From OncoLog, July/August 2004, Vol. 49, No. 7/8
DiaLog: Treating Cancer-Related Fatigue
by Ellen F. Manzullo, M.D., F.A.C.P.,
Department of General Internal Medicine, Ambulatory Treatment, and Emergency Care
Fatigue is the most common and distressing symptom experienced by patients with cancer. Although cancer-related fatigue is usually defined as an unusual and persistent sense of tiredness that accompanies cancer or cancer treatment, this symptom can also affect cancer survivors who have completed their treatment and have no evidence of malignancy. The condition may affect both physical and mental capacity and is unrelieved by rest. Often, fatigue takes the patient by surprise, and the clinician is at a loss to recommend an effective approach to help alleviate it. Recently, however, an increasing awareness of cancer-related fatigue has led to its acceptance as a diagnosis. In addition, the National Comprehensive Cancer Network has appointed a panel of experts in fatigue to provide guidelines for the evaluation and treatment of patients with this distressing symptom.
There are many possible causes of cancer-related fatigue, which has been observed in patients both before treatment and after chemotherapy, radiation therapy, bone marrow transplantation, or surgery. In addition, many comorbid conditions can contribute to cancer-related fatigue, including anemia, endocrine diseases (such as hypothyroidism), sleep disorders, pain, and psychiatric illness (such as depression and anxiety). Often a patient’s fatigue is due to several factors. Hence, when the clinician encounters a patient experiencing cancer-related fatigue, a thorough and systematic approach is warranted.
Cancer-related fatigue can be challenging to treat. Occasionally, a reversible cause, such as anemia, is discovered, and with treatment the patient experiences significant improvement. However, when several factors account for the fatigue, a multimodality approach is warranted. Often, physicians, nurses, nutritionists, physical therapists, and others are all needed to address the many facets of this symptom. Patients diagnosed with cancer should be offered education about cancer-related fatigue and strategies to help them cope with it. Nonpharmacologic therapies that could be beneficial are exercise and improved nutrition. Pharmacologic therapies include stimulants such as methylphenidate and modafinil, which both appear to be promising agents to combat the severity of cancer-related fatigue. At The University of Texas M. D. Anderson Cancer Center, the Fatigue Clinic was established in 1998 to improve the quality of life of patients with cancer-related fatigue by alleviating the severity of this symptom.
Research in cancer-related fatigue is in its infancy, and well-designed clinical trials are needed to evaluate both pharmacologic and nonpharmacologic treatments. As we obtain a better understanding of the pathophysiologic mechanisms of this symptom, we will be able to develop more effective modalities for its treatment and thus improve the quality of life of our patients.
For more information on this topic or for quesions about M. D. Anderson’s treatments, programs, or services, call the M. D. Anderson Information Line at (800) 392-1611 (in the United States) or (713) 792-3245 (in Houston and outside the United States).
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