BETHESDA, MarylandFatigue among cancer patients "is an
important problem, and it’s a legitimate topic for clinical
investigation," National Cancer Institute Clinical Director Gregory A.
Curt, MD, told Oncology News International, lamenting, " I don’t think it’s high on the radar
for the physicians."
This seems to be borne out by an accounting of the abstracts
presented at the annual meeting of the American Society of Clinical Oncology.
Of 3,127 abstracts, only 13 focused on cancer-related fatigue. Yet fatigue is
the most prevalent side effect of chemotherapy, affecting more people and
lasting longer than pain, nausea, and vomiting, according to a telephone survey
of 379 cancer patients sponsored by The Fatigue Coalition.
Dr. Curt said that physicians and patients often don’t talk
about cancer-related fatigue because they think nothing can be done about it.
That’s not true, he countered, and physicians need to start considering
options now that pain, nausea, and vomiting are yielding to treatment.
Commenting on the survey, he remarked: "Most oncologists thought pain was
more important than fatigue, but patients thought fatigue was more important
The survey was the second conducted by The Fatigue Coalition, a
multidisciplinary group of practitioners, researchers, and patient advocates
working to develop diagnosis and treatment guidelines. The first survey
concluded that fatigue was undertreated and seldom discussed. Major findings of
the new study are listed below.
76% of all cancer patients who responded experienced
fatigue at least a few days each month during their most recent chemotherapy
and 30% were fatigued every day.
91% of patients experiencing fatigue said it prevented a
"normal" life and 85% changed their daily routine as a result.
75% of patients who held jobs said fatigue made them change
their employment status in ways ranging from taking sick or vacation days to
going on disability or quitting work.
65% of all patients who responded said that their fatigue
caused a caregiver to take at least 1 day off work in a typical month.
One of the most surprising findings for Dr. Curt was that some
patients complained of fatigue as long as 2 years after treatment. He said he
does not know the cause.
While most patients (79%) discussed fatigue with their
physicians, nearly half (45%) of the patients did not believe anything could be
done about their fatigue and 40% said they received no recommendation in
response. Among those who did receive recommendations, the most common
suggestion was bed rest or relaxation (37%). Yet according to Dr. Curt, rest
"is one of the worst things to do. You get deconditioned."
Other suggestions were diet or nutrition (11%), vitamins (7%),
and prescription drugs (6%).
Range of Remedies
The problem of fatigue is complex, Dr. Curt acknowledged.
Patients are tired because they are sick, and they are receiving strong
therapies that can also cause fatigue. Yet fatigue can be addressed, he noted,
citing the work of Russell K. Portenoy, MD, of Beth Israel Medical Center in
New York City.
Physicians should first try to ascertain why the patient is
fatigued, Dr. Curt said. The range of remedies now available includes light
exercise, cutting out daytime naps, and creating a nighttime routine around a
hot bath and warm milk to promote sound sleep at night. For some patients,
treatment of anemia should be considered, Dr. Curt advised. If a patient is
taking a narcotic for pain relief, the medication might be titrated to a lower
dose or balanced with a stimulant, he said.
Although fatigue is still by and large neglected, Dr. Curt was
optimistic that it will receive more attention as other chemotherapy side
effects become less onerous. "We are in the same phase of treating
cancer-related fatigue, as we were in treating nausea and vomiting 15 years ago
and pain 10 years ago." he said "I remember when the first drugs that
were really good at treating nausea and vomiting came out, oncologists were
really worried that the chemotherapy wasn’t working because the patients
weren’t getting sick. Sometimes we associate side effects of our drugs with
the good effect of our drugs, but I think that both in pain research and nausea
and vomiting research, we’ve shown that the two can be de-linked."
Future cancer patients will seek out oncologists who pay more
attention to the patient’s needs, he predicted. Before that can happen,
however, Dr. Curt said more research is needed. "Knowing what the most
common causes of cancer related fatigue are and then knowing which of those
respond best to specific interventionswe don’t have the foggiest notion
about that now," he said.