Fatigue among patients with brain tumors

Abstract

Fatigue is a ubiquitous and an extremely distressing symptom among patients with brain tumors (BT), particularly those with high-grade gliomas. The pathophysiology of cancer-related fatigue (CRF) in the context of patients with BT is multifactorial and complex, involving biological, behavioral, medical and social factors. The etiology of CRF in the general oncology population is pointing to the role of inflammatory cytokines as a key factor in the genesis of CRF, but this research is currently limited in the setting of BT. CRF should be screened, assessed and managed according to clinical practice guidelines. Fatigue has recently emerged as a strong, independent prognostic factor for survival that provides incremental prognostic value to the traditional markers of prognosis in recurrent high-grade gliomas. Therefore, strategies to treat fatigue warrant investigation, not only to improve the QOL of a group of patients with often limited life expectancy, but also possibly to optimize survival.

Fatigue in patients with low grade glioma: systematic evaluation of assessment and prevalence

“…However, the included studies do show that fatigue seems to be a frequent problem prior to treatment [16], during radio- and chemotherapy [17, 30] and in the long term after treatment [11]. This is in line with patients with brain tumours of different origins than LGG [1, 47]. Unfortunately, this review was not able to distinguish the different contributions in terms of fatigue from different treatment modalities.…”

Cognitive functioning following brain irradiation as part of cancer treatment: Characterizing better cognitive performance

“…Survivors in the better‐performing group scored 7.5 points higher on fatigue (indicative of less fatigue) than those in the poorer‐performing group—differences that are clinically meaningful . Although it is possible that fatigue may have suppressed the effects of RT on cognition (as it is a common side effect of RT), we found that this was not the case—fatigue was not significantly associated with RT type ( r = −0.01) or use of sedating medications ( r = −0.1).…”

“…Specifically, our findings suggest that interventions to reduce modifiable factors such as fatigue in survivors postbrain RT may help buffer the neurotoxic effects of RT . Fatigue is common and persistent in this population, with more than 80% of brain tumor survivors experiencing fatigue during treatment and another 39% experiencing fatigue up to 8 years posttreatment . Patients also rate fatigue as more distressing than other treatment‐related side effects of pain, nausea, and vomiting .…”

“…Patients also rate fatigue as more distressing than other treatment‐related side effects of pain, nausea, and vomiting . Yet, it is well‐established that fatigue remains under‐diagnosed and under‐treated in this population …”

“…Given the importance of cognitive functioning in daily living, clinicians may be able to better protect it if they screen and monitor fatigue/vitality during and after RT, with a particular attention to those with greater cognitive deficits and fatigue. The National Comprehensive Cancer Network (2019) provides recommendations for assessment and management of cancer‐related fatigue that could be applied to this population.…”