n NEW YORK--Roughly 70% of cancer patients complain of fatigue at some point in their illness, and a search for reversible causes and multiple etiologies of such fatigue should be a part of standard practice, Ronald Blum, MD, said at a a symposium on fatigue in cancer sponsored by Cancer Care, Inc.
Dr. Blum, deputy director, Kaplan Comprehensive Cancer Center, New York University Medical Center, suggested a thorough assessment as the first step when patients report fatigue.
When taking the history, "we can probe with the word fatigue or a synonym. What has been the change in fatigue over time? Is it getting better? Get a global assessment, like the Karnofsky Performance Scale," he said. A review of medications, many of which have fatigue as a side effect, is also important.
Dr. Blum suggests reviewing systems to gauge the cause of fatigue. "I tell patients I'm going to start at your head and work to your toes. I'm usually overwhelmed by the information I pick up that patients have forgotten to tell me."
Headache-related fatigue in a cancer patient could be a sign of brain metasta-ses. "I saw a patient whose presenting symptom was tiredness. He wasn't sleeping because of recurring headaches. It turned out to be a brain mass," he said.
Often people with metastatic brain disease will have very subtle neurologic signs, including depression, confusion, and lethargy, but the main symptom these patients have is generally fatigue, he said.
Shortness of breath may indicate cardiopulmonary problems. "People may have pulmonary metastases or pneumonia," he said. One of his patients whose presenting symptom was fatigue turned out to have an intercardiac sarcoma that was obstructing flow into his lungs.