Understanding Anemia and Fatigue
In a study presented at the recent annual meeting of the American Society of Hematology, Dr. Dusan Kotasek of the Ashford Cancer Centre in Adelaide, Australia reported on a promising new treatment regimen to combat anemia in cancer patients.
Specifically, Kotasek documented findings involving the drug darbepoiten-alpha. The new treatment can be administered once every three weeks to fight anemia, Kotasek said, instead of the current standard regimen requiring multiple doses each week. "The results are exciting," he told the gathering, "since cancer patients with treatment-related anemia are usually treated for their anemia with once-weekly or thrice-weekly injections." His study involved 163 patients with solid tumors who were undergoing chemotherapy treatments for their cancer.
General fatigue, including fatigue caused by anemia, affects more than three-quarters of patients undergoing cancer treatment. It can include feeling tired, weak, exhausted, slow, or simply lethargic. Fatigue may be acute or chronic. Acute fatigue is normal tiredness with occasional symptoms that begin quickly and last for a short time. Simple rest and "taking it easy" may be all that is necessary to overcome it. Chronic fatigue is longer lasting, however. It can be a direct result of the cancer treatment, or can result from the spread of the cancer itself. It can become physically-and even emotionally-debilitating.
Fatigue can occur for many reasons. It can be caused by anemia, loss of appetite, decreased levels of hormones, medications, emotional distress, difficulty sleeping, pain and other factors. In the case of radiation, it may also be caused by the increased energy needed to repair damaged skin tissue.
Treatments for fatigue can include certain medications to stimulate blood cell production, or psychostimulant drugs to improve emotional well being. Treatment for chronic fatigue that is related to anemia may include red blood cell transfusions. Beyond these, moderate exercise, sufficient rest, and simply setting priorities have been shown to result in significant improvements.
One of the most problematic side effects of many chemotherapy drugs is the lowering of blood counts. The bone marrow produces three important blood components: red blood cells, which carry oxygen to cells throughout the body; white blood cells, which fight infection; and platelets, which help blood clot and stop bleeding. Chemotherapy treatments destroy some of the bone marrow cells, so fewer blood cells are produced. A drop in the levels of these cells can result in specific side effects:
When there are too few red blood cells, body tissues don't get enough oxygen to do their work. This condition is called anemia, which can show up as fatigue, dizziness, paleness, a tendency to feel cold, and even shortness of breath.
Treatment for fatigue that is related to anemia may include red blood cell transfusions. However, while transfusions are an effective treatment for anemia, possible side effects can include infection, transfusion reactions, graft-versus-host disease, and changes in immunity. Treatment for anemia-related fatigue in patients undergoing chemotherapy may also require drugs that stimulate the production of blood cells such aserthropoetin.
Your doctor will check your blood cell count often during your treatment and may give you growth factors to help your bone marrow make new blood cells.
It is not always possible to determine the factors that cause fatigue in patients with cancer. Beyond anemia, it could be caused by a number of other factors, including the treatment itself.
For example, several factors have been linked with fatigue caused by chemotherapy. Some people may respond to the diagnosis and treatment of cancer with mood changes and disrupted sleep patterns. Nausea, vomiting, chronic pain, and weight loss can also cause fatigue.
Fatigue has long been associated with radiation therapy, although it usually lessens after the therapy is completed. Not all patients return to their normal level of energy, however. Patients who are older, have advanced disease, or receive combination therapy (e.g., chemotherapy plus radiation therapy), are at a higher risk for developing long-term fatigue.
Biological therapy frequently causes fatigue. In this setting, fatigue is one of a group of side effects known as "flu-like" syndrome. This syndrome also includes fever, chills, muscle pain, headache, and a sense of generally not feeling well. The type of biological therapy used may determine the type and pattern of fatigue experienced.
Many people with cancer undergo surgery for diagnosis or treatment. But while fatigue following surgery can be a problem, it is often temporary. It can be made worse, however, when combined with the fatigue caused by other cancer treatments.
Fatigue may significantly affect the quality of life of cancer survivors-sometimes for years after treatment ends. Studies have shown that some patients continue to have moderate to severe fatigue for up to 18 years after bone marrow transplantation. Long-term therapies such as tamoxifen can also cause fatigue.
The American Cancer Society offers the following suggestions for overcoming cancer-related fatigue:
Cancer patients are often surprised by how fatigue affects their ability to recover, and how long it can last-even after treatment ends. Keep in mind that fatigue caused by cancer treatment is usually temporary. Your energy will slowly come back, especially if you stay moderately active. Take it slow, and be patient.
Annual Meeting of the American Society of Hematology, December 4, 2000, San Francisco, California
Annual Meeting of the American Society for Reproductive Medicine, September 28, 1999, Toronto, Canada
The National Cancer Institute (http://www.nci.nih.gov)
The American Cancer Society (http://www.cancer.org)
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