gms | German Medical Science

Fatigue is one of the most complaints of patients with cancer. Fatigue exists in 50 – 96 % of cancer patients particularly in individuals actively undergoing treatment. Fatigue is difficult to describe and patients express it in a variety of ways. Generally fatigue may be defined as a condition characterized by distress and decreased functional status related to a decrease in energy. Although a variety of treatment- and disease- related factors may contribute to the development of fatigue. The biochemical, physiologic, psychologic, and behavioural mechanisms of this symptom complex are poorly understood. Consequently, a thorough understanding of fatigue may lead to initiation of effective interventions. Several instruments to measure fatigue have been validated in patients with cancer and are being utilized to characterize the symptom of fatigue and its effect on quality of life. Interventions such as the use of erythropoietin to improve quality of life and functional capacity are being evaluated with promising results. Evidence suggests that anaemia may be a major factor in cancer related fatigue and quality of life in cancer patients. Anaemia can be related to the disease itself or due to therapy. Anaemia is often a significant contributor to symptoms in persons with cancer. The impact of anaemia varies depending on factors such as the rapidity of onset, patient age, plasma volume status, and the number and severity of comorbidities. The European Cancer Anaemia Survey (ECAS) included 15367 patients demonstrated a prevalence of anaemia in 39% at enrollment and 67% during the survey. Anaemia prevalence and incidence in cancer patients are high. Anaemia correlates with poor performace status. Cancer associated anaemia decreases patients´quality of life and may affect clinical treatment. Anaemia is best managed by treatment of the underlying cause. Supportive treatment includes nutritional interventions, transfusions as well as Erythropoiesis - Stimulating – Agents in the treatment of anaemia. A Medline analysis included 44 publications on fatigue since 1997, 18 of them demonstrated a correlation of haemoglobin-level and fatigue score . There is a strong evidence that in result of a consequent treatment of anaemia an elevation of the Hb-level there is an improvement of quality of life in cancer patients. This improvement is most pronounced between a range of 11 – 12 g/dl. Treatment of anaemia with the objective of improvement of the quality of life should be one part of the complex treatment modalities of the fatigue syndrom.