DOI: 10.1097/01.COT.0000387988.63844.29

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Issn Print: 0276-2234

Publication Date: 2010/08/10


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Relieving Cancer-Related Fatigue: Medication, Exercise, and Psychosocial Interventions

Mark Fuerst

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Excerpt

CHICAGO—The most prevalent, severe, and distressing symptom associated with cancer and cancer treatment is cancer-related fatigue. With 11 million cancer survivors, and counting in the United States, this problem will only continue to grow. However, researchers are on the verge of advancing quality care through both pharmacological and non-pharmacological interventions, said experts speaking here at an Education Session at the ASCO Annual Meeting.
Oncology clinicians often describe cancer-related fatigue as the sixth vital sign. The 2010 NCCN practice guidelines describe the problem as “a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness to exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.”
The key factors, noted Ann Berger, RN, PhD, Professor of Nursing at the University of Nebraska Medical Center, are fatigue that is unrelieved by rest or sleep, is not proportional to recent activity, and is not due to a comorbid psychiatric disorder.
The frequency of cancer-related fatigue ranges from 70% to 100% of patients when on treatment, and in metastatic disease, the rate often exceeds 75%. Under-treated disease is often accompanied by cancer-related fatigue (CRF), she added.
“Increased use of high-dose or combined chemotherapy and radiotherapy regimens may also lead to more CRF. As treatments advance, CRF will remain a prominent symptom. With dose-dense regimens of treatment in two-week cycles, patients hardly have any chance to recover, and fatigue becomes more persistent. On radiotherapy, patients report progressively more fatigue that peaks around Week 5. This can be a factor in not completing radiation treatments.”
Within the first five years after treatment, from 30% to 40% of patients report moderate to severe symptoms of cancer-related fatigue. “CRF affects all aspects of quality of life when it is persistent and severe,” Dr. Berger said, noting that it is difficult to demonstrate the problem to obtain or retain disability benefits from insurers.
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