Management of Fatigue in Patients with Advanced Cancer

Abstract

Opinion statementFatigue is a common and distressing symptom experienced by patients with cancer. It is most common in patients with locally advanced or metastatic incurable disease. It can have profound effects on quality-of-life and physical functioning. In addition to general supportive measures (directed at tackling contributory conditions and comorbidities), a variety of specific interventions have been developed which can be broadly categorised as physical therapies, psychological therapies or medication. There is some evidence that each of these approaches can have benefits in patients with earlier stage disease, those undergoing active treatment and in cancer survivors. The best evidence is for aerobic exercise, yoga, cognitive-behavioural therapy (CBT) and psycho-educational interventions. Less strong evidence supports the use of medications such as methylphenidate or ginseng. In patients with advanced disease, it is likely that the mechanisms of fatigue or the factors contributing to fatigue maintenance may be different. Relatively fewer studies have been undertaken in this group and the evidence is correspondingly weaker. The authors recommend the cautious use of aerobic exercise (e.g. walking) in those who are still mobile. The authors advise considering the use of psycho-educational approaches or CBT in those patients who are able to engage in such forms of therapy. In patients near the end-of-life, the authors advise use of dexamethasone (short-term use) and other pharmacological treatments only on the basis of a clinical trial.

Feasibility of a physical exercise intervention for patients on a palliative care unit: a critical analysis

“…The most common adverse events having a likely or proven connection to the intervention were fatigue, weakness, and myalgia, however reversible by rest. Especially fatigue, though, is a common symptom in advanced cancer patients and often not completely reversible by rest [ 45 ]. Exercise has been found to be helpful for treatment [ 45 ] but in line with our findings and previous data, it may also acutely deteriorate fatigue [ 46 ].…”

“…Especially fatigue, though, is a common symptom in advanced cancer patients and often not completely reversible by rest [ 45 ]. Exercise has been found to be helpful for treatment [ 45 ] but in line with our findings and previous data, it may also acutely deteriorate fatigue [ 46 ]. In order to measure the effects of exercise in PCU patients on acute and chronic fatigue we recommend to asses fatigue in upcoming trials with scores like the PROMIS cancer fatigue short form [ 47 ].…”

Methylphenidate Versus Placebo for Treating Fatigue in Patients With Advanced Cancer: Randomized, Double-Blind, Multicenter, Placebo-Controlled Trial

“…Cancer-related fatigue (CRF) is common and distressing. 1 It is more prevalent and severe in patients with advanced cancer 2 and those receiving palliative care. 3 , 4 Treatment options are limited.…”

Putting Methylphenidate for Cancer-Related Fatigue to Rest?

“…2 Despite lack of overt endorsement from guidelines and scant evidence for their benefit, psychostimulants, and particularly methylphenidate, are widely used for CRF, especially in individuals with advanced cancer receiving palliative care. [10][11][12][13] Methylphenidate is a CNS stimulant that increases dopamine and norepinephrine levels via reuptake inhibition, mainly in the prefrontal cortex. 14 In its immediate-release formulation, peak serum concentrations are typically reached within 2 hours and the duration of action is 2-4 hours.…”