Article

Cancer-related fatigue: The scale of the problem

Department of Family Medicine, University of Rochester, Rochester, New York, United States
The Oncologist (Impact Factor: 4.87). 02/2007; 12 Suppl 1(1):4-10. DOI: 10.1634/theoncologist.12-S1-4
Source: PubMed

ABSTRACT

Fatigue is one of the most common and debilitating symptoms experienced by patients with cancer. Cancer-related fatigue (CRF) is characterized by feelings of tiredness, weakness, and lack of energy, and is distinct from the "normal" drowsiness experienced by healthy individuals in that it is not relieved by rest or sleep. It occurs both as a consequence of the cancer itself and as a side effect of cancer treatment, although the precise underlying pathophysiology is largely unknown. CRF may be an early symptom of malignant disease and is reported by as many as 40% of patients at diagnosis. Virtually all patients expect fatigue from cancer therapy. Up to 90% of patients treated with radiation and up to 80% of those treated with chemotherapy experience fatigue. CRF continues for months and even years ollowing completion of treatment in approximately one third of the patients with cancer. The impact of CRF on a patient's quality of life (QoL), particularly in relation to physical functioning and the ability to perform activities of daily living, is both profound and pervasive. In addition, CRF is associated with considerable psychological distress and can impose a significant financial burden by limiting a patient's ability to work. These effects can extend to caregivers and family members, who may also have to reduce their working capacity in order to provide additional care for a patient with CRF. This paper examines the prevalence of CRF and explores the impact of this distressing symptom on patients' functioning and QoL. Disclosure of potential conflicts of interest is found at the end of this article.

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Available from: Pascal Jean-Pierre, Oct 06, 2014
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    • "CRF is one of the most commonly reported side effects of cancer and its treatment, affecting about 80% of people receiving chemotherapy or RT (Hofman, Ryan, Figueroa- Moseley, Jean-Pierre, & Morrow, 2007; National Comprehensive Cancer Network, 2012; Piper & Cella, 2010). People with cancer often characterize CRF as a lack of energy, weakness, muscle heaviness, inability to recover from physical activity in a timely manner, the need for exaggerated effort to complete a task, or the need for greater rest periods once a task is complete (Cheville, 2009; Hofman et al., 2007; Mitchell & Berger, 2011). Not only is CRF one of the most prevalent of cancer symptoms, it is also one of the most distressing, often negatively affecting multiple HRQOL domains (Barsevick, Frost, Zwinderman, Hall, & Halyard, 2010; El Tazi & Errihani, 2011; Ryan et al., 2007). "
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    ABSTRACT: Purpose: Mitochondrial dysfunction is a plausible biological mechanism for cancer-related fatigue. Specific aims of this study were to (1) describe the levels of mitochondrial oxidative phosphorylation complex (MOPC) enzymes, fatigue, and health-related quality of life (HRQOL) before and at completion of external beam radiation therapy (EBRT) in men with nonmetastatic prostate cancer (PC); (2) examine relationships over time among levels of MOPC enzymes, fatigue, and HRQOL; and (3) compare levels of MOPC enzymes in men with clinically significant and nonsignificant fatigue intensification during EBRT. Methods: Fatigue was measured by the revised Piper Fatigue Scale and the Functional Assessment of Cancer Therapy-Fatigue subscale (FACT-F). MOPC enzymes (Complexes I-V) and mitochondrial antioxidant superoxide dismutase 2 were measured in peripheral blood using enzyme-linked immunosorbent assay at baseline and completion of EBRT. Participants were categorized into high or low fatigue (HF vs. LF) intensification groups based on amount of change in FACT-F scores during EBRT. Results: Fatigue reported by the 22 participants with PC significantly worsened and HRQOL significantly declined from baseline to EBRT completion. The HF group comprised 12 men with clinically significant change in fatigue (HF) during EBRT. Although no significant changes were observed in MOPC enzymes from baseline to EBRT completion, there were important differences in the patterns in the levels of MOPC enzymes between HF and LF groups. Conclusion: Distinct patterns of changes in the absorbance of MOPC enzymes delineated fatigue intensification among participants. Further investigation using a larger sample is warranted.
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    • "Higher levels of fatigue in patients with cancer compared to the general population are a common finding (Hofman et al., 2007). Proinflammatory cytokines have been associated with cancer-related fatigue (Bower et al., 2011). "
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    ABSTRACT: An increasing body of literature indicates that chemotherapy (ChT) for breast cancer (BC) is associated with adverse effects on the brain. Recent research suggests that cognitive and brain function in patients with BC may already be compromised before the start of chemotherapy. This is the first study combining neuropsychological testing, patient-reported outcomes, and multimodal magnetic resonance imaging (MRI) to examine pretreatment cognition and various aspects of brain function and structure in a large sample. Thirty-two patients with BC scheduled to receive ChT (pre-ChT+), 33 patients with BC not indicated to undergo ChT (pre-ChT−), and 38 no-cancer controls (NCs) were included. The examination consisted of a neuropsychological test battery, self-reported aspects of psychosocial functioning, and multimodal MRI. Patients with BC reported worse scores on several aspects of quality of life, such as higher levels of fatigue and stress. However, cortisol levels were not elevated in the patient groups compared to the control group. Overall cognitive performance was lower in the pre-ChT+ and the pre-ChT− groups compared to NC. Further, patients demonstrated prefrontal hyperactivation with increasing task difficulty on a planning task compared to NC, but not during a memory task. White matter integrity was lower in both patient groups. No differences in regional brain volume and brain metabolites were found. The cognitive and imaging data converged to show that symptoms of fatigue were associated with the observed abnormalities; the observed differences were no longer significant when fatigue was accounted for. This study suggests that cancer-related psychological or biological processes may adversely impact cognitive functioning and associated aspects of brain structure and function before the start of adjuvant treatment. Our findings stress the importance to further explore the processes underlying the expression of fatigue and to study whether it has a contributory role in subsequent treatment-related cognitive decline.
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    • "Fatigue may be present at the time of diagnosis, and its prevalence exhibits a remarkable increase as the disease progresses[3,4]. The prevalence of cancer-related fatigue may be as high as 75% in untreated patients and may reach 90% among patients undergoing radiotherapy and/or chemotherapy[5,6]. The incidence and prevalence of colorectal cancer are high worldwide, and individuals older than 60 years old are the most affected. "

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