Fortbildungen / Formations continues 2012 - IUMSP

cer Center was founded in 1998 with the purpose of improving
patients’ quality of life by decreasing fatigue (49).
Data on 260 patients treated in the Fatigue Clinic were
recently reported. The most common interventions employed
were energy conservation, sleep hygiene, exercise
and relaxations. Among the patients who attended followup
59% achieved signi�cant fatigue reduction (23).
Multidimensional consequences of fatigue
There is increased recognition that the symptoms, which
are part of the illness manifestation, and the illness perceptions
are socially constructed and thus may change
across social contexts. The role of beliefs and values in
influencing individuals’ adaptation to social, political,
economical structures as well as to illness has been recognized
by social scientists (50).
Describing and understanding what happens to individuals
and their families as a result of fatigue and identifying
what individuals do to manage or reduce the impact of fatigue
are essential elements in determining multidimensional
interventions. The assessment of personal meaning
and suffering related to fatigue has been described as an
important component of the multidimensional assessment
of fatigue. Borneman et al interviewed an ambulatory cancer
population and coded the given answers following different
themes. Results demonstrate a negative impact of
fatigue on patients’ overall well-being altering the meaning
and suffering related to the cancer experience (51).
Data from the literature highlights a different attitude
among patients experiencing fatigue: some of them tend
to consider it as an inconvenience and a frustration that
had to be dealt with. Some others are able to gradually
adjust and accommodate to fatigue. Different attitudes,
in the few literature data published up to now, is demonstrated
by the families: in a Canadian exploratory study,
nearly 50% of the family members felt more of the impact
of fatigue than did their loved ones. Family subtly
assumed or took over responsibilities and activities the
patient could no longer perform (52). In a study conducted
upon a population of breast cancer survivals and their
families, the �ndings describe the dif�culties in family
adaptation when the family is not able to assign a clear
meaning to a chronic post-treatment symptom and build
upon family stress. A part of the families tended to shift
roles in the family system.
In the �nal weeks of life fatigue could represent a «natural
protection» that nature put in place in order to protect the
patient from activities and exceeding psycho-activation,
possibly resulting in an increasing burden of sufferance.
For this reason in some cases it may be inappropriate to
counteract arti�cially this process that characterizes the
�nal stage of life.
In conclusion a considerable burden is generated by fatigue
and, given that perception about illness and health
care are strongly tied to individuals’ beliefs and values,
different physical, emotional and spiritual mechanisms
are activated both in the patients and in the family system
to adapt. Interventions should be «ecological» and attuned
to the specific beliefs and values of the patients (50).
Key Learning Points
ORIGINALARTIKEL
- Fatigue is the most common and under-diagnosed
symptom in advanced cancer with multidimensional
consequences
- It is a symptom with speci�c characteristic and it is not
simple tiredness
- Assessment of fatigue should depend on subjective selfevaluation
by the patient and patients must be routinely
screened for this symptom
- Reversible causes must be detected and treated
- Psycho-stimulants may be used with success, even if it
is suggested upon expert opinion’ basis and no current
trials demonstrated conclusive positive results
- Steroids can be used for short periods of time. In long
term therapies they promote insulin resistance (aggravating
cachexia), proximal myopathy and increased risk
for infections
- In the final stages of life, fatigue may provide protection
and shielding from suffering for the patient and
treatment of fatigue may be detrimental
Literature
1. Campos MPO et al. Cancer-related fatigue: a practical review. Ann
Oncol 2011; 22: 1273-1279
2. Scialla SJ. Rede�ning cancer-related Asthenia-fatigue syndrome. J
Pall Med 2006; 9(4):866-872
3. Radbruch L et al. Fatigue in palliative care patients-an EAPC
approach. Palliat Med 2008; 22(1): 13-32
4. Brown LF et Kroenke K. Cancer-related fatigue and its associations
with depression and anxiety: a systematic review. Psychosom 2009;
50(5): 440-447
5. Mock V et al. NCCN practice guidelines for cancer-related fatigue.
Oncology 2000; 14(11A): 151-161
6. http://www.nccn.org. NCCN Cancer-related fatigue. Version 1.2010
7. Stone P et al. Fatigue in patients with cancer. Eur J Cancer 1998;
34: 1670-1676
8. Stone P et Minton O. Cancer-related fatigue. Eur J Cancer 2008 ;
44: 1097-1104
9. Moss RB et al. TNF-alpha and chronic fatigue syndrome. J Clin
Immunol 1999; 19: 314-316
10. Geinitz H et al. Fatigue, serum cytokines level and blood cell
counts during radiotherapy of patients with breast cancer. Int J Radiat
Oncol Biol Phys 2001; 51(3): 691-698
11. Mills PJ et al. The relationship between fatigue and quality of life
and in�ammation during anthracyclines-based chemotherapy in breast
cancer. Biol Psychol 2005; 69(1): 85-96
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