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(Drug information on methylphenidate) (Ritalin) and modafinil(Drug information on 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. Escalante.
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.