Pathophysiology of Cancer-Related Fatigue

Wang, Xin Shelley

doi:10.1188/08.cjon.s2.11-20

Cited by 115 publications

(105 citation statements)

References 115 publications

(127 reference statements)

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“…Usually, it comes on suddenly, does not result from activity or exertion, and is not relieved by rest or sleep [45]. Compelling new hypotheses regarding CRF pathophysiology have been proposed, such as the proinflammatory hypothesis, the serotonin hypothesis, the vagal-afferent-activation hypothesis, the anemia hypothesis, and the adenosine triphosphate hypothesis [46]; however, a consensus has not been reached in regard to the development of CRF. Better understanding of the specific mechanisms related to the development of fatigue in patients with cancer requires further investigations.…”

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confidence: 99%

Symptoms and quality of life of advanced cancer patients at home: a cross-sectional study in Shanghai, China

Wang

Shen

2010

Support Care Cancer

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The patients had relatively poorer QOL as compared with the US and Australian general populations. The factors related to QOL need to be considered in the palliative care of Chinese advanced cancer patients at home. QOL improvement can be achieved to some extent by effective symptom management, especially by alleviating emotional distress. The cut-point for QOL was statistically significant, and further studies are needed to define a clinically meaningful cut-point.

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Section: Itemmentioning

confidence: 99%

Symptoms and quality of life of advanced cancer patients at home: a cross-sectional study in Shanghai, China

Wang

Shen

2010

Support Care Cancer

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“…Cachexia not only increases the likelihood of morbidity from cancer but also is directly responsible for 20 -40% of deaths in cachectic patients (37). Cachexia is a detrimental syndrome, negatively affecting patient quality of life and the potential for recovery (14,41). Understanding the molecular mechanisms of cancer cachexia could assist in creating effective therapies to improve survival and quality of life in these patients.…”

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confidence: 99%

Metalloproteinase expression is altered in cardiac and skeletal muscle in cancer cachexia

Devine

Bicer

Reiser

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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Cardiac and skeletal muscle dysfunction is a recognized effect of cancerinduced cachexia, with alterations in heart function leading to heart failure and negatively impacting patient morbidity. Cachexia is a complex and multifaceted disease state with several potential contributors to cardiac and skeletal muscle dysfunction. Matrix metalloproteinases (MMPs) are a family of enzymes capable of degrading components of the extracellular matrix (ECM). Changes to the ECM cause disruption both in the connections between cells at the basement membrane and in cell-to-cell interactions. In the present study, we used a murine model of C26 adenocarcinoma-induced cancer cachexia to determine changes in MMP gene and protein expression in cardiac and skeletal muscle. We analyzed MMP-2, MMP-3, MMP-9, and MMP-14 as they have been shown to contribute to both cardiac and skeletal muscle ECM changes and, thereby, to pathology in models of heart failure and muscular dystrophy. In our model, cardiac and skeletal muscles showed a significant increase in RNA and protein levels of several MMPs and tissue inhibitors of metalloproteinases. Cardiac muscle showed significant protein increases in MMP-2, MMP-3, MMP-9, and MMP-14, whereas skeletal muscles showed increases in MMP-2, MMP-3, and MMP-14. Furthermore, collagen deposition was increased after C26 adenocarcinoma-induced cancer cachexia as indicated by an increased left ventricular picrosirius red-positive-stained area. Increases in serum hydroxyproline suggest increased collagen turnover, implicating skeletal muscle remodeling. Our findings demonstrate that cancer cachexia-associated matrix remodeling results in cardiac fibrosis and possible skeletal muscle remodeling. With these findings, MMPs represent a possible therapeutic target for the treatment of cancer-induced cachexia.

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“…15 Fatigue management is difficult in oncology patient care, both for patients being actively treated and for cancer survivors. Despite the possibility of placebo effect (especially in patients with worse symptoms at baseline) in clinical trials of fatigue treatment, 16 theory-driven individualized TCM practice appears to be a highly plausible treatment method, with integral control of the body plus pharmacologic effects that nonetheless need to be well defined.…”

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confidence: 99%

Ren Shen Yangrong Tang for Fatigue in Cancer Survivors: A Phase I/II Open-Label Study

Chen

et al. 2015

The Journal of Alternative and Complementary Medicine

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Objectives: This open-label, prospective, phase I/II trial was performed to establish the safety and efficacy of Traditional Chinese Medicine (TCM) herbal products for treating non-anemia-related fatigue in patients with cancer. Although this practice is widespread in China, it has not been confirmed in a prospective clinical study. Design: Thirty-three patients who had completed cancer treatment, had stable disease and no anemia, and reported moderate to severe fatigue (rated ‡ 4 on a 0-10 scale) were enrolled in a TCM outpatient clinic. Patients took Ren Shen Yangrong Tang (RSYRT) decoction, a soup containing 12 TCM herbs, twice a day for 6 weeks. RSYRT aims to correct qi deficiency. Fatigue was assessed before and after RSYRT therapy, which all patients completed. Results: No discomfort or toxicity was observed. Before the study, all patients had had fatigue for at least 4 months. Fatigue severity decreased significantly from before therapy to 6 weeks after therapy: from 7.06 to 3.30 on a 0-10 scale ( p < 0.001). Fatigue category (mild, moderate, severe) shifted significantly (p = 0.024): Of 22 patients with severe fatigue (rated ‡ 7) before therapy, 11 had mild fatigue and 11 had moderate fatigue after TCM treatment. The time-to-fatigue-alleviation was 2-3 weeks. Conclusion: RSYRT therapy was safe and was associated with fatigue improvement in nonanemic cancer survivors, consistent with historical TCM clinical practice experience. Because of a possible placebo effect in this open-label study, decoction RSYRT warrants further study in randomized clinical trials to confirm its effectiveness for managing moderate to severe fatigue.

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Pathophysiology of Cancer-Related Fatigue

Cited by 115 publications

References 115 publications

Symptoms and quality of life of advanced cancer patients at home: a cross-sectional study in Shanghai, China

Symptoms and quality of life of advanced cancer patients at home: a cross-sectional study in Shanghai, China

Metalloproteinase expression is altered in cardiac and skeletal muscle in cancer cachexia

Ren Shen Yangrong Tang for Fatigue in Cancer Survivors: A Phase I/II Open-Label Study

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