Can You Help Me Feel Less Exhausted All the Time?

Abstract

A 64-year-old woman with metastatic rectal cancer is admitted to the acute palliative care unit of our cancer center because of debilitating fatigue. She had been diagnosed with metastatic disease in 2009, when liver metastases were found 1 year after the primary treatment of her rectal cancer with preoperative radiotherapy and low anterior resection. Since then, she had been treated with resection of liver metastases in 2009 and 2010, palliative combination chemotherapy (oxaliplatin plus capecitabine) after the diagnosis of new liver and lung metastases in 2010, irinotecan in 2011, and then cetuximab until progression. She declined participation in a phase I clinical trial because she was afraid of experiencing adverse effects; she felt relatively well at the time. She had functioned without hindering symptoms until 2 weeks before admission. Her condition had deteriorated markedly since then. At admission, she is bedridden because of progressive fatigue. Furthermore, she complains of dyspnea and nausea and vomits approximately twice per day. She also suffers from pain in the upper abdomen, especially when rising from the bed. She is no longer able to care for her 84-year-old husband or her 40-year-old mentally disabled son, who lives with them. She is aware of her poor prognosis but is not able to share her sorrows with her family.

A randomized, placebo-controlled pilot trial of armodafinil for fatigue in patients with gliomas undergoing radiotherapy

“…Corticosteroids have been reported to improve fatigue in the general cancer population. 17 A double-blind, randomized, placebo-controlled study of dexamethasone (4 mg twice daily for 14 days) in 84 patients with advanced cancer revealed a significant improvement in FACIT-F. 18 As many glioma patients are already on dexamethasone for management of cerebral edema, it is unclear if increasing the dose of dexamethasone would be a meaningful intervention for fatigue. Our study was not designed to examine the role of steroids in fatigue.…”

The relationship between pro-inflammatory cytokines and pain, appetite and fatigue in patients with advanced cancer

“…In patients with advanced cancer, intensity of fatigue has been associated with other symptoms, in particular pain, dyspnoea, anorexia, psychological distress, and insomnia [39]. Fatigue is commonly described in symptom clusters with pain [40, 41], and indeed the primary trial was a pain intervention trial.…”

Medical management of brain tumors and the sequelae of treatment

“…Few studies have evaluated pharmacological and/or nonpharmacological interventions for fatigue in brain tumor patients (Table 6), but the literature in the general cancer population is more extensive. 176 Favorable effects on fatigue have been reported with exercise, psychoeducation on self-management of fatigue, and corticosteroids. 176 A meta-analysis found aerobic exercise to be more effective than the control intervention for fatigue during and following tumor-directed therapy, especially in solid tumor patients.…”

“…176 Favorable effects on fatigue have been reported with exercise, psychoeducation on self-management of fatigue, and corticosteroids. 176 A meta-analysis found aerobic exercise to be more effective than the control intervention for fatigue during and following tumor-directed therapy, especially in solid tumor patients. 177 However, the optimal type, intensity, and timing of exercise are not known.…”