BOSTONOncologists should screen cancer patients and survivors routinely
for fatigue and attempt to treat those who complain of exhaustion that rest
does not relieve, according to two speakers at the 14th international meeting
of the Multinational Association for Supportive Care in Cancer (MASCC) and
International Association for Oral Oncology.
Carmen P. Escalante, MD, director of the Fatigue Clinic at M.D. Anderson
Cancer Center, urged a multidisciplinary approach to diagnosis and treatment.
She said the 4-year-old clinic has recommended therapies ranging from
exercise and self-hypnosis to small doses of the stimulants methylphenidate
(Ritalin) and modafinil (Provigil) as well as other pharmacologic agents.
Many oncologists think they can’t treat fatigue, so they don’t try, she
told ONI, but her clinic has treated more than 100 patients. "In a
majority of cases, we can treat fatigue somewhat," she said. "Very rarely can
we make all the fatigue go away. We can bring it down to moderate levels, and
that’s very important to patients." Started in 1998, the clinic was the first
and may be the only fatigue clinic in the country, according to Dr.
Barbara F. Piper, DNSc, RN, associate professor, College of Nursing,
University of Nebraska Medical Center, said a consensus is emerging that
cancer-related fatigue is "a multicausal, multidimensional syndrome" with
temporal, sensory, affective, behavioral, and cognitive dimensions.
Nonetheless, she expressed concern that fatigue assessment is not being
integrated into clinical practice.
The failure to develop and implement guidelines is a basic problem. "Even
at the University of Nebraska, we do not have fatigue on our documentation
forms," Dr. Piper said in a discussion of guidelines developed separately by
the National Comprehensive Cancer Network (NCCN) and by the Classification of
Diseases 10th Revision-Clinical Modification (ICD-10).
Both speakers called for extensive clinical testing of guidelines and
treatments. Dr. Piper said the two fatigue guidelines are largely based on
expert opinions, and neither endorses a specific fatigue scale by which
physicians can measure the severity of symptoms.