Infographic with pictograms and captions: "no or little motivation; lack of concentration; inability to make decisions; short-term memory".

Fatigue in cancer: Just be tired?

Many peo­p­le are fami­li­ar with the sym­ptoms of exhaus­ti­on. Howe­ver, exhaus­ti­on that occurs in con­nec­tion with ill­nesses is refer­red to as fati­gue. It can be long-las­ting and even chro­nic, and many peo­p­le suf­fer from it. The cau­ses ran­ge from sleep dis­or­ders, stress and defi­ci­en­ci­es to a num­ber of dif­fe­rent dise­a­ses such as cancer.

The term “fati­gue” comes from the French lan­guage and lite­ral­ly means “tired­ness” or “exhaus­ti­on”. In addi­ti­on, fati­gue syn­dro­me is a com­mon sym­ptom in the popu­la­ti­on and in medi­cal prac­ti­ce. It occurs in dif­fe­rent cli­ni­cal pic­tures and can be very pro­no­un­ced. Some­ti­mes so strong that pati­ents feel serious­ly ill. Fati­gue can have many cau­ses. A spe­ci­fic cau­se can­not be iden­ti­fied. The­r­e­fo­re, the syn­dro­me is not easy to explain and under­stand. Fati­gue asso­cia­ted with chro­nic dise­a­se often impro­ves with tre­at­ment of the dise­a­se itself.

Frequency and Symptoms

The dise­a­se occurs world­wi­de and has a pre­va­lence of 0.2 — 0.4%, i.e. the pro­por­ti­on of peo­p­le with the dise­a­se in the total popu­la­ti­on. Accor­ding to con­sen­sus esti­ma­tes, almost half a mil­li­on peo­p­le in Ger­ma­ny suf­fer from Chro­nic Fati­gue Syn­dro­me, or CFS for short. Doc­tors often speak of myal­gic ence­pha­lo­mye­li­tis (ME). ME/CFS can lead to signi­fi­cant limi­ta­ti­ons in ever­y­day life. The World Health Orga­niza­ti­on (WHO) clas­si­fied ME/CFS as a ner­vous sys­tem dise­a­se in 1969. In the ICD (Inter­na­tio­nal Clas­si­fi­ca­ti­on of Dise­a­ses) it is coded under G93.3 as a neu­ro­lo­gi­cal disease.

Tho­se affec­ted often suf­fer from seve­re phy­si­cal weak­ne­ss, fati­gue and lack of strength for years. The­re are also sym­ptoms such as hea­da­ches and joint pain or cogni­ti­ve impairm­ents. For the majo­ri­ty of tho­se affec­ted, who are usual­ly dia­gno­sed at a young age bet­ween 20 and 40, CFS often means the abrupt end of their pro­fes­sio­nal and/or social life. Many of tho­se affec­ted beco­me unable to work, and some even requi­re care. The qua­li­ty of life of pati­ents with CFS is often worse than that of advan­ced can­cer pati­ents. So what does it look like when fati­gue appears par­al­lel to a tumor disease.

Tumor-Associated Fatigue

An often lea­den “fati­gue” that impairs both phy­si­cal and men­tal per­for­mance and can­not be explai­ned by lack of sleep or hea­vy stress: This is fati­gue that also dif­fers from “nor­mal” tired­ness (lack of sleep) or exhaus­ti­on (due to seve­re load) dif­fers. Fati­gue is one of the most com­mon and distres­sing sym­ptoms of can­cer that pati­ents have to strugg­le with. Most can­cer pati­ents return to their ori­gi­nal ener­gy levels within a year of com­ple­ting tumor tre­at­ment. Howe­ver, more recent stu­dies show that around 30% of pati­ents con­ti­nue to suf­fer from seve­re fati­gue and the life rest­ric­tions it cau­ses, even seve­ral years after treatment.

Sin­ce the cau­ses of fati­gue are mul­ti­fac­to­ri­al, COVID-19 dise­a­se can also be asso­cia­ted with the syn­dro­me. CFS can deve­lop after various serious viral infec­tions, such as the flu or COVID-19. Infec­tion can be the trig­ger, espe­ci­al­ly if you have can­cer. A not insi­gni­fi­cant pro­por­ti­on of our pati­ents show the full pic­tu­re of a CFS. Unfort­u­na­te­ly, it is still not exact­ly known why about a third of pati­ents deve­lop this chro­nic fati­gue. Howe­ver, the­re are various the­ra­py modu­les that can be used to impro­ve the sym­ptoms of fati­gue. The grue­ling sta­te of exhaus­ti­on often impro­ves again after a few weeks or months.

Fatigue management in cancer — What happens in the consultation?

When you come to a fati­gue con­sul­ta­ti­on, the sus­pi­ci­on has ari­sen in advan­ce through dis­cus­sions and ques­ti­on­n­aires that chro­nic tumor-asso­cia­ted fati­gue exists. Per­haps you have been fee­ling less pro­duc­ti­ve for a long time, often exhaus­ted and weak, and you have not been able to regain your old ener­gy level even after the end of the tumor the­ra­py. In the fol­lo­wing sec­tion you will learn how a typi­cal fati­gue con­sul­ta­ti­on works.

During the con­sul­ta­ti­on, your cur­rent (fati­gue) sym­ptoms will first be dis­cus­sed tog­e­ther, and the cour­se of the dise­a­se as well as rein­for­cing and reli­e­ving fac­tors or the­ra­pies will be ana­ly­sed. Your medi­cal histo­ry and the dia­gno­stics that have alre­a­dy been car­ri­ed out will be asses­sed. In par­ti­cu­lar, to be able to rule out addi­tio­nal fac­tors such as hypo­func­tion of the thy­ro­id gland, anemia and the like or to be able to tre­at them cor­rect­ly. If a modu­le is still miss­ing in the dia­gno­stics, it can be added if neces­sa­ry. In the next step, your trea­ting doc­tor would like to dis­cuss with you how you assess your fati­gue and offer you fur­ther infor­ma­ti­on on chro­nic tumor fati­gue in gene­ral and pos­si­ble the­ra­py stra­te­gies. This results in an indi­vi­du­al the­ra­py plan, which is made up of various com­pon­ents (e.g. sport, rela­xa­ti­on methods, medi­ca­ti­on, nut­ri­ti­on). Unfort­u­na­te­ly, fati­gue can­not be cured direct­ly at the moment, only the sym­ptoms can be trea­ted, cir­cu­la­to­ry pro­blems, pain, seve­re sleep dis­or­ders, defi­ci­en­ci­es such as vit­amin D defi­ci­en­cy, folic acid or sele­ni­um defi­ci­en­cy. It is also very important to avo­id over­ex­er­ti­on, which repea­ted­ly leads to seve­re fla­re-ups, and to learn rela­xa­ti­on tech­ni­ques, for exam­p­le through breathing exer­ci­s­es. That’s easier said than done, becau­se it’s main­ly young peo­p­le who want to work or have to look after child­ren who are affec­ted. But an important the­ra­peu­tic prin­ci­ple at the begin­ning is that you first bring in peace.

Over a lon­ger peri­od of time (e.g. 1 year), you will recei­ve a fati­gue ques­ti­on­n­aire about your cour­se every three months in order to be able to assess the effec­ti­ve­ness of the the­ra­pies. After six and twel­ve months, you will come back to the fati­gue con­sul­ta­ti­on for an inter­view. The­re, the atten­ding phy­si­ci­ans would like to know how you are doing with regard to fati­gue, which the­ra­py modu­les have work­ed well or in which points we should chan­ge or adapt the therapy.

10 facts about fatigue in cancer

  1. Fati­gue is a com­mon sym­ptom during and even many years after a tumor disease
  2. Fati­gue is more than “simp­le tiredness”
  3. The­re are many cau­ses of fatigue
  4. Careful medi­cal histo­ry is important
  5. Fati­gue is often the sym­ptom that affects peo­p­le the most in ever­y­day life
  6. The­ra­py is based on seve­ral pil­lars of sym­ptom relief
  7. The the­ra­py plan depends on the indi­vi­du­al sym­ptoms and the respec­ti­ve situa­ti­on of the patient
  8. The­ra­py should be adjus­ted over time
  9. The cau­se of (tumour-rela­ted) fati­gue is not yet well unders­tood scientifically
  10. It’s often easier tog­e­ther — self-help groups, the­ra­py groups, coope­ra­ti­on bet­ween therapists


Fati­gue Cen­ter at the Cha­ri­té

Fati­gue Cen­ter at the Munich Cli­nic r.d. Isar

Gui­de­line “Long-/Post-COVID-Syn­dro­me“–027p_S1_Post_COVID_Long_COVID_2021-12.pdf

Health City Ber­lin

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