Mesothelioma Fatigue

It has been estimated that around 75-80% of cancer patients suffer with fatigue while undergoing treatment; however this estimate could be well below the real figure as a patient has to report the symptom before it can be recorded. Even so, fatigue that is reported is often overlooked by physicians and is rarely treated to the same degree that other symptoms such as pain, nausea and depression are. Shockingly, two thirds of patients say that fatigue affects their everyday life more than cancer-related pain does and that similarly it affects their long term quality of life more severely than both nausea and depression1.

Fatigue, when associated with cancer can have a very rapid onset and is normally reported to become more severe during the acute phase of treatment i.e. during the most intense periods. Saying this, a third of patients go on to suffer with chronic fatigue that doesn’t improve even when the treatment sessions come to an end. This means that cancer-related fatigue may be caused by a number of physiological and psychological factors including:

•	Primary factors that are directly due to the disease e.g. anemia, insomnia and sleep problems, pain, emotional stress etc.
•	Secondary factors that are common in some cancer cases such as infection, cardiac, pulmonary and renal dysfunctions etc.
•	Severe weight loss or decrease in caloric intake due to loss of appetite.
•	An imbalance in the body’s electrolyte levels which can be caused by becoming malnourished and underweight.

There are a number of scales that are used to establish the severity of a patient’s fatigue; however no one scale is any more precise than any other and so the World Health Organization has not as yet produced a definitive scale.

One of the most common and powerful contributors to cancer-related fatigue is anemia. This occurs when the level of hemoglobin in the blood decreases to a level below the normal range and in cancer patients this can be due either to treatment or to iron deficiency caused by malnutrition. Anemia is a common side effect of both radiotherapy and chemotherapy however because the patient is focused on the cancer itself, fatigue often isn’t noticed until it seriously starts to affect their day to day life. These forms of treatment are also known to cause pain, nausea and vomiting, loss of appetite and thus malnutrition and over time this can weaken the patient and cause fatigue.

Treating cancer-related fatigue starts with correcting any underlying conditions, so for example:

•	Anemia can be treated with iron tablets and the diet can be changed to include high protein foods with plenty of iron and other vitamins. If anemia becomes severe however then a simple blood transfusion helps to dramatically increase the levels of hemoglobin in the blood.
•	Depression can be treated with a number of antidepressants that enable the patient to live a more productive life.
•	Non-steroidal anti-inflammatory painkillers and opioid drugs can be used to control pain that may be emotionally draining for the patient. 
•	A short hospital stay can help to rehydrate severely dehydrated patients by means of an IV infusion. 
•	Antibiotics can be prescribed to combat any secondary infections which may be causing fatigue to worsen.
•	Sleeping tablets can often help patients to beat insomnia and other sleep disorders so that they have a better chance of beating their fatigue by themselves.

As can be seen there are a number of ways to treat cancer-related fatigue and it is important that patients do get help for the condition. Cancer is hard enough to fight even when the patient is energized and feeling relatively well and so everything possible should be done to keep the patient in this high energy state for as long as possible. 

Fighting fatigue: http://www.mesothelioma-aid.org/fatigue.htm