I recently found an article in Oncology Times that was very interesting due to the fact that patients I see every day often complain of fatigue.
The article was based on a new study reported in Supportive Care in Cancer. According to the lead author, Andrea Cheville, MD, Associate Professor and Director of Cancer Rehabilitation and Lymphedema Services at Mayo Clinic, rehabilitative and supportive care is limited, particularly in the community setting.¹
Fatigue was the focus of her study, which involved surveys of 160 patients with stage IV lung, breast, colon, or prostate cancers that had moderate to severe fatigue. Patients had an average fatigue score of 6.4 (scale 1-10). About 58 percent of participants remembered NCCN Guidelines being discussed for treatment of their fatigue. The use of pharmaceuticals was the more frequently discussed intervention. This is due to the fact that physicians are comfortable with prescribing, and it's a lot quicker than providing a behavioral intervention.
Causes for fatigue may be related to insomnia and anemia -- it has also been theorized that chemotherapy agents may even cause toxicity at the mitochondrial level. The study noted that it's difficult to have an effective solution for fatigue that does not have one specific cause, but is associated with cancer and its treatment. Fatigue is not an isolated symptom, but commonly occurs with other symptoms in symptom clusters.
More research is needed to find and treat the underlying physiology of fatigue. Dr. Amy Abernethy, MD noted, “Overall, oncologists don’t have much in their toolbox to help patients with fatigue. As a result, we spend a lot of time deciding whether we should be measuring and assessing it.”
The NCCN guidelines list four categories for cancer-related fatigue treatment ²:
- General Management Strategies (e.g., energy conservation)
- Non-pharmacologic (e.g., activity enhancement)
- Psychosocial Strategies
We are fortunate to have a comprehensive Complementary Medicine program at our cancer center where we offer massage, Reiki, reflexology, color light therapy, music, relaxation, guided imagery, aromatherapy, yoga, and exercise programs. We also include individual and group discussions regarding various general topics such as energy conservation, priority lists, etc.
This type of program gives people a sense of control, and has very few side effects. Oftentimes, just validating their feelings and the fact that the fatigue is “real” is helpful.
What has been your experience in dealing with cancer-related fatigue?
- Oncology Times, February 25, 2013, Vol. 35, No. 4
- NCCN Cancer Related Fatigue Guidelines, Version 1.2013