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Management of Fatigue in the Cancer Patient

Management of Fatigue in the Cancer Patient

Fatigue is the most common problem
experienced by oncology patients.[1-2] In this issue of ONCOLOGY, Drs. Lesage
and Portenoy present an excellent overview of the potential etiologies,
assessment parameters, and treatment options for this complex, multidimensional
symptom. As they note in their comprehensive review, research on this symptom,
which has a significant impact on oncology patients’ ability to function and
quality of life, is limited. Therefore, one is left to consider what important
research questions need to be answered regarding cancer-related fatigue.

Pain-Fatigue Parallels

Because of the similarities between pain and fatigue (eg, both
are subjective phenomena and multidimensional problems, with complex etiologies
and multiple treatment options that need to be individualized), it may be
beneficial to examine the conceptual ideas and research approaches that led to
the greatest advances in our understanding of pain mechanisms and pain
management and determine whether these ideas and approaches could be applied to
investigations of cancer-related fatigue. It should be noted that some of the
most important ideas and approaches regarding pain mechanisms and management
evolved after years of research and clinical experience. Perhaps we can
capitalize on the ones that enhanced our knowledge and apply them to more
quickly improve the management of cancer-related fatigue.

One of the most revolutionary ideas in pain management to evolve
in recent years is the concept that pain is more than a symptom. Pain is a
disease and requires a disease management approach to ensure effective
treatment. It took more than 30 years for this view to be fully
appreciated, but it has become an accepted part of clinical practice through the
establishment of medical departments of pain medicine and palliative care (such
as the one that Dr. Portenoy chairs). Perhaps the same approach is warranted for
fatigue. The recognition of fatigue as a disease could lead to more intensive
investigations of this significant clinical problem.

Determining the Etiology

One of the cardinal principles of effective pain management is
to ascertain the etiology or cause of the pain. For most pain management plans
to be effective, they must focus on eliminating or ameliorating the cause of the
pain. Although Drs. Lesage and Portenoy point out that there are likely to be
multiple etiologies for cancer-related fatigue, the major priority of research
is to identify the molecular and biochemical mechanisms that underlie its
development. Clinicians often discount patients’ subjective reports of pain
when a recognized etiology is not evident. Likewise, clinicians discount
patients’ subjective reports of cancer-related fatigue because the underlying
mechanisms are unknown.

Our understanding of the peripheral and central mechanisms that
result in the development of acute and chronic pain was greatly enhanced when
appropriate animal models were developed and used to evaluate the effects of
mechanism-based interventions. Until scientists begin to collaborate with
clinicians to develop animal models for cancer-related fatigue, progress in
mechanistic-based interventions will be slow.

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