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Fatigue: Pharmacological and non-pharmacological treatments
Presentation by Dr. Fausto Roila at the TAO Congress on 8/9 December 2016 in Paris
Dr. Roila presents various treatment options for cancer-related fatigue, which affects the vast majority of cancer patients and can occur before, during and even after anti-cancer treatment has been completed. The underlying mechanisms of this symptom are not yet fully understood; it is hypothesised to be correlated with elevations in levels of proinflammatory cytokines, 5-hydroxytryptophan dysregulation, hypothalamic-pituitary-adrenal axis dysfunction, circadian rhythm disturbances and increased vagal tone. Determinants of fatigue include tumour-related factors and complications (e.g. anaemia, anorexia/cachexia), physical symptoms associated with the tumour or the treatment (e.g. pain, dyspnea), comorbid conditions (e.g. cardiovascular disease), psychological or behavioural factors (e.g. anxiety, depression), side effects of other medication or iatrogenic factors. Dr. Roila emphasizes the importance of screening patients for fatigue at their initial clinical visit and on a regular basis during and after their treatment in order to identify the factors that contribute to fatigue and determine a treatment strategy for the individual patient.
Pharmacological intervention includes psychostimulants, antidepressants, acetylcholinesterase inhibitors, corticosteroids, L-carnitine and coenzyme Q10. Various trials with regard to these pharmacological agents in the management of fatigue are presented.
Furthermore, various non-pharmacological options are available. Adequate physical activity should be encouraged in all patients, unless they have physical or disease-related limitations. Psychosocial interventions, such as behavioural therapies and psychoeducational therapies, can reduce cancer-related fatigue after the treatment. Dr. Roila also discusses trials on other interventions, such as ginseng, yoga, acupuncture, massage and music therapy. However, additional research is needed, particularly in the post-treatment population, as many of the currently available studies in this field are compromised by methodological flaws.
Dr. Fausto Roila, Azienda Ospedaliera Santa Maria, Terni, Italy