l m "NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue" (PDF) (Version 1.2010 ed.). National Comprehensive Cancer Network. 22 January 2010.
- ^ a b c d e f g h "Fatigue". National Cancer Institute. 1980-01-01. Retrieved 6 October 2010.
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- ^ Jose Stephy, Diwan Sanjay Kumar. Effect of standardized exercise program on reported fatigue in patients of cancer receiving chemotherapy. Clinical Cancer Investigation Journal 3(5): 373-376
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