Why consider fatigue in cancer

In Western societies one in three people will experience cancer at some point in their lifetime, and one in four will die from it (Higginson 1997). In England and Wales there are 220 000 new cases of cancer per year, and around 140 000 deaths from cancer. Cancer accounts for around 22% of all deaths within developed countries and 9.5% of deaths within developing countries (Stjernsward and Pampallona 1998).

In the future cancer is predicted to increase worldwide, with cancer of the lung, trachea and bronchus alone rising to the fifth most common form of death globally in 2020 (Murray and Lopez 1997a,b, 2000). In 2015 predictions estimate that almost 14% of deaths in developed countries and around 28% in developing countries will be due to cancer (Stjernsward and Pampallona 1998). Cancer affects people of all ages, from children and adolescents through to the very old, although most people who suffer cancer are in the older age groups, over 65 or 75 years of age (Higginson 1997).

Cancer is characterized by multiple symptoms, caused by the primary tumour, metastasis, and the side-effects of treatment, be it surgery, radiotherapy, or chemotherapy. Symptoms also result from the emotional, social, and spiritual effects of cancer and its treatment. They can also be caused by, or exacerbate, pre-existing illness, especially in older people who may have other chronic conditions. Sometimes symptoms can be devastating. Suffering can extend beyond the person directly affected to family members, friends, and anyone involved in caring for the person.

It is in this context that this book considers an important symptom—that of fatigue. Patients, caregivers, and oncology health professionals now are realizing a consensus that fatigue is one of the most important symptoms of cancer today (Curt 2001). In advanced cancer, many studies have found that fatigue (or weakness, or asthenia) is the most common symptom (Coyle et al. 1990; Edmonds et al. 1998; Connill et al. 1997). This is consistent in different cultures (Koffman et al. 2003).

Cancer-related fatigue is emerging now partly because the management of many other symptoms, particularly pain, nausea, and vomiting, has improved, and partly because until recently cancer-related fatigue was something to be endured rather than a symptom amenable to differential diagnosis and treatment. Only recently has the problem been considered as real, and still it is too seldom discussed and treated (Curt 2001).

This book challenges this relative neglect, and gathers together the main evidence regarding the epidemiology, pathophysiological mechanisms, associated factors and symptoms, meaning, assessment, and treatment options of fatigue in cancer.

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