User:Anthonyhcole/Cancer-related fatigue

Notes from Fitzgibbon & Loeser 2010 page 26"Cancer-rlated fatigue (CRF) is a common, persistent, and subjective sense of tiredness related to cancer or treatment for cancer that interferes with usual functioning. (Citing Mock V, Atkinson A, Barsevick A, et al. (2001) NCCN practice guidelines for cancer-related fatigue. Oncology. Williston Park '14 151-161.) Although fatigue is a common symptom during cancer treatment and in cancer survivors, it may also occur in patients before initiastion of treatment. It can also be a long-term (>5 years> problem in survivors. [...] By altering a person's ability to engage in meaningful personal, work and social activities, CRF can have a major negative impact on QoL. Fatigue is frequently one of the initial symptoms experienced by patients and tends to increase with the progression of cancer and cancer treatment. [...] In addition to the direct impact from cancer, various treatment modalities, particularly chemotherapy and radiation, are known to cause fatigue for many patients for an extended period of time. It is estimated that fatigue is present at the time of diagnosis in approximately 50% of cancer patients. It occurs in up to 75% of patients if bone metastases already are present. An estimated 60% to 96% of cancer patients in treatment experience fatigue, including 60% to 93% of patients on radiation therapy and 80% to 96% of patients on chemotherapy." page 27 The pathogenisis of fatigue in patients with cancer is not well understood, but proposed mechanisms include the direct effect of cancer and the various modes of cancer treatment plus a wide variety of concomitant diseases (such as anemia, infections, dehydration, and electrolyte disorders), sleep disorders, chronic pain, immobility and lack of exercise, and a variety of psychosocial disorders. [...] There is no agreement on the best pharmacologic treatment for CRF. There is little evidence that methylphenidate is effective, although hematopoietic agents (erythropoietin, darbepoietin,) appear to relieve fatigue associated with chemotherapy-induced anemia. Antidepressant studies have shown mixed results. Paroxetins seems to show benefit for fatigue primarily when it is a symptomof clinical depression. Bupropion, a norepinephrine/dopamine reuptake inhibitor, may have psychostimulant-like effects, and therefore may be more beneficial for treating fatigue. Modafinil has been used to treat fatigue associated with neurodegenerative disorders such as multiple sclerosis and amyotrophic lateral sclerosis. It is now being increasingly used for cancer-related symptoms targeted by psychostimulants. Preliminary evidence suggests that modafinil is efficacious in improving opioid-induced sedation, cancer-related fatigue, and depression.