Fatigue is the most common symptom in cancer patients undergoing treatment. From a personal perspective, this fatigue can be described as incapacitating and debilitating -- it is nothing that I have ever experienced prior to my treatment with Bendamustine.
Cancer-related fatigue results in substantial physical, psychosocial, and economic consequences for both patients and caregivers. Have you encountered patients in your practice and clinical experience who reported the inability to perform activities of daily living?
Researchers have proposed that one possible explanation for the development of fatigue in cancer patients is the increased secretion of proinflammatory cytokines in response to both the treatment and the disease itself. The cytokines can affect mood, muscle mass, and strength, and metabolic status to induce fatigue. They developed a study to help determine the effectiveness of dexamethasone as compared to a placebo in the management of cancer-related fatigue.
Eligible patients included those with advanced cancer and with three or more cancer-related fatigue symptoms (i.e. fatigue, pain, nausea, loss of appetite, depression, anxiety and/or sleep disturbance). Patients were randomly assigned to either dexamethasone 4 mg or a placebo orally twice per day for 14 days. The primary end point was a change in the Functional Assessment of Chronic Illness-fatigue (FACIT-F) sub-scale from baseline to day 15.
A total of 84 patients were evaluated. The improvement in the FACIT-F scale at day 15 was significantly higher in the dexamethasone group than in the placebo group. The frequency of adverse effects was not significantly different between the groups. The results demonstrate that dexamethasone is more effective than a placebo in improving cancer-related fatigue and quality of life in patients with advanced cancer.
By using the results of this study, researchers may have a better understanding of the biological mechanisms of these cancer-related fatigue symptoms, and in the future, develop cytokine specific suppressive therapies. Would it not benefit our patients if we could treat these troubling symptoms?
Have any of your patients experienced a decrease in fatigue while taking dexamethasone? What else have your patients found to be beneficial?
- Cella, D. (2001) Cancer-Related Fatigue: Prevalence of Proposed Diagnostic Criteria in a United States Sample of Cancer Survivors. Journal of Clinical Oncology.
- Ahlberg, K. (2003) Assessment and management of cancer –related fatigue in adults. Lancet.
- Yennurajalingam, S. (2013) Reduction of Cancer-Related Fatigue with Dexamethasone: A Double-Blind, Randomized, Placebo-Controlled Trial in Patients with Advanced Cancer. Journal of Clinical Oncology.