Deutsche Zeitschrift für Onkologie 2005; 37(2): 52-57
DOI: 10.1055/s-2005-862561
Forschung

Karl F. Haug Verlag, in: MVS Medizinverlage Stuttgart GmbH & Co. KG

Tumorbedingte Fatigue

Maria Steingräber, Petra Feyer
Further Information

Publication History

Publication Date:
29 June 2005 (online)

Zusammenfassung

Fatigue ist ein definiertes psychosomatisches Krankheitsbild infolge einer Tumorerkrankung mit eigenständiger ICD-Nummer. Drei Viertel aller Tumorpatienten leiden darunter. Die Symptome sind multifaktoriell bedingt und werden individuell mit unterschiedlichen Auswirkungen verarbeitet. Fatigue kann den Patienten von der Tumordiagnose an begleiten, durch die Nebenwirkungen der Therapie sogar verstärkt werden und weit über die Rehabilitationsphase hinaus bestehen. Die Dynamik der Erkrankung kann individuell durch Selbsteinschätzung des Patienten mit standardisierten Fragebögen erfasst werden. Die Prognose ist schwer abzuschätzen und korreliert häufig mit dem Verlauf der Grunderkrankung.

Die Therapieansätze folgen dem gegenwärtigen Verständnis der Erkrankung. Sie sind soweit als möglich kausal orientiert, wie am Beispiel der Korrektur von Hämoglobin-Werten bei einer zu Grunde liegenden Tumoranämie, oder symptomorientiert supportiv, psychoonkologisch oder psychosozial. Notwendig sind fast immer multimodale Therapieansätze. Fatigue ist in jedem Fall individuell mit gutem Erfolg für die Lebensqualität der Patienten therapierbar.

Summary

Fatigue is a defined psychosomatic symptom among patients with cancer. Nearly 3/4 of the cancer patients will experience fatigue. Fatigue is described as an unusual, excessive whole body experience that is disproportionate and unrelated to activity and is not relieved by rest or sleep. Cancer related fatigue is a subjective experience and has a great impact on quality of life and the ability to sustain social relationships. The etiology is complex and multifactorial, many contributing factors influence the intensity of fatigue. The underlying pathomechanism is not fully clarified. Fatigue is exacerbated by the treatment and can persist many years after the cancer therapy.

The evaluation and treatment requires a multidisciplinary approach. The therapy is multimodal. The therapy of contributing factors like anemia and depression, symptom control (pain), the normalization of the sleep-activity rhythm, moderate aerobic exercises, psychooncological, psychosocial and pharmacological interventions are ways to treat fatigue.

Literatur

  • 01 Ahlberg K, Ekman t, Wallgren A, Gaston-Johansson F. Fatigue, psychological distress, coping and quality of life in patients with uterine cancer.  J Adv Nurs.. 2004;  45 (2) 205-13
  • 02 Adamsen L, Midtgaard J, Andersen C, Quist M, Moeller T, Roerth M. Transforming the nature of fatigue through exercise: qualitative findings from a multidimensional exercise programme in cancer patients undergoing chemotherapy.  Eur J Cancer Care. 2004;  13 (4) 362-70
  • 03 Barsevick A M, Dudley W, Beck S, Sweeney C, Whitmer K, Nail L. A randomized clinical trial of energy conservation for patients with cancer-related fatigue.  Cancer. 2004;  100 (6) 1302-10
  • 04 Bennett B, Goldstein D, Lloyd A, Davenport T, Hickie I. Fatigue and psychological distress-exploring the relationship in women treated for breast cancer.  Eur J Cancer. 2004;  40 (11) 1689-95
  • 05 Biswal B M, Kumaraswamy N, Mukhtar F. Prevalence of fatigue among cancer patients undergoing external radiotherapy: Southeast Asian.  J Trop Med Pub Health. 2004;  35 (2) 463-7
  • 06 Brown D J, Mc Millan D C, Milroy R. The correlation between fatigue, physical function, the systemic inflammatory response, and psychological distress in patients with advanced lung cancer.  Cancer. 2005;  103 (2) 377-82
  • 07 Bruera E, Driver L, Barnes E A, Willey J, Shen L, Palmer J L, Escalante C. Patient-controlled methylphenidate fort he management of fatigue in patients with advanced cancer: a preliminary report.  J Clin Oncol. 2003;  21 (23) 4439-43
  • 08 Can G, Durna Z, Aydiner A. Assessment of fatigue in and care needs of Turkish women with breast cancer.  Cancer Nurs. 2004;  27 (2) 153-61
  • 09 Carlson L E, Angen m, Cullum J, Goodey E, Koopmans J, Lamont L, Mac Rae J H, Martin M, Pelletier G, Robinson J, Simpson J S, Speca M, Tillotson L, Bultz B D. High levels of untreated distress and fatigue in cancer patients.  Br J Cancer. 2004;  90 (12) 2297-304
  • 10 Cella D, Petermann A, Passik S, Jacobsen P, Breitbart W. Progress toward guidelines for the management of fatigue.  Oncology. 1998;  12 (11A) 369-77
  • 11 Cella D, Kallich J, McDermott A, Xu X. The longitudinal relationship of hemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials.  Ann Oncol. 2004;  15 (6) 979-86
  • 12 De Jong N, Candel M J, Schouten H C, Huijer Abu-Saad H, Courtens A M. Course of mental fatigue and motivation in breast cancer patients receiving adjuvant chemotherapy.  Ann Oncol. 2005;  16 (3) 372-82
  • 13 Dimeo F, Schmittel A, Fietz T, Schwartz S, Köhler P, Böning D, Thiel E. Physical performance, depression, immune status and fatigue in patients with hematological malignancies after treatment.  Ann Oncol. 2004;  15 (8) 1237-42
  • 14 Donovan K A, Jacobson P B, Andrykowski M A, Winters E M, Balducci L, Malik U, Kenady D, McGrath P. Course of fatigue in women receiving chemotherapy and /or radiotherapy for early stage breast cancer.  J Pain Symptom Manage. 2004;  28 (4) 373-80
  • 15 Donovan H S, Ward S. Representations of fatigue in women receiving chemotherapy for gynecologic cancers.  Oncol Nurs Forum. 2005;  32 (1) 113-6
  • 16 El-Banna M M, Berger A M, Farr L, Foxall M J, Friesth B, Schreiner E. Fatigue and depression in patients with lymphoma undergoing autologous peripheral blood stem cell transplantation.  Oncol Nurs Forum. 2004;  31 (5) 937-44
  • 17 Ganz P A, Moinpur C M, Pauler D K, Kornblith A b, Gaynor E R, Balcerzak S P, Gatti G s, Erba H P, McCoy S, Press O W, Fisher R I. Health status and quality of life in patients with early-stage Hodgkin`s disease treated on Southwest Oncology Group Study 9133.  J Clin Oncol. 2003;  21 (18) 3512-9
  • 18 Gelinas C, Filion L. Factors related to persistent fatigue following completion of breast cancer treatment.  Oncol Nurs Forum. 2004;  31 (2) 269-78
  • 19 Glaus A. Das Konzept Fatigue in der Onkologie - Definitionen, Hintergründe. In: Weis J, Bartsch HH: Fatigue bei Tumorpatienten. Freiburg; Karger 2000: 1-13
  • 20 Haghighat S, Akbari M E, Holakouei K, Rahimi A, Montazeri A. Factors predicting fatigue in breast cancer patients.  Supp Care Cancer. 2003;  11 (8) 533-8
  • 21 Headley J A, Ownby K K, John L D. The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer.  Oncol Nurs Forum. 2004;  31 (5) 977-83
  • 22 Hjermstad M J, Knobel H, Brinch L, Fayers P M, Loge J H, Holte H, Kaasa S. A prospective study of health-related quality of life, fatigue, anxiety and depression 3-5 years after stem cell transplantation.  Bone Marrow Transplant. 2004;  34 (3) 257-66
  • 23 Holzner B, Kemmler G, Greil R, Kopp M, Zeimet A, Raderer M, Hejna M, Zochbauer S, Krajnik G, Huber H, Fleischhacker W W, Sperner-Unterweger B. The impact of hemoglobin levels on fatigue and quality of life in cancer patients.  Ann Oncol. 2002;  13 (6) 965-73
  • 24 Hwang S S, Chang V T, Rue M, Kasimis B. Multidimensional independent predictors of cancer-related fatigue.  J Pain Symptom Manage. 2003;  26 (1) 604-14
  • 25 Jacobsen P B, Garland L L, Booth-Jones M, Donovan K A, Thors C L, Winters E, Grendys E. J Pain Symptom Manage. 2004;  28 (1) 7-18
  • 26 Jacobsen P B. Assessment of fatigue in cancer patients.  J Natl Cancer Inst. 2004;  32 93-7
  • 27 Jones M, Schenkel B, Just J, Fallowfield L. Epoetin alfa improves quality of life in patients with cancer: results of metaanalysis.  Cancer. 2004;  101 (8) 1720-32
  • 28 Kim S D, Kim H SH. Effects of a relaxation breathing exercise on fatigue in haemopoietic stem cell transplantation patients.  J Clin Nurs. 2005;  14 (1) 51-5
  • 29 Kohara H, Miyauchi t, Suehiro Y, Ueoka H, Takeyama H, Morita T. Combined modality treatment of aromatherapy, footsoak and reflexology relieves fatigue in patients with cancer.  J Pall Med. 2004;  7 (6) 791-6
  • 30 Kumar N, Allen K A, Riccardi D, Bercu B B, Cantor A, Minton S, Balducci L, Jacobsen P B. Fatigue, weight gain, lethargy and amenorrhea in breast cancer patients on chemotherapy: is subclinical hypothyroidism the culprit?.  Breast Cancer Res Treat. 2004;  83 (2) 149-59
  • 31 Mercadante S, Girelli D, Casuccio A. Sleep disorders in advanced cancer patients: prevalence and factors associated.  Supp Care Cancer. 2004;  12 (5) 355-9
  • 32 Mock V. Evidence-based treatment for cancer-related fatigue.  J Natl Cancer Inst. 2004;  32 112-8
  • 33 Molassiotis A, Chan C W. Fatigue patterns in Chinese patients receiving chemotherapy.  Eur J Oncol Nurs. 2001;  5 (1) 60-7
  • 34 Morrow G R, Andrews P L, Hickok J T, Roscoe J A, Matteson S. Fatigue associated with cancer and its treatment.  Support Care Cancer. 2002;  10 (5) 389-98
  • 35 Oldervoll L M, Kaasa S, Hjermstad M J, Lund J A, Loge J H. Physical exercise results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients?.  Eur J Cancer. 2004;  40 (7) 951-62
  • 36 Prins J B, Bos E, Huibers M J, Servaes P, van der Werf S P, van der Meer J W, Bleijenberg G. Social support and the persistence of complaints in chronic fatigue syndrome.  Psychother Psychosom. 2004;  73 (3) 174-82
  • 37 Reuter K, Härter M. The concepts of fatigue and depression in cancer.  Eur J Cancer. 2004;  13 (2) 127-34
  • 38 Rüffer J U, Flechtner H, Tralls P, Josting A, Sieber M, Lathan B, Diehl V. Fatigue in long-term survivors of Hodgkinӱs lymphoma: a report from the German Hodgkin Lymphoma Study Group.  Eur J Cancer. 2003;  39 (15) 2179-86
  • 39 Stone P, Hardy J, Richards M, Hern R. A study to invastigate the prevaslance severity and correlates of fatigue among patients with cancer in comparison with a control group of volunteers without cancer.  Ann Oncol. 2000;  11 561-67
  • 40 Tchekmedyian N S, Kallich J, McDermott A, Faysers P, Erder M H. The relationship between psychological distress and cancer-related fatigue. Cancer.  2003;  98 (1) 198-203
  • 41 Van Weert E, Hoekstra-Weebers J E, Grol B M, Otter R, Arendzen J H, Postema K, van der Schans C P. Physical functioning and quality of life after cancer rehabilitation.  Int J Rehabil Res. 2004;  27 (1) 27-35
  • 42 Vickers A J, Straus D J, Fearon B, Cassileth B R. Acupuncture for postchemotherapy fatigue: a phase II study.  J Clin Oncol. 2004;  22 (9) 1731-5
  • 43 Windsor P M, Nicol K F, Potter J. A randomised, controlled trial of aerobic exercise for treatment- related fatigue in men receiving radical external beam radiotherapy for localized prostata carcinoma.  Cancer. 2004;  101 (3) 550-7
  • 44 Wratten C, Kilmurray J, Nash S, Seldon M, Hamilton C S, O Brien P C, Denham J W. Fatigue during breast radiotherapy and its relationship to biological factors.  Int J Radiat Oncol Biol Phys. 2004;  59 (1) 160-7
  • 45 Weigang-Köhler K. Fatigue – wenn Krebspatienten ständig saft-und kraftlos sind. Gehen Sie der Ursache auf den Grund.  MMW Fortschr Med. 2003;  145 152-156

Korrespondenzadresse

Dr. med. Maria Steingräber

Klinik für Strahlentherapie und Radioonkologie
Vivantes Klinikum Berlin-Neukölln

Rudower Str. 48

12351 Berlin

Email: maria.steingraeber@vivantes.de