Cancer-related fatigue

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Cancer fatigue
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Cancer-related fatigue is a

fatigue that is experienced by nearly all cancer
patients.

Among patients receiving

biotherapy.[1] On average, cancer-related fatigue is "more severe, more distressing, and less likely to be relieved by rest" than fatigue experienced by healthy people.[1]
It can range from mild to severe, and may be either temporary or a long-term effect.

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

symptom of cancer.[2]

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

cancer wasting, and genetic problems.[1] Additionally, some forms of cancer may cause fatigue through more direct mechanisms, such as a leukemia that causes anemia by preventing the bone marrow from producing blood cells efficiently. A relationship between Interleukin 6 and fatigue has been observed in studies, albeit inconsistently. Increased markers of sympathetic nervous system activity are also associated with cancer related fatigue.[3]

Screening

The

oncologist, throughout treatment, and afterwards.[1] Screening
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

symptom journal
.

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:

hot flashes
), can cause fatigue, and may also need treatment.

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

chronic fatigue syndrome.[2]

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

Occupational Therapist
. These include scheduling high-priority tasks during the patient's best time of day, using labor-saving devices, delegating tasks to caregivers, and avoiding unimportant activities, so that the patient will have more energy available for other activities.

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

amphetamines may reduce fatigue in some patients.[1][8][9][10][11]

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.

difficulty breathing
, and fatigue form a common symptom cluster. Fatigue often increases as patients with advanced cancer approach death. As a result, people who are dying often sleep much more than a healthy person.

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.

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

bone marrow transplant
patients, and the incidence may be different for survivors of other cancers.

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 after treatment for childhood cancer.

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

  1. ^ 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.
  2. ^ a b c d e f g h "Fatigue". National Cancer Institute. 1980-01-01. Retrieved 6 October 2010.
  3. PMID 25975676
    .
  4. ^ 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
  5. PMID 22895961
    .
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