You are here

Kanser hastalarında halsizlik semptomunun değerlendirilmesi ve birlikte görülen klinik problemler

Evaluation of the fatigue symptom in patients with cancer and associated clinical problems

Journal Name:

Publication Year:

Keywords (Original Language):

Author Name
Abstract (2. Language): 
Fatigue is often overlooked in the assessment although it is one of the most common complaints of the patients with cancer. It is a subjective and nonspecific complaint, which negatively affects the life of the patient. Mechanisms of fatigue are multifactorial. Chronic illnesses, treatment modalities, complications (anemia, metabolic abnormalities, …) or psychological stress may cause fatigue. Fatigue developing during chemotherapy or radiotherapy may depend on the treatment modalities administered, however, it is not easy to explain the etiology of fatigue persisting after the end of treatment. Fatigue has been found to be as a factor affecting survival negatively in studies where predicted survival is 100 days. However, most of the studies performed on patients with a predicted survival of 30 days failed to find fatigue as a major predictor of survival. Fatigue loses its prognostic significance since almost all patients with short-term survival have fatigue. Currently there are many questions remained unanswered about the pathophysiology and treatment of the fatigue in cancer patients. Why do patients continue to experience fatigue months or even years following the diagnosis and treatment of cancer? Which treatment modalities are effective in preventing or reducing fatigue? Will the treatment of fatigue be able to improve survival in patients with cancer?
Abstract (Original Language): 
Halsizlik, kanser hastalarının en yaygın semptomlarından birisi olmasına rağmen sıklıkla gözardı edilir. Hastanın yaşamını olumsuz etkileyen, spesifik olmayan, subjektif bir şikâyettir. Mekanizması çok faktörlüdür. Kronik hastalıklar, tedavi yöntemleri, ortaya çıkan komplikasyonlar (anemi, metabolik bozukluklar, …) veya psikolojik stres halsizliğe neden olabilir. Kemoterapi veya radyoterapi sırasında ortaya çıkan halsizlik, tedavi yöntemlerine bağlanabilir; fakat tedavilerin bitiminden sonra halsizliğin devam etmesinin etiyolojisini açıklamak kolay değildir. Hastaların tahmini sağkalımının 100 gün veya daha fazla olduğu çalışmalarda, halsizlik sağkalımı negatif etkileyen bir faktör olarak bulunmuştur. Fakat yaşam beklenti süresi 30 gün olan hastalarda yapılan çalışmaların çoğunda ise halsizlik sağkalımı etkileyen bir faktör olarak bulunmamıştır. Yaşam beklenti süresi kısa olan hastaların çoğunda halsizlik mevcut olduğu için, halsizlik prognostik önemini kaybeder. Günümüzde kanser hastalarında halsizliğin patofizyolojisi ve tedavisi ile ilişkili yanıtlanamamış birçok soru vardır. Niçin kanser hastalarında halsizlik tanı ve tedaviyi takiben aylar, hatta yıllarca devam ediyor? Hangi tedavi yaklaşımları halsizliğin azaltılmasında veya önlenmesinde etkindir? Halsizliğin tedavi edilmesi kanser hastalarında sağkalımı değiştirebilecek mi?
141-146

REFERENCES

References: 

1. Donnelly S, Walsh D. The symptoms of advanced cancer.
Semin Oncol 1995; 22 (Suppl 3): 67-72.
2. Stone P, Hardy J, Broadley K, Tookman AJ, Kurowska A,
A'Hern R. Fatigue in advanced cancer: a prospective controlled cross-sectional study. Br J Cancer 1999; 79: 1479-
1486.
3. Stone P, Richards M, A'Hern R, Hardy J. A study to
investigate the prevalence, severity and correlates of
fatigue among patients with cancer in comparison with a
control group of volunteers without cancer. Ann Oncol
2000; 11: 651-567.
4. Cella D, Lai JS, Chang CH, Peterman A, Slavin M.
Fatigue in cancer patients compared with fatigue in the
general United States population. Cancer 2002; 94: 528-
538.
5. Walsh D, Donnelly S, Rybicki L. The symptoms of
advanced cancer: relationship to age, gender, and performance status in 1,000 patients. Support Care Cancer
2000; 8: 175-179.
6. Lawrence DP, Kupelnick B, Miller K, et al. Evidence
report on the occurrence, assessment, and treatment of
fatigue in cancer patients. J Natl Cancer Inst MonogrCilt 50 · Sayý 2 · Gülhane TD Halsizlik semptomunun deðerlendirilmesi · 145
2004; 32: 40-50.
7. Curt GA, Breibart W, Cella D, et al. Impact of cancerrelated fatigue on the lives of patients: new findings from
the fatigue coalition. Oncologist 2000; 5: 353-360.
8. Mock V, Atkinson A, Barsevick A, et al. National
Comprehensive Cancer Network. NCCN practice
guidelines for cancer-related fatigue. Version 1 2004.
9. Jacobsen PB. Assessment of fatigue in cancer patients. J
Natl Cancer Ins Monogr 2004; 32: 93-97.
10. Donnelly S, Walsh D, Rybicki L. The symptoms of
advanced cancer: identification of clinical and research
priorities by assessment of prevalence and severity. J
Palliat Care 1995; 11: 27-32.
11. Oi-Ling K, Man-Wah DT, Kam-Hing DN. Symptom
distress as rated by advanced cancer patients, caregivers
and physicians in the last week of life. Palliat Med 2005;
19: 228-233.
12. Cella D, Davis K, Breitbart W, et al. Cancer-related
fatigue: prevalence of proposed diagnostic criteria in
United States sample of cancer survivors. J Clin Oncol
2001; 19: 3385-3391.
13. Okuyama T, Akechi T, Kugaya A, et al. Factors correlated
with fatigue in disease-free breast cancer patients: application of the Cancer Fatigue Scale. Support Care Cancer
2000; 8: 215-222.
14. Hjermstad MJ, Fossa SD, Oldervoll L, Holte H, Jacobsen
AB, Loge JH. Fatigue in long-term Hodgkin's Disease
survivors: a follow-up study. J Clin Oncol 2005; 23: 6587-
6595.
15. Vogelzang NJ, Breitbart W, Cella D, et al. The Fatigue
Coalition. Patient, caregiver, and oncologist perceptions
cancer-related fatigue: results of a tripart assessment survey. Semin Oncol 1997; 34: 4-12.
16. Cella D, Paul D, Yount S, et al. What are the most important symptoms targets when treating advanced cancer?
Survey of providers in the National Comprehensive
Cancer Network (NCCN). Cancer Investigation 2003;
21: 526-535.
17. Maltoni M, Nanni O, Scarpi E, et al. Successful validation
of the palliative prognostic score in terminally ill cancer
patients. J Pain Symptom Manage 1999; 17: 240-247.
18. Llobera J, Esteva M, Rifa J, et al. Terminal cancer: duration and prediction of survival time. Eur J Cancer 2000;
36: 2036-2043.
19. Maltoni M, Caraceni A, Brunelli C, et al. Prognostic factors in advanced cancer patients: evidence-based clinical
recomendations-a study by the Steering Commitee of the
European Association for Palliative Care. J Clin Oncol
2005; 23: 6240-6248.
20. Cleeland CS, Bennett GJ, Dantzer R, et al. Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of
cancer symptoms. Cancer 2003; 97: 2919-2925.
21. Turner R, Anglin P, Burkes R, et al. Epoetin alfa in cancer patients: evidence based guidelines. J Pain Symptom
Manage 2001; 22: 954-965.
22. Harper P, Littlewood T. Anemia of cancer: impact on
patient fatigue and long-term outcome. Oncology 2005;
69 (Suppl 2): 2-7.
23. Stasi R, Abriani L, Beccaglia P, et al. Cancer-related
fatigue. Cancer 2003; 98: 1786-1801.
24. Leyland-Jones B, Semiglazov V, Pawlicki M, et al.
Maintaining normal hemoglobin levels with epoetin alfa
in mainly nonanemic patients with metastatic breast cancer receiving first-line chemotherapy: a survival study. J
Clin Oncol 2005; 23: 5960-5972.
25. Henke M, Laszig R, Rube C, et al. Erythropoietin to treat
head and neck cancer patients with anemia undergoing
radiotherapy: randomized, double-blind, placebo-controlled trial. Lancet 2005; 362: 1255-1260.
26. Monti M, Castellani L, Berlusconi A, et al. Use of red
blood cell transfusions in terminally ill cancer patients
admitted to a palliative care unit. J Pain Symptom Manage
1997; 13: 18-22.
27. Laviano A, Meguid MM, Rossi-Fanelli F. Cancer anorexia: clinical implications, pathogenesis, and therapeutic
strategies. Lancet Oncol 2003; 4: 686-694.
28. Kurzrock R. The role of cytokines in cancer related
fatigue. Cancer 2001; 92: 1684-1688.
29. Gutstein HB. The biologic basis of fatigue. Cancer 2001;
92: 1678-1683.
30. Schwartz AL, Thompson JA, Masood N. Interferon
induced fatigue in patienst with melanoma: a pilot study
of exercise and methylphenidate. Oncol Nursing Forum
2002; 29: E85-E90.
31. Farag SS, George SL, Lee EJ, et al. Postremission therapy
with low-dose interleukin 2 with or without intermediate
pulse dose interleukin 2 therapy is well tolerated in elderly paients with acute myeloid leukemia: Cancer and
Leukemia Group B study 9420. Clin Cancer Res 2002; 8:
2812-2819.
32. Naglieri E, Lopez M, Lellli G, et al. Interleukin-2, interferon-alpha and medroxyprogesterone acetate in metastatic renal cell carcinoma. Anticancer Res 2002; 22: 3045-
3051.
33. Demitrac MA. Neuroendocrine aspects of chronic fatigue
syndrome: a commentary. Am J Med 1998; 105: 11S-14S.
34. Bruera E, Ernst S, Hagen N, et al. Effectiveness of megestrol acetate in patients with advanced cancer: a randomized, double-blind, crossover study. Cancer Prev Control
1998; 2: 74-78.
35. Neri B, Garosi VL, Intini C. Effect of medroxyprogesterone acetate on the quality of life of the oncology
patient: a multicentric cooperative study. Anticancer
Drugs 1997; 8: 459-465.
36. Westman G, Bergman B, Albertsson M, et al. Megestrol
acetate in advanced, progressive, hormone insensitive
cancer. Effects on the quality of life: a placebo-controlled,
randomized, multicentre trial. Eur J Cancer 1999; 35:
586-595.
37. Klinkenberg M, Willems DL, van der Wal G, et al.
Symptom burden in the last week of life. J Pain Symptom
Manage 2004; 27: 5-13.
38. Tamburini M, Brunelli C, Rosso S, et al. Prognostic value146 · Haziran 2008 · Gülhane TD Yavuzþen ve Kömürcü
of quality of life scores in terminal cancer patients. J Pain
Symptom Manage 1996; 11: 32-41.
39. Lawlor PG, Gagnon B, Mancini IL, et al. Delirium a predictor of survival in older patients with advanced cancer.
Arch Intern Med 2000; 160: 2866-2868.
40. Winnigham ML. Strategies for managing cancer-related
fatigue syndrome. Cancer 2001; 92: 988-997.
41. Dimeo F, Schmittel A, Fietz T, et al. Physical performance, depression, immune status and fatigue in patients
with hematological malignancies after treatment. Ann
Oncol 2004; 15: 1237-1242.
42. Jacobsen PB, Weitzner MA. Evaluating the relationship of
fatigue to depression and anxiety in cancer patients. In:
Portenoy R, Bruera E (eds). Issues in Palliative Care
Research. New York: Oxford University Press, 2003:
127-150.
43. Winell J, Roth AJ. Depression in cancer patients.
Oncology 2004; 18: 1554-1560.
44. Spiegel D, Giese-Davis J. Depression and cancer: mechanism and disease progression. Biol Psychiatry 2003; 54:
269-282.
45. Derogatis LR, Abeloff MD, Melisaratos N. Psychological
coping mechanism and survival time in metastatic breast
cancer. JAMA 1979; 242: 1504-1508.
46. Loberiza FR, Rizzo JD, Bredeson CN, et al. Association
of depressive syndrome and early deaths among patients
after stem cell transplantation for malignant diseases. J
Clin Oncol 2002; 20: 2118-2126.
47. Stommel M, Given BA, Given CW. Depression and functional status as predictors of death among cancer patients.
Cancer 2002; 94: 2719-2727.
48. Schwartz AL. Daily fatigue patterns and effect of exercise
in women with breast cancer. Cancer Pract 2000; 160:
526-534.
49. Hanna A, Sledge G, Mayer ML, et al. A phase II study of
methylphenidate for the treatment of fatigue. Support
Care Cancer 2005 Aug 12; [Epub ahead of print].
50. Homsi J, Walsh D, Nelson KA. Psychostimulants in supportive care. Support Care Cancer 2000; 8: 385-397.
51. Homsi J, Nelson KA, Sarhill N, et al. A phase II study of
methylphenidate for depression in advanced cancer. Am J
Hosp Palliat Care 2001; 18: 403-407.
52. Sarhill N, Walsh D, Nelson KA, et al. Methylphenidate
for fatigue in advanced cancer: a prospective open-label
pilot study. Am J Hosp Palliat Care 2001; 18: 187-192.
53. Bruera E, Driver L, Barnes EA, et al. Patient-controlled
methylphenidate for the management of fatigue in
patients with advanced cancer: a preliminary report. J Clin
Oncol 2003; 21: 4439-4443.
54. Marrow GR, Hickok JT, Roscoe JA, et al. Differential
effects of paroxetine on fatigue and depression: a randomized, double-blind trial from The University of
Rochester Cancer Center Community Clinical Oncology
Program. J Clin Oncol 2003; 21: 4635-4641.
55. Fisch MJ, Loehrer PJ, Kristeller J, et al. Fluoxetine versus
placebo in advanced cancer outpatients: a double-blinded
trial of the Hoosier Oncology Group. J Clin Oncol 2003;
21: 1937-1943.
56. Mercado G, Adelstein DJ, Saxton JP, et al.
Hypothyroidism. A frequent event after radiotherapy and
after chemotherapy for patients with head and neck carcinoma. Cancer 2001; 92: 2892-2897.
57. Kumar N, Allen KA, Riccardi D, et al. Fatigue, weight
gain, lethargy and amenorrhea in breast cancer patients on
chemotherapy: is subclinical hypothyroidsm the culprit?
Breast Cancer Res Treat 2004; 83: 149-159.
58. Fleishman SB. Treatment of symptom clusters: pain,
depression, and fatigue. J Natl Cancer Inst Monogr 2004;
32: 119-123.
59. Bruera E, Roca E, Cedaro L, et al. Action of oral methylprednisone in terminal cancer patients: a prospective randomized double blind study. Cancer Treat Reports 1985;
69: 751-754.
60. Willox JC, Corr J, Shaw J, et al. Prednisolone as an
appetite stimulant in patients with cancer. Br Med J 1984;
288: 27.
61. Moertel CG, Schutt AJ, Reitemeier RJ, et al.
Corticosteroid therapy of preterminal gastrointestinal
cancer. Cancer 1974; 33: 1607-1609.
62. Glare P, Virik K, Jones M, et al. A systematic review of
physicians' survival predictions in terminally ill cancer
patients. Br Med J 2003; 327: 195-198.
63. Vigano A, Dorgan M, Buckingham J, et al. Survival prediction in terminal cancer patients: a systematic review of
medical literature. Palliat Med 2000; 14: 363-374.
64. Courneya KS, Mackey JR, Bell GJ, et al. Randomized
controlled trial of exercise training in postmenopausal
breast cancer survivors: cardiopulmonary and quality of
life outcomes. J Clin Oncol 2003; 21: 1660-1668.
65. Mock V, Frangakis C, Davidson NE, et al. Exercise manages fatigue during breast cancer treatment: a randomized
controlled trial. Psychooncology 2005; 14: 464-477.
66. Mock V, Pickett M, Ropka ME, et al. Fatigue and quality
of life outcomes of exercise during cancer treatment.
Cancer Pract 2001; 9: 119-127.
67. Dodd MJ, Miaskowski C, Paul SM. Symptom clusters
and their effect on the functional status of patients with
cancer. Oncol Nurs Forum 2001; 28: 465-470.
68. Mercandate S, Girelli D, Casuccio A. Sleep disorders in
advanced cancer patients: prevalence and factors associated. Support Care Cancer 2004; 12: 355-359.
69. Bower JE, Ganz PA, Desmond KA, et al. Fatigue in breast
cancer survivors: occurrence, correlates, and impact on
quality of life. J Clin Oncol 2000; 18: 743-753.
70. Beach P, Siebeneck B, Buderer NF, Ferner T. The relationship between fatigue and nutritional status in patients
receiving radiation therapy to treat lung cancer. Oncol
Nurs Forum 2001; 28: 1027-1031.

Thank you for copying data from http://www.arastirmax.com