|
|
Fatigue While everyone knows what it feels like to be occasionally exhausted, people with cancer who suffer from fatigue -- resulting from the disease itself or its treatment -- often suffer from a debilitating exhaustion that can last days, weeks or months. Cancer fatigue, often described by patients as a total lack of energy, is a near universal problem among cancer patients. It is the most common side effect of cancer and its treatment, affecting 76 percent of patients undergoing therapy. Unfortunately, while medical science has been making steady progress in treating cancer itself, cancer-related fatigue is frequently over-looked, under-recognized and under-treated. "For many patients, fatigue is the constant reminder that they have cancer. Yet despite its prevalence and distressing consequences, it is one of the least understood symptoms of cancer," said Russell Portenoy, M.D., Department of Pain Medicine and Palliative Care, Beth Israel Medical Center, New York City, and chairman of The Fatigue Coalition, a multi-disciplinary group of medical practitioners, researchers and patient advocates that authored a recent survey about fatigue. Cancer-related fatigue should be screened for or assessed at every healthcare visit. This provides for discussion of management strategies and outlines ongoing or follow-up evaluation. The causes and effects of fatigue are complex, and there is no established method to assess it. Patients may not report it and clinicians are usually focused on other indicators. Indeed, it is often dismissed by medical professionals with such comments as, "Of course you're tired -- you have cancer," rather than viewed as a medical condition that can and should be addressed. While thousands of cancer studies have been conducted, researchers are only now beginning to study cancer fatigue. Symptoms Of Cancer Fatigue Patients treated by either surgery, radiation or chemotherapy experience such side effects as pain, nausea, and fatigue as a consequence of the treatment. Some treatments, the cancer itself or other disorders can also lead to anemia (an abnormally low level of red blood cells), a frequent source of fatigue for cancer patients. The symptoms of cancer fatigue include not only feeling tired -- weak, worn out, drained, "wiped out" -- but also leg pain, difficulty climbing stairs or walking short distances, shortness of breath after light activity, and difficulty performing ordinary tasks such as cooking, cleaning, taking a shower or making the bed. Cancer fatigue can have mental and emotional effects as well. Patients may have difficulty concentrating while reading or watching television, or have trouble thinking clearly and making decisions. Fatigue also may underlie patients' feelings of low self-esteem and frustration, often resulting in feelings of helplessness or despair. Changes in sleep, daily activity or eating patterns can cause fatigue, as can anxiety, depression or stress. Consequences Of Fatigue Aside from the discomfort of feeling exhausted, fatigue can pose a number of obstacles to coping with cancer and reaping the full benefits of available treatments. Fatigue can significantly interfere with your quality of life and may limit the number of chemotherapy cycles that could be administered, which may limit the effectiveness of treatment altogether. "It's not acceptable to tell patients that fatigue is just something they must live with," said Dr. Portenoy. "We need to create greater awareness about cancer-related fatigue and develop approaches for assessing and treating it. For some patients, treating fatigue may be as important as treating the disease." Treating Cancer Fatigue In many cases, the known causes of cancer-related fatigue can be treated and possibly relieved, at least to some degree. Proper nutrition, vitamin and mineral supplements, stimulants, anti-depressant and anti-anxiety medications, lifestyle modifications and even psychological counseling can help alleviate fatigue. To treat the anemia that contributes to fatigue, oncologists have traditionally relied on blood transfusions to raise red blood cell levels and help restore energy, if only temporarily. Although transfusions can bring quick but temporary results, many physicians try to avoid them because of potential risks. Today, medication for chemotherapy-related anemia can increase red blood cells, reduce the need for transfusion, and may improve your ability to engage in everyday activities and cope with the disease. Focusing Attention On Cancer Fatigue Fatigue, like pain, is not easily measured. Caregivers need to realize that unrecognized fatigue may be a major factor when patients can't perform their jobs properly, keep up their daily activities or maintain social contacts. In the early 1970s, medical authorities began to call attention to the occurrence and costs of under-treating pain. And, last year, the American Pain Society Quality of Care Committee issued a consensus statement calling for guidelines to improve patient well-being and to recognize potential obstacles to adequate pain management. "Management of fatigue deserves the same attention as management of cancer pain," said David Cella, Ph.D., Director, Center on Outcomes, Research and Education, Evanston Northwestern Health Care, Northwestern University in Chicago, and a member of The Fatigue Coalition. The Fatigue Coalition was formed in 1996 and will implement a series of educational and research initiatives during the next several years to elevate the importance of diagnosing and treating fatigue in cancer patients. The Coalition's first undertaking was a national survey of oncologists, cancer patients and caregivers to determine the incidence and impact of cancer fatigue. "It is The Coalition's mission to promote greater understanding of cancer fatigue in the hope of improving the everyday life of cancer patients and their families," Dr. Cella said. The National Comprehensive Cancer Network (NCCN) 2003 Cancer-Related Fatigue Guidelines recommends screening for cancer-related fatigue at each patient encounter. This allows for earlier recognition of anticipated fatigue patterns and facilitates opportunities for education and discussion of management strategies. Cancer-Related Fatigue Instruments Cancer-related fatigue does not discriminate. Multifactor causes and contributors make the assessment and treatment of fatigue very individual and patient-focused. Several instruments have been and are being used to assist in screening and monitoring cancer-related fatigue, although no one standard fatigue instruments covers the diverse nature of cancer-related fatigue. The National Comprehensive Cancer Network (NCCN, 2003) has as it’s cancer-related fatigue screening guidelines, the expectation that fatigue will be screened and/or evaluated at each patient encounter. No specific instrument is specified. Screening should at minimum include the ongoing question of “Rate Your Fatigue” on a scale of 0-10, with zero being without fatigue and ten being overwhelming fatigue. In a recent meta-analysis, Amy Schwartz, PharmD, discussed the validity of several published cancer-related fatigue instruments. To follow are several instruments including authors. Please note sources in the Reference List. You may be asked to complete one or more than one of these assessments to determine how extensive your fatigue may be. Brief Fatigue Inventory (BFI) Mendoza, et al, 1999 |
|
||
