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Management of Fatigue in the Cancer Patient

Management of Fatigue in the Cancer Patient

The article by Drs. Lesage and Portenoy is an excellent overview
of current knowledge regarding the etiology, diagnosis, and treatment of fatigue
in the cancer patient. Although we still have much to learn about cancer-related
fatigue, noteworthy progress has been made over the past 10 years in identifying
the problem, describing its consequences, establishing it as a recognized
diagnostic entity, understanding its causes, and offering treatments.

Three Trends

This progress can be attributed to three trends in oncology
practice and research. The first is the progress made in other areas of
supportive oncology, most notably antiemetic control and pain management.
Although not eradicated, these formerly preeminent concerns in supportive
oncology have, by comparison to fatigue, receded in prevalence and impact on
quality of life. This has exposed fatigue as the next most vexing symptom in
cancer management.

A second trend is the increase of available therapies and,
equally important, a willingness of funding agencies (public and private) to
support fatigue research in oncology. Researchers tend to turn their attention
to areas that hold promise of discovery and promise of funding. Cancer-related
fatigue has achieved both distinctions over the past decade. With any luck, this
trend will continue through a wave of studies examining the value of many
pharmacologic and nonpharmacologic approaches to management.

Finally, a third trend is the popularization of a host of
diverse "unproven" remedies for symptoms related to cancer and the
cancer itself. Parallel to this has been the increasing attention paid by
mainstream oncologists to the "whole person" with cancer. In the name
of complementary, alternative, or integrative medicine, many oncology providers
have associated with (or at least referred patients to) allied professionals in
the delivery of ancillary treatments for a range of symptoms and concerns,
including fatigue. This reflects an increasing realization that symptoms such as
fatigue should not simply be dismissed as part of the cancer treatment
experience.

Causal Mechanisms

Nevertheless, as pointed out by Lesage and Portenoy, the trend
toward more fatigue research these past several years has been slow to produce
results that can be immediately applied to improve patient care. Extensive work
must be done to determine the many causes of fatigue in cancer patients. This
work will not instantly produce effective interventions, although it will
identify targets. Red blood cells, cytokines, "tumor burden,"
deconditioning, muscle loss, depression, and insomnia are frequently
hypothesized to be causal factors. However, little is known about most of these
factors and their relationship to fatigue.

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