From OncoLog, July/August 2006, Vol. 51, No. 7/8

House Call: Tired of Being Tired

by Sunni Hosemann

What’s the most common and distressing symptom cancer patients face? Pain? Nausea? No, it’s fatigue.

“I always emphasize this fact to patients,” said Ellen Manzullo, M.D., a professor in the Departments of General Internal Medicine, Ambulatory Treatment, and Emergency Care as well as co-director of M. D. Anderson’s Fatigue Clinic. “People are usually relieved when I say it because they feel like their symptom has been validated. I think they get some comfort in knowing that they are not alone.”

“At M. D. Anderson, about 50% of patients with blood-related cancers have severe levels of fatigue, as do about one-third of those with solid tumors,” said Shelley Wang, M.D., an assistant professor in the Department of Symptom Research. In some cases, fatigue can be a presenting symptom; in other cases, however, it is not.

Another point worth emphasizing, said Dr. Manzullo, is that not all fatigue is physical—mental fatigue can be part of the whole complex as well. Unrecognized, fatigue can become much more than an annoyance; it can actually impair the person’s daily life and may even have an impact on treatment success. Still, it is one of the least discussed aspects of cancer. Why?

Communicating is key

“When we talked to patients,” said Charles Cleeland, Ph.D., head of Symptom Research at M. D. Anderson, “they said they don’t tell their doctors about their fatigue because nothing can be done about it.”

In the meantime, not recognizing and managing fatigue early can have serious consequences. “Not identifying it leads to physical deconditioning, isolating oneself from family and friends, and other factors that contribute to poor outcome. If cancer treatment is causing the fatigue, the problem may become so unmanageable that the patient stops treatment for awhile, which could impact survival,” Dr. Cleeland added.

It’s important to talk to your doctor if you are feeling fatigued. “There have been some studies that suggest that if physicians have information about a symptom available at the time of the consult, then they are more likely to do something about it,” said Dr. Cleeland. “If patients don’t report symptoms, then the physician will never know to treat them. There are things that can be done, but nothing is going to be done if you don’t tell someone.”

An objective measure

To help simplify and encourage communication about symptoms, physicians at M. D. Anderson have developed the Brief Fatigue Inventory (BFI), which allows patients to rate the severity of several fatigue-related symptoms on a 0-10 scale. Because the BFI uses numeric ratings, it provides a simple, non–language-based way to indicate the patient’s level of fatigue.

“Many dimensions of fatigue can be measured,” noted Dr. Cleeland. “The most important ones that we have incorporated in the BFI are how much fatigue a patient is feeling and how much of an effect it has on daily life. The BFI is an attempt to help patients think of these symptoms as measurable, as much as blood pressure and other clinical factors.” This gives patients and their doctors a more objective way to talk about the problem and see changes over time.

A sample of BFI can be found at www.mdanderson.org/topics/fatigue, or you can informally rate your fatigue on a scale of 0-10. The information can serve as a means of initiating conversations about fatigue between patients and their family members or doctors—communication that is the first, crucial step in dealing with fatigue.

For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.

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