Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

New research on causes of cancer patients’ fatigue

19.07.2004


May be due more to depression and poor physical performance than physiological side effects

Fatigue – a common problem in patients who are recovering from leukaemia, lymphoma, myeloma and other haematological cancers – is associated with depression and reduced physical performance and not, as previously suggested, with anaemia, a flagging immune system or other physiological conditions. That is the conclusion of a German research team, reported (Monday 19 July), in Annals of Oncology.

Cancer related fatigue – defined as an unusual and persistent sense of tiredness that can occur during or after treatment, may affect physical and mental ability and is not relieved by rest – is the most common and distressing problem for cancer patients after treatment. For many patients it is so severe that it limits normal daily activity.



Lead researcher Dr Fernando Dimeo said that no one fully understood the origins of this extreme fatigue: among the factors proposed as possible causes were anaemia, impaired nutritional status, sleep disturbances, changes in the concentrations of cytokines (small proteins released by cells that affect the behaviour of other cells) due to the interaction between the tumour and the immune system, impaired thyroid, liver or kidney function, mental and social status and a reduced level of activity.

Dr Dimeo and colleagues from the Charité University Medical Center in Berlin, studied over 70 patients in remission who had been free of treatment for at least three months. They all underwent physical examinations, answered questionnaires and had a range of blood tests after undertaking a series of physical activities.

"We evaluated possible biological and immunological mechanisms of fatigue. We could find no correlation between fatigue, diagnosis, time since chemotherapy, renal, hepatic or thyroid function, severity of anaemia, serum albumin concentration, cytokine activity or other inflammatory or immune system markers," he said.

"However, the scores for depression and physical performance in those patients with fatigue scores in the upper and lower quartile were significantly different even though there was no difference in the values of laboratory tests for the two groups. The mean depression score of those who scored highly for fatigue was 10 times higher than those with low fatigue scores. The mean performance score of those scoring highly for fatigue was five times lower than those with low fatigue scores.

Dr Dimeo said that there were some limitations to the study. For example, the information from questionnaires may be biased because of patients’ subjective feelings and expectations about physical limitations and may not reflect their actual experience. Also, levels of fatigue can fluctuate in patients with cancer, so longer-term studies may provide better understanding of the causes. However, any patients with side effects or signs of infection that might have been responsible for fatigue were excluded from the study.

"We feel, therefore, that our results reflect a genuine lack of association between fatigue and thyroid, immune, haematological, renal and hepatic function, although these conditions may be a factor in certain patients," he said.

"Impaired physical performance and depression seem to be critical components in cancer-related fatigue although we have not yet clarified the association between the two factors. Impaired performance can result in increased dependence, lower self-esteem, reduced social activities, restricted family life and a pessimistic mood. The patient can also interpret poor performance as a sign of poor health and this increases psychological distress. On the other hand, depressed and anxious patients are more likely to limit outdoor activities and resort to a passive lifestyle, which can result in loss of muscle condition and physical performance."

So, the question now facing the researchers is – is the depression the cause of the poor physical performance or is it the other way round? Or could it be that both these problems are related to a third, as yet unknown factor?

They now plan a larger study. "Although patients who have had major surgery for stomach, bowel or lung cancer may have fatigue that can be related more to nutritional deficits or poor lung function, we feel that our findings may apply to most cancer patients, so we will be examining the correlates of fatigue in further groups of patients," said Dr Dimeo.

Meanwhile, he added, their existing findings already have implications in the clinic. The diagnostic work-up of patients should include evaluating their workload, psychological status and physical performance.

"There are also treatment implications. In the recent past several publications have underlined the role of anaemia as a major cause of fatigue in patients undergoing chemotherapy. Erythropoetin (EPO) is sometimes given to stimulate the production of red blood cells. But, our findings and those of other studies, show that chronic fatigue in patients who are free of relapse may not be related to haemoglobin concentrations. While all patients with severe anaemia feel tired, a low percentage of patients with chronic fatigue are anaemic."

Margaret Willson | EurekAlert!
Further information:
http://www.esmo.org

More articles from Health and Medicine:

nachricht Speed data for the brain’s navigation system
06.12.2016 | Deutsches Zentrum für Neurodegenerative Erkrankungen e.V. (DZNE)

nachricht Study suggests possible new target for treating and preventing Alzheimer's
02.12.2016 | Oregon Health & Science University

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Significantly more productivity in USP lasers

In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.

Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...

Im Focus: Shape matters when light meets atom

Mapping the interaction of a single atom with a single photon may inform design of quantum devices

Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...

Im Focus: Novel silicon etching technique crafts 3-D gradient refractive index micro-optics

A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.

Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...

Im Focus: Quantum Particles Form Droplets

In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.

“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...

Im Focus: MADMAX: Max Planck Institute for Physics takes up axion research

The Max Planck Institute for Physics (MPP) is opening up a new research field. A workshop from November 21 - 22, 2016 will mark the start of activities for an innovative axion experiment. Axions are still only purely hypothetical particles. Their detection could solve two fundamental problems in particle physics: What dark matter consists of and why it has not yet been possible to directly observe a CP violation for the strong interaction.

The “MADMAX” project is the MPP’s commitment to axion research. Axions are so far only a theoretical prediction and are difficult to detect: on the one hand,...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ICTM Conference 2017: Production technology for turbomachine manufacturing of the future

16.11.2016 | Event News

Innovation Day Laser Technology – Laser Additive Manufacturing

01.11.2016 | Event News

#IC2S2: When Social Science meets Computer Science - GESIS will host the IC2S2 conference 2017

14.10.2016 | Event News

 
Latest News

Simple processing technique could cut cost of organic PV and wearable electronics

06.12.2016 | Materials Sciences

3-D printed kidney phantoms aid nuclear medicine dosing calibration

06.12.2016 | Medical Engineering

Robot on demand: Mobile machining of aircraft components with high precision

06.12.2016 | Power and Electrical Engineering

VideoLinks
B2B-VideoLinks
More VideoLinks >>>