Introduction

Fatigue has been identified as the most distressing and prevalent cancer-related symptom in a variety of cancer populations. Incidence of cancer-related fatigue ranges from 40 to 100 , depending on cancer diagnoses, treatment modalities, and disease stages (Berger 1998 Fu et al. 2002 Hickok et al. 1996 Hinds et al. 1999 Schag et al. 1994 Porock et al. 2000 Winningham et al. 1994). People with cancer describe their fatigue experience as being different from the fatigue that healthy people...

Is fatigue a biologically appropriate response to cancer and therapy

This teleological question may appear an irrelevant question to ask of a clinical symptom, but it addresses whether non-exercise-induced fatigue may have a 'useful' (or at the least a non-disadvantageous) function to an animal otherwise why would we have the capacity to generate or express this state To illustrate the importance of this question consider the nausea and vomiting associated with cancer chemo- and radiotherapy. These symptoms are now thought to be due to inappropriate activation...

Progesterone derivatives

Weight gain and appetite stimulation are now recognized as secondary effects of treatment for hormone-sensitive cancers using progesterone derivatives (Gregory et al. 1985 Tchekmedyian et al. 1987). Randomized controlled trials have been conducted to evaluate the efficacy of megestrol acetate (MA) and medroxyprogesterone (MPA) (Downer et al. 1993) as appetite stimulants (Simons et al. 1996). In some studies weight gain seems to be related to a gain in fat mass (Lambert et al. 2002 Engelson et...

Definitions and descriptions

The work undertaken by Hockenberry and colleagues has led to an appreciation of fatigue as a debilitating, functionally limiting problem for children and adolescents with cancer, which has a negative impact on the ability to participate in normal daily activities. Descriptions and reports of fatigue found in this group were similar to those identified by children with chronic fatigue syndrome (CFS) (Walford et al. 1993 Carter et al. 1995, 1996, 1999), as well as by adults with cancer (Knoff...

A model of the relationship between capacity and performance

Figure 13.1 presents the hypothesized relationships between fatigue as a symptom experience, capacity for action, and functional performance. The symptom experience of fatigue refers to the intensity, severity, and duration of fatigue. Capacity for action includes, but is not limited to, the motor and cognitive components necessary for functional performance. Motor components include range of motion, muscle strength, A MODEL OF THE RELATIONSHIP BETWEEN CAPACITY AND PERFORMANCE 281 Fig. 13.1...

Models of fatigue

Models have been developed for the development of fatigue in non-cancer and cancer patients. Our review of fatigue unrelated to cancer indicates that predisposed individuals (perhaps with a genetic vulnerability, previous experience of ill-health in childhood, or a past psychiatric disorder) who are confronted by an acute stressor (for example a serious viral illness, surgery, or stress from a life event) may develop fatigue, and this fatigue is more likely to become chronic if they respond by...

References

Akechi, T., Kugaya, A., Okamura, H., Yamawaki, S., and Uchitomi, Y. (1999) Fatigue and its associated factors in ambulatory cancer patients a preliminary study. Journal of Pain and Symptom Management, 17,42-8. Andrykowski, M.A., Curran, S.L., and Lightner, R. (1998) Off-treatment fatigue in breast cancer survivors a controlled comparison. Journal of Behavioral Medicine, 21, 1-18. Ashbury, F.D., Findlay, H., Reynolds, B., and McKerracher, K. (1998) A Canadian survey of cancer patients'...

Beneficial effects of exercise in individuals with cancer

The benefits of exercise are the same for people with cancer as for healthy people. Research on the impact of exercise and physical activity on cancer-related fatigue has been undertaken with patients receiving, or those who have completed, treatment. Most intervention studies have been conducted with patients undergoing treatment for breast cancer and or receiving bone marrow transplantation (MacVicar and Winningham 1986 Mock et al. 1994, 1997 Schwartz 2000). All of these studies used...

Progestational steroids

Progestational steroids such as medroxyprogesterone acetate (MPA) or megestrol acetate (MA) are often used as hormone therapy for cancers of the breast, prostate, endometrium, or kidney. However, these drugs have also been used for symptomatic relief of anorexia and cachexia, and a number of randomized controlled trials have demonstrated their effectiveness for this indication (Bruera et al. 1990 Tchekmedyian et al. 1992 Downer et al. 1993 Loprinzi et al. 1993 Gebbia et al. 1996 Simons et al....

List of Contributors

Clinical Instructor Department of Pediatrics Baylor College of Medicine, Houston Texas, USA Professor of Comparative Physiology Department of Basic Medical Sciences St George's Hospital Medical School Cranmer Terrace London, UK Cancer Research UK Nursing Research Fellow Department of Palliative Care and Policy Guy's, King's and St Thomas' School of Research Coordinator Department of Pediatrics Baylor College of Medicine, Houston Texas, USA Clinical Instructor Department of Pediatrics Baylor...

Implications for practice

Fatigue assessment and prescriptions for managing fatigue should be a vital aspect of care for cancer patients and survivors during treatment and follow-up care. Exercise and physical activity should be considered as an important fatigue management strategy. Prescription of exercise or physical activities should consider individual health status, exercise type, intensity, duration, frequency, and progression. Table 14.4 lists suggested considerations when prescribing exercise and physical...

What are the conceptual similarities and differences between fatigue and depression

In order to understand the conceptual similarities and differences between depression and fatigue, it is necessary to consider how these two concepts have been defined. Our approach to this issue focuses on the different ways in which fatigue and depression have been assessed in cancer patients. Three distinct approaches to the measurement of depression can be identified the single-symptom approach, the symptom cluster approach, and the clinical syndrome approach. The single-symptom approach...

The validity and reliability of fatigue questionnaires

Nineteen self-report instruments available in English were identified in the CRF literature from 1980 to present. Table 9.1 summarizes their properties. They are grouped into multiple categories in the table, depending on whether they consist of a single fatigue item or multiple items, are incorporated in another instrument or are freestanding, and are uni- or multidimensional measures of fatigue. The four single-item measures of fatigue are the Rhoten Fatigue Scale RFS Rhoten 1982 , Visual...

HT agonists exercise duration

5-HT receptor down-regulation in trained athletes Fig. 3.5 Summary of the possible involvement of brain 5-hydroxytryptamine 5-HT and the hypothalamic-pituitary axis HPA in the genesis of fatigue induced by exercise and associated with chronic fatigue syndrome CFS . L-tryptophan the precursor for 5-HT synthesis and branched chain amino acids BCAA compete for the same transporter into the brain so that when muscles are exercising and using BCAA more L-tryptophan is able to enter the brain via the...