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Fatigue in the Advanced Cancer Patient Doctor, why am I so tired?

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Presentation on theme: "Fatigue in the Advanced Cancer Patient Doctor, why am I so tired?"— 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 fatigue May precede diagnosis Often assd with cachexia Worsened by chemo/RT/surg Rarely assessed or treated

4 Symptom Prevalence Pain Fatigue/Asthenia Constipation Dyspnea Nausea Delirium Depression/suffering % % 70% 60% % % %

5 Asthenia 3 elements Fatigue easily tired; ability to maintain adequate performance Weakness subjective sensation; difficulty initiating activity (not neuro/muscular disease) Mental fatigue impaired concentration, memory loss & emotional lability

6 Etiology Cachexia/malnutrition Dehydration Infection Hematologic causes Metabolic disorders Chronic hypoxia Neurologic dysfn Psychogenic causes Endocrine disorders Insomnia Chronic overexertion Pharmacologic Cardio/pulm disorders Liver failure Renal failure Chemo/RT

7 Causes Electrolyte disorders Ca ++, K +, Mg ++, Na + Endocrine disorders thyroid, cortisol, diabetes Hematologic Hgb, WBC

8 Causes Infections TB, viral (e.g. hepatitis), fungal Neurologic disorders auto dysfn, myasthenia, parkinsonism Pharmacologic chemotx, sedatives, EtOH, narcotics

9 Mechanisms 3 factors Direct: produced by tumor Induced: secondary to tumor effect Accompanying: associated with malignancy, contribute to asthenia

10 CNS Mechanisms Hypothetical, little actual research RAS active in fatigue experience cortical stimulation & sensory activity Chronic stimulation (pain) may yield fatigue Physical fatigue may protect RAS Asthenia d/t breakdown of RAS by stimuli from environment & cortex; humoral factors

11 Mechanisms in Muscle Cachexia = loss of muscle and fat Pts with N caloric intake may show: lactate production atrophy of type II fibres cathepsin-D impaired mm function Caused by asthenins/cytokines

12 Assessment Why? Subjective sensation; self-assess best Characterize, monitor, research purposes Many tools developed Gold standard (nonexistent): simple, easily understood valid, reliable, multidimensional

13 Assessment Tools Unidimensional Performance status (Karnofsky, ECOG) Rhoten Fatigue Scale Multidimensional Fnal Assessment of Cancer Tx (FACT) Edm Fnal Assessment Tool (EFAT) Multidnal Fatigue Inventory (MFI-20)

14 Management Pharmacologic measures Corticosteroids (Decadron) appetite, energy, short-term Amphetamines (Ritalin) sedation, activity, opioid assn Megesterol acetate (Megace) appetite, ? asthenia, expensive

15 Management Promising Rx treatments Thalidomide AIDS wasting, anti-TNF Melatonin Cannabinoids Clenbuterol -3 fatty acids

16 Management Non-pharmacologic measures Moderate exercise Adapting ADL Rest, energy conservation Psychotherapy Self-help; activity diary Family/caregiver involvement

17 Conclusions Common condition Multiple causes Mechanisms unclear Assessment important Multidimensional treatment More research needed

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