BALTIMOREFatigue is a universally recognized complication of cancer,
caused by both the disease itself and its treatment, but the role of anemia
in causing fatigue has received insufficient attention, according to MiKaela
Olsen, RN, MS. This oversight has led to undertreatment of anemia, but
proper evaluation and treatment can reduce anemia and the fatigue and other
troubling symptoms it causes, she said at an industry-sponsored symposium
held in conjunction with the Oncology Nursing Society annual meeting. Ms.
Olsen is an oncology/bone marrow transplant/hematology clinical nurse
specialist at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
In recent years, important progress has been made in pain control, but
cancer patients report that fatigue has a greater influence on their lives
than pain, nausea, or depression, according to Ms. Olsen.
Fatigue can arise from depression and sleep deprivation, both common
among cancer patients. The rapid division of cancer cells and the damage to
tissues caused by chemotherapy are also important contributing factors.
Because chemotherapy agents and radiation appear to target better-oxygenated
cells, patients with higher red blood cell counts have higher quality of
life and better medical outcomes than those with lower counts, Ms. Olsen
explained. During the 1990s, however, concerns about the risks of blood
transfusions focused attention more on fatigue thresholds and tolerance than
on increasing red blood cell count.
Anemia Is Universal Fact
Anemia is a universal fact of cancer treatment, Ms. Olsen noted. All
patients receiving chemotherapy suffer from at least grade 1 or 2 anemia,
she said, and 8% suffer from grade 3 or 4. Symptoms of anemia can include
dyspnea, headache, weakness, and tachycardias.
Hypothermia, chills, and pallor can result as the body compensates for
hypoxia by diverting blood from small vessels to major organs. In addition,
the increased cardiac output needed to counter hypoxia can have serious
consequences including heart failure, myocardial infarction, and even death,
The signs and symptoms of anemia should be monitored and, if indicated,
laboratory tests should be performed to check hemoglobin, hematocrit,
reticulocyte count, and red blood cell indicators, Ms. Olsen advised.