Cancer Related Fatigue

In this episode of Kessler Foundation's podcast, Ashish Khanna, MD, attending physician, Cancer Rehabilitation, Kessler Institute for Rehabilitation, presents on "Cancer Related Fatigue," a common symptom that cancer patients complain about.

This is part one of a five part series. Listen to the series as it's posted.

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Below is an excerpt from the lecture.

Ashish Khanna: I'll give you a brief intro to what is cancer rehab, and why do we need it? Basically, we have a lot of patients who luckily, through advances in science, are now living many years after a cancer diagnosis, which is great. The downside of that, of course, is that many people are living with the side effects of cancer and cancer treatments. A lot of the downstream effects of cancer that people frankly never really lived long enough to experience, now we're seeing those for the first time. 

Fatigue is Common

AK: Fatigue is the most common side effect of cancer and cancer treatments. It occurs in about 60 to 96 percent. That's almost 100% of patients in some studies. And then importantly, it may persist for months or even years after successful treatment completion. Right? So 30% of patients in one study continued to report fatigue 1 to 5 years after diagnosis, and then 63% of them even after 5 years, so from 5 to 10 years they continued to feel fatigued.

This is another interesting study I put in this talk just because I think it's kind of illustrative. It's an old one now from 2000. But these guys, they looked at 538 cancer patients. And then let's look at-- and this is a viewpoint study. Right? From the oncologist's point of view, and I would expand this to say all of the doctor community who are here are guilty of this, they thought that pain was more clinically relevant than fatigue. Right? So 61% of the oncologists when you asked them, "What's the most important thing that a cancer patient is dealing with?" would check the box for pain. Only 37% of people said fatigue. Now let's ask the patients. 61% of them said that fatigue affected their life every day much more than pain.

Inflammation Effecting Fatigue

AK: What does inflammation do? So this is a cycle here. It causes problems with your sleep/wake cycle, right, so decreased sleep efficiency, more time awake, increased latency to sleep, so more time spent lying in your bed staring at the ceiling counting sheep. So it affects the sleep/wake cycle. Now, that affects your neuroendocrine system, so you have a flattened cortisol response and a bunch of different issues which I won't go into. But those are basically your neuroendocrine system. And this is a cycle here. So they feed into each other. The ultimate endpoint of all of these things are these CNS effects. Oops, sorry. And then all of these CNS sort of depression, dealing with serotonin, a lot of different neurotransmitters, a lot of different stuff, results in depression, fatigue, impaired sleep, cognitive dysfunction. But this is the one we're here to talk about today, which is fatigue. All right.

So again, just mentioning it, different picture, same thing. We have cancer, infection, wounds, stress, cancer treatments. Those are going to cause immune cells to release their cytokines, and then that's going to have an effect on your central nervous system, particularly serotonin, dopamine, and cause a decreased appetite, decreased energy, those kinds of things, changes in your sleep, and impaired learning and memory. All right.

Screening Fatigue

AK: Oncology guidelines state that fatigue should be screened, assessed, and managed. All patients should be screened using age-appropriate measures. The fatigue should be evaluated, monitored, treated promptly, all that. It also says that health care professionals experienced in fatigue evaluation and management should be consulted.