General symptoms of oncology: fatigue

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Oncological fatigue: a comprehensive review

Fatigue, or increased fatigue, is one of the most common and exhausting symptoms experienced by patients with cancer. Unlike the usual fatigue that occurs after physical or mental stress and passing after rest, fatigue associated with cancer (Cancer-RELEETED FATIGUE, CRF) is characterized by its intensity, duration and non-compliance of the degree of activity. It can significantly worsen the quality of life, affecting the physical, emotional and social well -being of the patient. Understanding the development mechanisms, risk factors, diagnostic methods and CRF management strategies are crucial for improving the results of treatment and improving the quality of life of cancer patients.

Determination and characteristics of oncological fatigue

Oncological fatigue (CRF) is defined as an exhausting, stable, subjective feeling of fatigue or exhaustion associated with cancer or its treatment, which is not proportional to recent activity and interferes with everyday activity. It is important to note that CRF is not just a “normal” fatigue. It is characterized by:

  • Intensity: The fatigue that patients describe as “overwhelming”, “exhausting” or “unbearable”.
  • Duration: Fatigue that does not pass after rest and can last for weeks, months or even years after the completion of treatment.
  • Influence on the quality of life: Fatigue that interferes with everyday activity, such as work, study, self -care, social interactions and rest.
  • The inconsistency of the degree of activity: Fatigue, which is disproportionate to the level of physical or mental stress. Even insignificant activity can cause severe fatigue.
  • Lack of relief after rest: Unlike ordinary fatigue, CRF is not facilitated after sleep or rest. Patients often wake up tired and feel exhausted throughout the day.
  • Accompanying symptoms: CRF is often accompanied by other symptoms such as pain, depression, anxiety, sleep disturbances, cognitive disorders and a decrease in appetite.

The prevalence of oncological fatigue

The prevalence of CRF varies depending on the type of cancer, stage of the disease, the type of treatment and other factors. However, in general, CRF is a very common symptom:

  • During treatment: Up to 90% of patients receiving active cancer treatment (for example, chemotherapy, radiation therapy, surgery) are experienced by CRF.
  • After treatment: In a significant number of patients (25-35%), CRF remains for several months or years after the completion of treatment. This condition is known as “chronic oncological fatigue.”
  • In the progressive stage of cancer: CRF is one of the most common and exhausting symptoms in patients with progressive cancer.

Factors contributing to the development of oncological fatigue

CRF is a multifactorial state, and its development can be caused by a combination of physiological, psychological and behavioral factors. The most important factors include:

  • Cancer: Cancer itself can cause fatigue through various mechanisms, such as:
    • Cytokine production: Cancer cells and the immune system release cytokines (for example, interleukins, tumor necrosis factor), which can cause inflammation and fatigue.
    • Metabolic disorders: Cancer can violate normal metabolism, leading to a deficiency of energy and fatigue.
    • Anemia: Cancer can cause anemia (a decrease in the number of red blood cells), which leads to a decrease in oxygen delivery to tissues and fatigue.
    • Cachexia: Cancer can cause cachexia (loss of weight and muscle mass), which leads to weakness and fatigue.
  • Cancer treatment: Many types of cancer treatment can cause fatigue, including:
    • Chemotherapy: Chemotherapy can damage rapidly dividing cells, including bone marrow cells, which leads to anemia and fatigue.
    • Radiation therapy: Radiation therapy can damage tissues in the irradiation area, causing inflammation and fatigue.
    • Surgery: Surgery can cause pain, inflammation and blood loss, which leads to fatigue.
    • Immunotherapy: Immunotherapy can cause inflammation and fatigue, since it stimulates the immune system.
    • Hormonal therapy: Hormonal therapy can cause hormonal changes, which can lead to fatigue.
    • Target therapy: Targeted therapy can cause specific side effects that can lead to fatigue.
  • Related diseases: The presence of other diseases (for example, depression, anemia, thyroid diseases, chronic pain) can aggravate CRF.
  • Psychological factors: Depression, anxiety, stress and insomnia can aggravate CRF.
  • Behavioral factors: Lack of physical activity, poor nutrition, dehydration and smoking can aggravate CRF.
  • Medicines: Some drugs (for example, painkillers, antidepressants, antihistamines) can cause fatigue.
  • Sleep disorders: Sleep disorders (for example, insomnia, apnea in a dream) can aggravate CRF.
  • Hormonal changes: Hormonal changes caused by cancer or its treatment can lead to fatigue. For example, a decrease in testosterone levels in men or estrogen in women can cause fatigue.
  • Genetic factors: Some studies show that genetic factors can play a role in predisposition to CRF.

Physiological mechanisms for the development of oncological fatigue

Despite the fact that the exact mechanisms of CRF development have not been fully studied, it is assumed that several physiological processes participate in its development:

  • Inflammation: The production of cytokines (for example, interleukins, tumor necrosis factor) causes systemic inflammation, which can affect the brain, muscles and other organs, causing fatigue. Cytokins can violate the normal work of neurotransmitters, such as serotonin and dopamine, which play an important role in the regulation of mood, energy and sleep.
  • Violation of the axis of the hypothalamus pituitary-adultery (GGN): Cancer and its treatment can violate the normal functioning of the GAG ​​axis, which regulates the body’s reaction to stress. Violation of the GGN axis can lead to an imbalance of hormones, such as cortisol, which can cause fatigue.
  • Mitochondrial dysfunction: Mitochondria is cellular organelles that produce energy. Cancer and its treatment can damage mitochondria, which leads to a decrease in energy production and fatigue.
  • Oxidative stress: Cancer and its treatment can lead to an increase in the production of free radicals, which causes oxidative stress. Oxidative stress can damage cells and tissues, which leads to fatigue.
  • Changes in neurotransmitters: Cancer and its treatment can affect the level of neurotransmitters, such as serotonin, dopamine and norepinephrine, which play an important role in the regulation of mood, energy and sleep.
  • Anemia: A decrease in the number of red blood cells (anemia) leads to a decrease in oxygen delivery to tissues, which causes fatigue. Anemia can be caused by cancer, its treatment (for example, chemotherapy) or other factors.
  • Changes in metabolism: Cancer can violate the normal metabolism of glucose, fats and proteins, which leads to a deficiency of energy and fatigue.
  • Changes in muscle function: Cancer and its treatment can lead to loss of muscle mass and weakness, which causes fatigue.

Psychological factors aggravating oncological fatigue

The psychological state of the patient plays an important role in the perception and intensity of CRF. The most important psychological factors include:

  • Depression: Depression is very common in patients with cancer and can significantly aggravate CRF. Depression can lead to a decrease in motivation, sleep impairment and a decrease in appetite, which can increase fatigue.
  • Anxiety: Anxiety is also often found in patients with cancer and can increase CRF. Anxiety can lead to tension, insomnia and increased excitability, which can increase fatigue.
  • Stress: Chronic stress associated with the diagnosis of cancer, treatment and uncertainty of the future can aggravate CRF. Stress can lead to the production of cortisol, which can disturb sleep and enhance fatigue.
  • Catastrophilisation: The tendency to exaggerate the negative aspects of the disease and treatment can enhance CRF.
  • Feeling of helplessness and hopelessness: A sense of helplessness and hopelessness can lead to a decrease in the motivation for treatment and control of CRF.
  • Social isolation: Social isolation can aggravate CRF, as it deprives patients of support and social interactions that can help them cope with the disease and treatment.
  • Relax fear: Relax fear can cause anxiety and stress that can aggravate CRF.

Diagnosis of oncological fatigue

CRF diagnosis requires a thorough assessment of the patient, including:

  • A history of anamnesis: The doctor must ask the patient in detail about the nature, intensity, duration and influence of fatigue on his daily life. It is important to find out when fatigue began, that it exacerbates or facilitates, and how it affects sleep, appetite, mood, physical activity and social interactions.
  • Physical examination: The doctor must conduct a physical examination to identify possible causes of fatigue, such as anemia, hypothyroidism or infection.
  • Laboratory research: Laboratory studies can be prescribed to exclude other possible causes of fatigue, such as anemia, hypothyroidism, impaired liver or kidney function, infection and vitamin deficiency. The most important laboratory research includes:
    • General blood test: To assess the level of hemoglobin and other blood indicators that may indicate anemia.
    • Biochemical blood test: To assess the function of the liver and kidneys, the level of electrolytes and other indicators that may indicate metabolic disorders.
    • Analysis for thyroid hormones: To exclude hypothyroidism.
    • Analysis for vitamin D: To exclude vitamin D.’s deficiency
  • Assessment of the psychological state: It is important to evaluate the patient’s psychological state in order to identify possible depression, anxiety or stress that can aggravate CRF. Various questionnaires and scales can be used to evaluate depression and anxiety.
  • The use of scales and questionnaires to evaluate fatigue: There are several scales and questionnaires that can be used to assess the intensity and influence of CRF on the quality of life of the patient. The most common scales include:
    • Fatigue Severity Scale, FSS This is a widely used scale to assess the intensity of fatigue.
    • FACIT-FATIGUE fatigue questionnaire: This is a questionnaire that assesses the influence of fatigue on various aspects of the patient’s life, such as physical activity, social interactions and mood.
    • A multidimensional scope of tiredness (Multidimensional Fatigue Inventory, Mfi-20): This is a scale that evaluates various aspects of fatigue, such as general fatigue, physical fatigue, mental fatigue, reducing activity and reducing motivation.

It is important to note that there is no single test for the CRF diagnosis. The diagnosis is based on a comprehensive assessment of the patient taking into account his anamnesis, physical examination, laboratory studies and the results of assessing the psychological state and the level of fatigue.

Differential diagnosis

It is important to distinguish CRF from other states that can cause fatigue, such as:

  • Anemia: Anemia can be caused by cancer, its treatment or other factors.
  • Hypothyroidism: Hypothyroidism (decreased function of the thyroid gland) can cause fatigue.
  • Depression: Depression can cause fatigue and other symptoms, such as a decrease in mood, loss of interest in life and sleep disturbance.
  • Sleep disorders: Sleep disorders (for example, insomnia, apnea in a dream) can cause fatigue.
  • Chronic pain: Chronic pain can cause fatigue.
  • Infections: Infections can cause fatigue.
  • Malnutrition: Insufficient nutrition can cause fatigue.
  • Dehydration: Dehydration (dehydration) can cause fatigue.
  • Medicines: Some drugs can cause fatigue.

Office of oncological fatigue

CRF management should be comprehensive and individualized, taking into account the causes, risk factors and needs of each patient. The most effective CRF management strategies include:

  • Treatment of the underlying disease: Treatment of cancer (for example, surgery, chemotherapy, radiation therapy, immunotherapy) can help reduce the fatigue associated with cancer.
  • Correction of concomitant diseases: Treatment of concomitant diseases (for example, anemia, depression, hypothyroidism) can help reduce fatigue.
  • Pharmacological treatment:
    • Stimulants: In some cases, stimulants (for example, methylphenidate) can be assigned to reduce fatigue. However, stimulants should be used with caution, since they can cause side effects, such as insomnia, anxiety and an increase in blood pressure.
    • Erythropoetin-stimulating drugs (ESA): ESA can be prescribed for the treatment of anemia caused by chemotherapy, which can help reduce fatigue. However, ESA should be used with caution, as they can increase the risk of thromboembolic complications.
    • Antidepressants: Antidepressants can be prescribed for the treatment of depression, which can aggravate CRF.
  • Non -pharmacological treatment methods:
    • Exercise: Regular physical exercises can help reduce fatigue, improve mood and increase energy level. Patients should begin with easy exercises and gradually increase their intensity and duration. Aerobic exercises are recommended (for example, walking, swimming, cycling) and strength exercises.
    • Nutrition: Healthy nutrition can help reduce fatigue, improve mood and increase energy. Patients should use a sufficient amount of proteins, carbohydrates and fats, as well as vitamins and minerals. It is important to consume products rich in iron to prevent anemia.
    • Hydration: Enough fluid consumption can help reduce fatigue. Patients should drink at least 8 glasses of water per day.
    • Dream: A sufficient dream can help reduce fatigue. Patients should try to sleep at least 7-8 hours at night. It is important to observe sleep and wakefulness, avoid the use of caffeine and alcohol before bedtime and create comfortable conditions for sleep.
    • Cognitive-behavioral therapy (KPT): KPT can help patients cope with CRF, teaching them stress strategies, improving sleep and increasing motivation for physical activity.
    • Yoga and Tai-Chi: Yoga and Tai-chi can help reduce fatigue, improve mood and increase energy level.
    • Massage: Massage can help reduce fatigue, improve mood and relieve muscle tension.
    • Acupuncture: Acupuncture can help reduce fatigue, improve mood and relieve pain.
    • Music therapy: Music therapy can help reduce fatigue, improve mood and reduce stress.
    • Art Therapy: Art therapy can help patients express their emotions and cope with CRF.
    • Rehabilitation: Participation in rehabilitation programs can help patients restore physical function, improve their mood and improve the quality of life.

Self -help and fatigue management strategies

Patients can use the following self -help strategies to control CRF:

  • Planning: Plan your actions for the day so as not to overload yourself. Divide large tasks into smaller ones and perform them gradually.
  • Prioritization: Determine which tasks are the most important, and focus on their implementation. Do not waste energy on the performance of tasks that are not necessary.
  • Rest: Rest regularly during the day. Even a short break can help you restore energy.
  • Delegation: Ask for help from family members, friends or colleagues. Feel free to delegate tasks that you cannot perform yourself.
  • Stress restriction: Avoid stressful situations. If you cannot avoid stress, try using stress control strategies, such as meditation, deep breathing or yoga.
  • Support: Suppose support for family members, friends, psychologist or support group. A conversation with other people who understand that you are worried can help you deal with CRF.
  • Maintaining a diary of fatigue: Keeping a diary of fatigue can help you track the level of fatigue and identify the factors that exacerbate or facilitate it.
  • Regular consultations with a doctor: Regular consultations with a doctor are necessary to control CRF and adjust the treatment plan.

Forecast and quality of life

CRF can significantly worsen the quality of life of patients with cancer, affecting their physical, emotional and social well -being. Fatigue can lead to a decrease in physical activity, impaired sleep, a decrease in appetite, depression, anxiety, social isolation and a decrease in performance.

The CRF forecast depends on several factors, such as the type of cancer, the stage of the disease, the type of treatment and concomitant diseases. In some patients, CRF takes place after the treatment is completed, while in other CRFs can remain for several months or years.

It is important that patients with cancer and their doctors pay sufficient attention to CRF management in order to improve the quality of life of patients and increase the effectiveness of treatment.

The role of a nurse in the management of oncological fatigue

Medical sisters play a key role in CRF management. They assess patients, identify risk factors, teach patients and members of their families CRF management strategies, coordinate patient care and evaluate treatment effectiveness. Medical sisters can also act as patient lawyers, helping them access the necessary resources and services.

Medical sisters should be well aware of CRF and its management. They should be able to conduct a comprehensive assessment of patients, identify risk factors, teach patients and members of their families CRF management strategies and evaluate treatment effectiveness. Medical sisters should also be able to provide emotional support to patients and members of their families.

Studies in the field of oncological fatigue

Numerous studies in the field of CRF are conducted, aimed at:

  • Understanding CRF development mechanisms: Research is aimed at studying physiological, psychological and behavioral factors that contribute to the development of CRF.
  • Development of new CRF diagnostic methods: Research is aimed at developing more accurate and reliable CRF diagnostic methods.
  • Development of new CRF treatment methods: Studies are aimed at developing new pharmacological and non -pharmacological methods of CRF treatment.
  • Improving the quality of life of patients with CRF: Research is aimed at developing strategies that can help improve the quality of life of patients with CRF.

The results of these studies can lead to the development of more effective methods of CRF prevention and treatment, which will improve the quality of life of patients with cancer.

Conclusion

Oncological fatigue is a common and exhausting symptom that can significantly worsen the quality of life of patients with cancer. Understanding the development mechanisms, risk factors, diagnostic methods and CRF management strategies are crucial for improving the results of treatment and improving the quality of life of cancer patients. A comprehensive and individualized approach to CRF management, including pharmacological and non -pharmacological methods of treatment, as well as self -help strategies, can help patients cope with fatigue and improve their quality of life.

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