Presentation on theme: "Fatigue in the Advanced Cancer Patient"— Presentation transcript:
1 Fatigue in the Advanced Cancer Patient Doctor, why am I so tired?
2 Fatigue & Cancer Definitions Causes Pathophysiology Assessment Treatment issues
3 Fatigue & Asthenia Greek (Asthenos) “absence or loss of strength” Combination of physical & mental fatigueMay precede diagnosisOften ass’d with cachexiaWorsened by chemo/RT/surgRarely assessed or treated
9 Mechanisms 3 factors Direct: produced by tumor Induced: secondary to tumor effectAccompanying: associated with malignancy, contribute to asthenia
10 CNS Mechanisms Hypothetical, little actual research RAS active in fatigue experiencecortical stimulation & sensory activityChronic stimulation (pain) may yield fatiguePhysical fatigue may protect RASAsthenia d/t breakdown of RAS by stimuli fromenvironment & cortex; humoral factors
11 Mechanisms in Muscle Cachexia = loss of muscle and fat Pts with N caloric intake may show: lactate productionatrophy of type II fibres cathepsin-Dimpaired mm functionCaused by ‘asthenins’/cytokines
12 Assessment Why? Subjective sensation; self-assess best Characterize, monitor, research purposesMany tools developedGold standard (nonexistent):simple, easily understoodvalid, reliable, multidimensional
13 Assessment Tools Unidimensional Performance status (Karnofsky, ECOG) Rhoten Fatigue ScaleMultidimensionalF’nal Assessment of Cancer Tx (FACT)Edm F’nal Assessment Tool (EFAT)Multid’nal Fatigue Inventory (MFI-20)
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