Fatigue
Therapies for Cancer and Cancer-Treatment Related Anemia

Cancer related anemia, be it from cancer or treatments or varied combinations, is highly associated with fatigue. By definition, anemia is a decrease in the number of actual circulating red blood cells. (See How To Read a CBC, under the Neutropenia Symptom). Red blood cells, by way of their heme (hemoglobin), carry oxygen to muscles and organs of your body. Maintaining a near normal level of red blood cells can alleviate common symptoms of anemia and allow you to have more meaningful quality of life. (See Cancer and Chemotherapy-Induced Anemia and Fatigue, under the Fatigue Symptom).

Management of anemia depends on its causes and can be related to vitamin and dietary deficiencies. With cancer and cancer-treatment related anemia, the cause can be over or under-functioning bone marrow. Our blood cells generally begin from what is known as a stem cell produced by our bone marrow, that then grows to become the type of blood cell we most need. Feedback mechanisms within our bodies tell the bone marrow, that produces the stem cell, whether it should become a red cell, a white cell or a platelet.

Transfusions (intravenous delivery of blood) of packed red blood cells have been the primary treatment for anemia. Whole blood is rarely given, because only a part of whole blood (red cells, white cells and platelets) is specifically needed. Therefore to treat anemia, patients will often receive only red blood cells . Although red blood cells are typed and matched (tested to be the same blood type as yours) in a laboratory, repeated exposure to blood other than your own can cause you to develop antibodies to blood. Sometimes your body doesn't like the blood it receives, and your body will react with chills or fevers or pain and aches. Over time, these reactions may become more common. A blood transfusion is not unsafe, when needed, as blood is checked for communicable diseases and can be tested and treated for antibodies to red blood cells, but there are still some risks associated with receiving someone else's blood. Recent guidelines for blood transfusions may dictate that blood is available only when you have symptoms requiring it (like being short of breath) or when your hemoglobin and hematocrit levels are very low. Fatigue related to anemia often occurs when hemoglobin levels are between 8 and 12; therefore other options may be needed.

Recent medical advances, because of two decades of intense interest by researchers, have produced substances that can mimic our body's feedback mechanisms, to help regulate and direct the production of specific types of blood cells. Erythropoietin is the name of a hormone that naturally occurs in our bodies. It is secreted by our kidneys and helps to increase production of red blood cells. Cancer or cancer related treatments may overwork or override this process, allowing anemia to develop or continue or worsen.

Epoetin alfa is an approved medication for the treatment of anemia related to cancer. This is a natural glycoprotein like that produced by the kidneys. Several trade names of this medication are now available by prescription (Epogen® and Procrit®). These growth factors are generally given 1 to 3 times a week, and are given by subcutaneous injection (a shot, under the skin). A new addition to the treatment options for anemia, is darbepoetin alfa(trade name Aranesp®). This form of erythropoietin is given less often. By subcutaneous injection, Aranesp® may be given every 14 days, depending on your prescription and your healthcare provider's practice.

When injections are needed outside of a clinic or a doctor or nurse's office, you or someone near you may be taught how to give you your erythropoietin shots. This can be done safely and conveniently. A healthcare provider will show you how it is done, and then observe you doing it, until you are comfortable with the process.

Erythropoietin does not immediately begin to correct anemia by regulating production of red blood cells. This process may take a week or two. Blood tests will be done over this time to continue to evaluate your anemia. Your healthcare team may ask you to take an iron replacement, as iron is needed to produce red blood cells. Although generally mild, the following side effects have been reported from using erythropoietin therapy: dizziness, headaches, joint aches, nausea, and diarrhea. Be sure to talk with your healthcare provider if you are experiencing these side effects, as many can be managed and controlled.