Topic: Suggestions for management of cancer-related fatigue
Most of the info. are from current medical practice literature.
First to identify and treat the the factors known to be associated with cancer-related fatigue.(ie: abnormal serum electrolytes etc.;careful titration of opioid analgesics etc.);If other diseases cause anemia,they should be treated and identified also.(ie:blood loss,hemolysis,iron,B12 and folate deficiency)
1.Correction of anemia-the most common reversible cause of fatigue in patients with cancer either due to the cancer treatment or the underlying disease.
RBC blood transfusions or use of ESAs(epogen,darbepoetin) when Hemoglobin is<10.is used.(see Dec/2010 ASCO updated guideline below) . But contraversy is still remain whether and how to use ESAs effectively.
on Dec.2010,ASCO updated the guideline for ESAs indicated that ,based on 13 randomized controlled trails,the data show that ESAs INCREASE the risk of venous thromboembolism and /or survival in patients with cancer.ESAs showed increased in risks in tumor progression in certain type of cancer patients . The new specific indications are ESAs should only be initiated to avoid transfusion,not for other purposes such as improving fatigue or quality of life. Clinical judgement is needed when using ESAs when Hgb is >10.
2a.Intervention such as Yoga(consisted of breathing,yoga postures and meditation)exercise twice weekly for six weeks improve sleep quality,fatigue and quality of life.Acupuncture twice a week also show benefit in a randomized phase 2 trial by 31%-75% in fatigue symptom resolution.
2b.A study involved 417 older patients(65-92 years old) with cancer during and after chemo treatment done by Univ. of Rochester in New York and presented at ASCO 6/2011 meeting indicated that patients 65 and older who exercised DURING treatment(Tx)reported significantly less" shortness of breath" and better self-rated health 6 months AFTER Tx compared to those who did not exercise. Patient 80 and older who exercised during Tx reported significantly less nausea,fatigue,and total side effects 6 months after Tx compared to those who did not exercise.
3.Administration of psychostimulants has been reported to improve fatigue symptoms in an open-label studies; but double- blind studies are needed to prove its true effectiveness.Modafinil,methlphenidate are the 2 most common ones.
4. Administration of antidepressants may be helpful especially for patients suffer both depression and fatigue.;nortriptyline,amitriptyline etc.
5.Steroids may be most useful for patients with cancer-related fatigue who are in the late stage of cancer.
For a more in depth about this subject apart from using medication;the following link by Marion is a good way to start.
http://www.cancer.net/patient/Cancer+Ne … +Survivors
Last edited by PCL1029 (Sat, 02 Jul 2011 21:46:40)