Chronic Fatigue In Adult Cancer Survivors
National Advisory Unit on Late Effects after Cancer Treatment
Oslo University Hospital
Kristin Valborg Reinertsen , specialist in oncology and senior consultant. She completed her PhD in 2011 on long-term effects after treatment for breast cancer.
The author has completed the ICMJE form and reports no conflicts of interest.
Regional Advisory Unit for Palliative Care
Oslo University Hospital
Jon Håvard Loge , specialist in psychiatry and in child and adolescent psychiatry. He heads the Regional Advisory Unit for Palliative Care, South-Eastern Norway Regional Health Authority. He is professor II at the Department of Behavioural Sciences in Medicine. He was head of the National Advisory Unit on Late Effects after Cancer Treatment from 2011 to 2014. He has worked with late effects after cancer treatment since the mid 1990s with particular focus on chronic fatigue in cancer survivors.
The author has completed the ICMJE form and reports no conflicts of interest.
Department of General Practice/Family Medicine
Institute of Health and Society
University of Oslo
Mette Brekke , specialist in general practice and professor. She also works as a GP at the Kurbadet group practice, Oslo.
The author has completed the ICMJE form and reports no conflicts of interest.
National Advisory Unit on Late Effects after Cancer Treatment
Oslo University Hospital
Cecilie E. Kiserud , PhD and senior consultant in oncology. She heads the National Advisory Unit on Late Effects after Cancer Treatment.
Cancer Fatigue Is Different From Fatigue That Healthy People Feel
When a healthy person is tired from day-to-day activities, their fatigue can be relieved with sleep and rest. Cancer fatigue is different. People with cancer get tired after less activity than people who do not have cancer. Also, cancer fatigue is not completely relieved by sleep and rest, interferes with daily activities, and may last for a long time. Fatigue usually decreases after cancer treatment ends, but some people may still feel fatigue for months or years.
Cancer Related Fatigue In Prostate Cancer
James Randall1, Waqar Haque2, E. Brian Butler2, Bin S. Teh2
1Department of Radiation Oncology, University of Texas Medical Branch , , USA
Correspondence to:
Submitted Dec 14, 2018. Accepted for publication Dec 17, 2018.
doi: 10.21037/tau.2018.12.06
One of the most commonly experienced toxicities to treatment during cancer management is cancer-related fatigue . The National Comprehensive Cancer Network defines CRF as a distressing, persistent, subjective sense of tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. . This symptom represents a massive detriment to quality of life, as 5090% of cancer patients will experience this phenomenon during their treatment . Furthermore, up to 30% of cancer patients will continue to experience fatigue during follow-up visits after treatment completion . Severity of fatigue will vary with the site of malignancy, extent of disease, and treatment modality.
CRF is a symptom commonly experienced by patients undergoing external beam radiation therapy for prostate cancer. The typical pattern for CRF during EBRT is a progression in severity throughout the treatment, which peaks just before completion . An estimated 71% of men receiving EBRT will experience clinically significant fatigue. Persistent fatigue lasting more than 1 year after completion of EBRT was also reported by 2433% of men .
Recommended Reading: Is Fatigue A Symptom Of Prostate Cancer
Is Fatigue A Sign Of Cancer
Fatigue may develop as a symptom of blood cancers, such as leukemia, lymphoma and multiple myeloma, because these cancers start in the bone marrow, which produces red blood cells that carry oxygen throughout the body.
Fatigue may also be a symptom of undiagnosed metastatic cancer . This is more common in cancers that arent typically caught early, such as lung cancer or ovarian cancer.
Its uncommon for fatigue to be the only symptom of undiagnosed cancer. A more concerning scenario develops when patients experience both fatigue and pain in one area thats getting progressively worse, along with unexplained weight loss and loss of appetite.
However, these symptoms may also be caused by an infection or another medical condition, such as anemia, depression, thyroid dysfunction, vitamin deficiency or sleep apnea, to name a few possibilities.
If a patient came to me complaining primarily of fatigue, my first thoughteven as an oncologistprobably wouldnt be cancer.
There may not be a simple answer behind whats causing your fatigue, and discovering the root cause often takes some digging, along with some trial and error with various therapeutic approaches.
Figure : Prostate Cancer Prevalence Versus Testosterone Levels
SOURCE: Morgentaler A. Testosterone and Prostate Cancer: An Historical Perspective on a Modern Myth. European Urology 2006 50: 93539. PMID: 16875775.
Abraham Morgentaler, M.D., an associate clinical professor of surgery at Harvard Medical School and the director of Mens Health Boston, specializes in treating male sexual and reproductive difficulties.* In his book, Testosterone for Life, he touts the benefits of testosterone supplementation, including improved libido, mood, cognition, muscle mass, bone density, and red blood cell production. He also argues in the book, an excerpt of which follows, that some men who have had prostate cancer can take testosterone without upping their risk of cancer recurrence.
| *Editors note: Dr. Morgentaler has received support from companies that make testosterone therapies. |
Many well-respected experts advocate a more conservative approach: prescribing testosterone sparingly until more evidence convincingly shows a lack of harm in the long run, and until studies demonstrate which patients are most likely to reap significant benefits. One is Ian Thompson, M.D., chairman of the Department of Urology at the University of Texas Health Sciences Center at San Antonio and a principal investigator for the Prostate Cancer Prevention Trial .* He shares his views on testosterone supplementation with Harvard editors following the book excerpt.
Don’t Miss: How To Fight Chemo Fatigue
How To Find Help For Cancer Fatigue
It can be hard to pinpoint the cause of cancer-related fatigue, especially if a combination of factors is working together to cause it. There may not be one simple answer. Keep looking for help, even if initial tests for obvious sources of fatigue are negative.
Keep in mind that conventional oncologists arent usually trained on all the research thats been done on how to manage side effects and help improve quality of life. Their focus is on drugs used to treat cancer. But don’t assume your oncologist is the only one capable of managing your side effects, nor the only one who should be following your progress.
Physicians who work in integrative medicine, functional medicine and naturopathy may be more experienced with how to manage those symptoms using relatively non-toxic approaches. These providers may be more likely to know about and use strategies that show the potential to improve patients quality of life without causing harmful side effects. However, be cautious with any provider who claims their treatments will cure cancer in lieu of conventional therapy.
If youre not getting the help youre looking for, consider seeking a second opinion at an oncology center like CTCA. Cancer centers are more likely to offer resources to explore the multifactorial processes that could be affecting fatigue.
What Other Factors Contribute To Fatigue
Several other factors could contribute to fatigue, including:
- Tumor cells compete for nutrients, often at the expense of the normal cells’ growth.
- Decreased nutrition from the side effects of treatments can also cause fatigue.
- Cancer treatments, specifically chemotherapy, can cause reduced blood counts, which may lead to anemia, a blood disorder that occurs when the blood cannot adequately transport oxygen through the body. When tissues don’t get enough oxygen, fatigue can result.
- Medicines used to treat side effects such as nausea, pain, depression, anxiety, and seizures can also cause fatigue.
- Research shows that chronic, severe pain increases fatigue.
- Stress can worsen feelings of fatigue. Stress can result from dealing with the disease and the “unknowns,” as well as from worrying about daily tasks or trying to meet others’ needs.
- Fatigue may result when you try to maintain your normal daily routines and activities during treatments. Modifying your schedule and activities can help conserve energy.
- Depression and fatigue often go hand-in-hand. It may not be clear which started first. One way to sort this out is to try to understand your depressed feelings and how they affect your life. If you are depressed all the time, were depressed before your cancer diagnosis, or are preoccupied with feeling worthless and useless, you may need treatment for depression.
Read Also: What Can Cause Leg Fatigue
What Else Can Cause Fatigue
Many other factors can make you feel tired and fatigued if you have cancer. Some of these include:
- not sleeping well at night or sleeping too much during the day
- treatment may be harder for you to cope with especially if you’re elderly
- your tiredness may make it harder for you to concentrate so everything seems more difficult making you feel even more tired
- travelling to and from the hospital for treatment
- having a lot of visitors when you are staying in hospital
- looking after children
- other health problems such as diabetes, problems with your lungs, heart problems and being overweight
You can ask your nurses to tell your visitors that they can only stay with you for a short time. Don’t feel bad if you have to do this. You need a lot of rest and your friends and family will understand.
Fatigue And Memory Problems May Be Related
During and after cancer treatment, you may find that you cannot pay attention for very long and have a hard time trying to think, remember, and understand. This is called attention fatigue. Sleephelps to relieve attention fatigue, but sleep may not be enough when the fatigue is related to cancer. Take part in restful activities and spend time outdoors to help relieve attention fatigue.
Read Also: What Can Cause Severe Fatigue And Tiredness
Cancer Related Fatigue And Quality Of Life In Patients With Advanced Prostate Cancer Undergoing Chemotherapy
Andreas Charalambous
1Cyprus University of Technology, 15th Vragadinou Street, 3041 Limassol, Cyprus
2University of Turku, 20014 Turku, Finland
Abstract
Cancer related fatigue is a common and debilitating symptom that can influence quality of life in cancer patients. The increase in survival times stresses for a better understanding of how CRF affects patients QoL. This was a cross-sectional descriptive study with 148 randomly recruited prostate cancer patients aiming to explore CRF and its impact on QoL. Assessments included the Cancer Fatigue Scale, EORTC QLQ-C30, and EORTC QLQ-PR25. Additionally, 15 in-depth structured interviews were performed. Quantitative data were analyzed with simple and multiple regression analysis and independent samples -test. Qualitative data were analyzed with the use of thematic content analysis. The 66.9% of the patients experienced CRF with higher levels being recorded for the affective subscale. Statistically significant differences were found between the patients reporting CRF and lower levels of QoL and those that did not report fatigue and had higher levels of QoL . The interviews emphasized CRFs profound impact on the patients lives that was reflected on the following themes: dependency on others, loss of power over decision making, and daily living disruption. Cancer related fatigue is a significant problem for patients with advanced prostate cancer and one that affects their QoL in various ways.
1. Introduction
2. Methods
Fatigue Can Decrease Your Quality Of Life
Cancer fatigue can affect all areas of your life by making you too tired to take part in daily activities, relationships, social events, and community activities. You might miss work or school, spend less time with family and friends, or spend more time sleeping. In some cases, physical fatigue leads to mental fatigue and mood changes. This can make it hard for you to pay attention, remember things, and think clearly. If you suffer from cancer fatigue, you may need to take leave from a job or stop working completely. Job loss can lead to money problems and the loss of health insurance. All these things can lessen your quality of life and self-esteem.
Recommended Reading: What Can Cause Muscle Weakness And Fatigue
Certain Drugs Are Being Studied For Cancer Fatigue
The following drugs are being studied for cancer fatigue:
- Psychostimulants are drugs that improve mood and help decrease fatigue and depression. Psychostimulant drugs may help some patients have more energy, a better mood, and help them think and concentrate. The use of psychostimulants for treating fatigue is still being studied. The FDA has not approved psychostimulants for the treatment of fatigue.
- Bupropion is an antidepressant that is being studied to treat fatigue in patients with or without depression.
- Steroids are being studied in patients with advanced cancer. Dexamethasone is a steroid that reduces inflammation, but has unwanted side effects. In one clinical trial, patients who received dexamethasone reported less fatigue than the group that received a placebo.
Talk to your doctor about the risks and benefits of these drugs.
What Exactly Is Fatigue
Everyone describes it a bit differently. Some men say they are dog-tired, drained or weary all the time. Others say they’re completely knackered and exhausted most of the day.
The key difference is that fatigue goes beyond occasional tiredness. Itâs like your energy has been completely zapped â making it harder to sleep, work, hang out with friends and family, and get on with everyday life. It’s not usually the kind of sleepiness that you can push through by getting a good night of sleep, or with a cup of coffee. This feeling of being drained can linger for a long time, sometimes even months or years. Simply just being tired, on the other hand, usually goes away after resting up a bit.
People describe this type of fatigue as âwhole-body tirednessâ.
You May Like: How To Test For Chronic Fatigue Syndrome
Neuroendocrine Alterations And Cancer
Hypothalamic-pituitary-adrenal axis dysregulation and fatigue
Alterations in the HPA axis have been proposed as a mechanism underlying cancer-related fatigue, either directly or through effects on inflammatory processes. The HPA axis is an important regulator of cytokine production and has potent anti-inflammatory effects. These effects can occur via alterations in glucocorticoid production and/or decreased sensitivity of the glucocorticoid receptor to hormone ligation. Preliminary evidence suggests alterations in both pathways among patients with cancer-related fatigue. In terms of cortisol production, breast cancer survivors with persistent fatigue show alterations in diurnal cortisol slope, with elevated levels of evening cortisol relative to non-fatigued controls. Fatigued breast cancer survivors also demonstrate blunted cortisol responses to psychological stress that are correlated with elevations in stimulated cytokine production and may underlie elevated inflammatory activity. However, studies have not shown alterations in total daily cortisol production or 24-hour urinary free cortisol in breast cancer survivors with post-treatment fatigue, . In ovarian cancer patients, higher levels of evening cortisol and reduced cortisol variability are associated with fatigue before treatment onset, and normalization of cortisol profiles in the following year is associated with reductions in fatigue.
Autonomic nervous system dysregulation and fatigue
Describing And Managing Weakness
Weakness is decreased strength. If this is caused by surgery in a certain part of the body or loss of a body part, the weakness might be helped by physical therapy or occupational therapy. If weakness is caused by having an infection or having changes in blood levels, such as low blood counts, low electrolytes, or changes in hormones, treatment to help with the specific problem can help decrease weakness.
Recommended Reading: Adrenal Fatigue And Hair Loss
Contributing Factors To Severe Fatigue Before Cancer Treatment
In the differences on contributing factors between severely fatigued cancer patients and non-severely fatigued cancer patients are described. Severely fatigued cancer patients reported to have more fatigue in the period before diagnosis, more pain, and being less physically active. These differences were significant for both periods, 1 and 3 years before diagnosis. Severely fatigued cancer patients also reported currently more pain and being less physically active, than non-severely fatigued cancer patients. In addition, they reported significantly more sleeping problems, and more feelings of depression and anxiety.
When Is Radiation Therapy Used
There are some instances where the practitioners opt for radiotherapy for prostate cancer as opposed to other forms of treatment. Here are some of the situations in which radiation therapy may be used:
- As the first treatment of cancer, which is still confined to the prostate gland.
- It is used along with hormone therapy during the first treatment for prostate cancer that has extended the nearby tissues.
- After the reoccurrence of cancer in the area, it was before surgery.
- To keep cancer under control and relieve you from the symptoms for as long as possible if the cancer is advanced.
You May Like: Anti Fatigue Mat That Chair Can Roll On
Medicines Other Than Chemotherapy May Add To Fatigue
Patients may take medicines for pain or conditions other than the cancer that cause drowsiness. Opioids, antidepressants, and antihistamines have this side effect. If these medicines are taken at the same time, fatigue may be worse.
Taking opioids over time may lower the amount of sex hormones made in the testicles and ovaries. This can lead to fatigue as well as sexual problems and depression.
Fatigue Before Cancer Treatment
Almost a quarter of cancer patients may already be experiencing severe fatigue before their treatment starts, researchers in the Netherlands have found. They assessed 179 patients with various malignancies before treatment initiation and found that 23.5 per cent were severely fatigued. Prevalence of fatigue varied between diagnoses with prostate cancer at 14.3 per cent, breast cancer at 20.3 per cent and gastrointestinal cancer at 28.1 per cent. Factors that appeared to contribute to severe fatigue were lower physical activity, depressive mood, impaired sleep and rest during the day and night, and fatigue one year before diagnosis.
Goedendorp MM, Gielissen MFM, Verhagen CAH et al. Br J Cancer 2008 99:1408-14
Originally published in the November 2008 edition of MIMS Oncology & Palliative Care.
Also Check: How To Treat Adrenal Fatigue With Supplements
