Cancer-Related Fatigue

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Cancer-Related Fatigue
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DEFINITION OF CANCER-RELATED FATIGUE
Cancer-related fatigue is a persistent,
subjective sense of tiredness related to cancer
or cancer treatment that interferes with usual
functioning.
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Cancer-Related Fatigue

• Acute fatigue physiologic response, recoverable
• Chronic fatigue pathologic condition, unable
  to recover even after rest
• Affect body and mind physical, emotional,
  mental
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Cancer-Related Fatigue

• Temporal relationship with intervention
• Chemotherapy peaks within days
• Radiation therapy peaks after weeks
• May persist for prolonged period
• Almost universal with biologic response modifiers

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Causes of Cancer-Related Fatigue
Physiologic Underlying neoplasm
Antineoplastic treatment Concomitant
systemic disease Sleep disorders
Immobility and lack of exercise Chronic
pain Psychological Anxiety, depression
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Cancer-related pathophysiology that cause fatigue
Symptoms related to energy imbalance
Pain and pain treatment
Anemia Cachexia Infection Paraneoplastic
syndrome Metabolic disorder
Stress and mood Fatigue induced by cancer
therapy
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Signs of Cancer-Related Fatigue

• Feeling tired, weary or exhausted even after
  sleeping
• Lacking energy to do your regular activities
• Having trouble concentrating, thinking clearly,
  or remembering
• Feeling negative, irritable, impatient, or
  unmotivated
• Lacking interest in normal day-to-day activities
• Spending less attention on personal appearance
• Spending more time in bed or sleeping

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Diagnosis of Cancer-Related Fatigue

• Ask the patient
• Do you feel tired or fatigued?
• Does fatigue make you change your activities?

Patient self-report is the best diagnostic tool
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Prevalence of Cancer-Related Fatigue
Fatigue-1 Fatigue-2 studies

• 50 at diagnosis, 75 if bone metastasis
• Patient with chemotherapy 80-96
• Patient with radiotherapy 60-93

Cox et al In general population, 20 men and
30 women always feel tired.
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Impact on QOL
Fatigue-1 study 1996

• 2/3 patients considered that fatigue affected
  their
• performance of normal daily activities
• 61 patients claimed that fatigue influenced
  their
• life more than pain

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Impact on QOL
Fatigue-2 Study 1998

• Fatigue (25) other than nausea (13) as the
  main
• symptom after chemotherapy
• Loss of emotional control 90
• A feeling of isolation and solitude 74
• Dejection 72
• Marked effect on employment and financial
  status
• 75 had changed employment
• The effects on care-giver more working breaks
  (20)

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Extent of The Problem
Stone et al Ann Oncol 2000
538 cancer patients

• 52 never reported fatigue to their oncologist
• Only 14 had received treatment or advice on
• how to manage fatigue
• 33 with fatigue declared they had not received
• adequate treatment

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Extent of The Problem
Oncologists view pain in more clinically
relevant than fatigue (61 vs 37)
Patients view fatigue affects everyday life
much more than pain (61 vs 19)
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1. Screening
2. Primary evaluation
3. Interventions
4. Reevaluation

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SCREENING
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Primary Evaluation Phase
Focused History
? Disease status and treatment Rule out
recurrence or progression Current
medications/medication changes ? Review of
systems ? In-depth fatigue assessment
Onset, pattern, duration Change over time
Associated or alleviating factors
Interference with function
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How is Fatigue Assessed?

1. When did the fatigue first start?
2. When did you first realize that it is an unusual
   type of fatigue for you?
3. How has it progressed over the course of your
   treatment or since your diagnosis?
4. What help relieve your fatigue?
5. What makes your fatigue worse?
6. How has the fatigue affected your daily
   activities or the activities that give meaning
   and enjoyment to your life?

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Assessment of Treatable Contributing Factors

• Pain
• Emotional distress depression
• Sleep disturbance
• Anemia
• Nutrition assessment
• weight/calori intake change
• fluid, electrolyte imbalance
• Activity level changes in exercise or activity
  pattern,
• deconditioning
• Comorbidities infection, cardiac, pulmonary,
  renal,
• hepatic, neurologic, endocrine, hypothyroidism

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Anemia and Cancer-Related Fatigue
Correlation between Hb levels (? 12g/dL vs. ?
12g/dL) and fatigue
QOL parameters P value
Higher QOL scores 0.003 Less
fatigue 0.01 Fewer symptoms of
anemia 0.02 Better sensation of physical well
being 0.003 Better sensatin of function al well
being 0.001
QOL quality of life Sobreo et al. Semin Hemato
2001, 2815-18
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Treatment of Anemia-related Fatigue

• Iron, folic acid replacement
• Blood transfusion
• Erythropoietin therapy supported by strong
• clinical evidence
• 10,000 units sc tiw or
• 40,000 units sc weekly

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INTERVENTION-1
Patient/Family Education
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INTERVENTION-2
Common Strategies for Management of Fatigue
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INTERVENTION-3
Non-Pharmacologic
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INTERVENTION-4
Pharmacologic
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Re-evaluation
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Patient Self-Care
What to look for?

• Feeling like you have no energy
• Increased sleeping
• Lack of desire to do normal activities
• Decreased attention to personal appearance
• Feeling tired even after sleeping
• Difficulty concentrating

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Patient Self-Care
What to do?

• Plan rest periods to conserve energy for
  important things
• Schedule necessary activities throughout the day
  rather than all at once
• Engage in light activity
• Get enough rest and sleep
• Eat a nutritious diet including plenty of liquids
  
• Remember that fatigue caused by treatment side
  effects is temporary and that energy will

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Finale
Fatigue is common in cancer patients which should
be recognized, evaluated, monitored, documented
and treated promptly at all stages of the
disease, both during and after treatment.
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The End