Cancer-Related
Fatigue
慈濟醫院血液腫瘤科
高瑞和醫師
DEFINITION OF CANCER-RELATED FATIGUE
Cancer-related fatigue is a persistent, subjective
sense
of tiredness related to cancer or cancer treatment
that
interferes with usual functioning.
中文：疲憊，疲累
Cancer-Related Fatigue
• Acute fatigue: physiologic response, recoverable
Chronic fatigue: pathologic condition, unable to
recover even after rest
• Affect body and mind: physical, emotional, mental
• 身心憔悴
Cancer-Related Fatigue
• Temporal relationship with intervention
Chemotherapy peaks within days
Radiation therapy peaks after weeks
• May persist for prolonged period
• Almost universal with biologic response modifiers
Causes of Cancer-Related Fatigue
Physiologic
Underlying neoplasm
Antineoplastic treatment
Concomitant systemic disease
Sleep disorders
Immobility and lack of exercise
Chronic pain
Psychological
Anxiety, depression
Cancer-related pathophysiology that cause fatigue
Symptoms related to
energy imbalance
Anemia
Cachexia
Infection
Paraneoplastic syndrome
Metabolic disorder
Pain and pain treatment
Stress and mood
Fatigue induced by
cancer therapy
Signs of Cancer-Related Fatigue
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•
•
•
•
•
•
Feeling tired, weary or exhausted even after sleeping
Lacking energy to do your regular activities
Having trouble concentrating, thinking clearly, or
remembering
Feeling negative, irritable, impatient, or unmotivated
Lacking interest in normal day-to-day activities
Spending less attention on personal appearance
Spending more time in bed or sleeping
Diagnosis of Cancer-Related Fatigue
Ask the patient
•
Do you feel tired or fatigued?
•
Does fatigue make you change your activities?
Patient self-report is the best diagnostic tool
Prevalence of Cancer-Related Fatigue
Fatigue-1 & Fatigue-2 studies
• 50% at diagnosis, 75% if bone metastasis
• Patient with chemotherapy 80-96%
• Patient with radiotherapy 60-93%
*Cox et al: In general population, 20% men and
30% women always feel tired.
Impact on QOL
Fatigue-1 study 1996
• 2/3 patients considered that fatigue affected their
performance of normal daily activities
• 61% patients claimed that fatigue influenced their
life more than pain
Impact on QOL
Fatigue-2 Study 1998
• Fatigue (25%) other than nausea (13%) as the main
symptom after chemotherapy
• Loss of emotional control: 90%
• A feeling of isolation and solitude: 74%
• Dejection: 72%
• Marked effect on employment and financial status:
75% had changed employment
• The effects on care-giver: more working breaks (20%)
Extent of The Problem
Stone et al Ann Oncol 2000
538 cancer patients
• 52% never reported fatigue to their oncologist
• Only 14% had received treatment or advice on
how to manage fatigue
• 33% with fatigue declared they had not received
adequate treatment
Extent of The Problem
Oncologist’s view: pain in more clinically
relevant than fatigue (61% vs 37%)
Patient’s view: fatigue affects everyday life much
more than pain (61% vs 19%)
1. Screening
2. Primary evaluation
3. Interventions
4. Reevaluation
SCREENING
Primary Evaluation Phase
Focused History:
 Disease status and treatment
Rule out recurrence or progression
Current medications/medication changes
 Review of systems
 In-depth fatigue assessment
Onset, pattern, duration
Change over time
Associated or alleviating factors
Interference with function
How is Fatigue Assessed?
1. When did the fatigue first start?
2. When did you first realize that it is an unusual
type of fatigue for you?
3. How has it progressed over the course of your
treatment or since your diagnosis?
4. What help relieve your fatigue?
5. What makes your fatigue worse?
6. How has the fatigue affected your daily
activities or the activities that give meaning and
enjoyment to your life?
Assessment of Treatable Contributing Factors
• Pain
• Emotional distress: depression
• Sleep disturbance
• Anemia
• Nutrition assessment:
weight/calori intake change
fluid, electrolyte imbalance
• Activity level: changes in exercise or activity pattern,
deconditioning
• Comorbidities: infection, cardiac, pulmonary, renal,
hepatic, neurologic, endocrine, hypothyroidism
Anemia and Cancer-Related Fatigue
Correlation between Hb levels ( 12g/dL vs.  12g/dL) and fatigue
QOL parameters
P value
Higher QOL scores
Less fatigue
Fewer symptoms of anemia
Better sensation of physical well being
Better sensatin of function al well being
0.003
0.01
0.02
0.003
0.001
QOL: quality of life
Sobreo et al. Semin Hemato 2001, 28:15-18
Treatment of Anemia-related Fatigue
• Iron, folic acid replacement
• Blood transfusion
• Erythropoietin therapy: supported by strong
clinical evidence
10,000 units sc tiw or
40,000 units sc weekly
INTERVENTION-1
Patient/Family Education
INTERVENTION-2
Common Strategies for Management of Fatigue
INTERVENTION-3
Non-Pharmacologic
INTERVENTION-4
Pharmacologic
Re-evaluation
Patient Self-Care
What to look for?
• Feeling like you have no energy
• Increased sleeping
• Lack of desire to do normal activities
• Decreased attention to personal appearance
• Feeling tired even after sleeping
• Difficulty concentrating
Patient Self-Care
What to do?
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Plan rest periods to conserve energy for important
things
Schedule necessary activities throughout the day
rather than all at once
Engage in light activity
Get enough rest and sleep
Eat a nutritious diet including plenty of liquids
Remember that fatigue caused by treatment side
effects is temporary and that energy will
Finale
Fatigue is common in cancer patients
which should be recognized, evaluated,
monitored, documented and treated
promptly at all stages of the disease, both
during and after treatment.
誌謝
PPTT Members
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林炯森 林哲斌 林勝豐 吳銘芳 高瑞和 張正雄
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The End