From the Guidelines
Waxing and waning fatigue is a common feature of metastatic cancer, including those with liver metastases, affecting up to 90% of cancer patients, as reported in the most recent study 1.
Fatigue Mechanisms
The fatigue experienced by patients with metastatic cancer to the liver can be attributed to several mechanisms, including:
- The cancer itself consuming energy resources
- The liver's compromised function affecting metabolism and detoxification processes
- Inflammatory cytokines released by the immune system in response to cancer causing systemic effects
- Anemia often developing as cancer progresses
- The liver's role in processing medications, leading to increased side effects from cancer treatments and contributing to fatigue patterns
Management Strategies
Management of fatigue in patients with metastatic cancer to the liver typically involves a combination of:
- Treating the underlying cancer
- Addressing reversible causes like anemia
- Energy conservation strategies
- Light exercise as tolerated
- Sometimes medications like methylphenidate or modafinil for severe cases, as suggested by the updated guideline 1 Patients should track fatigue patterns to identify triggers and optimal times for activities, and discuss any significant changes in fatigue with their healthcare provider, as this could indicate disease progression or treatment effects, highlighting the importance of regular assessment and management of cancer-related fatigue, as emphasized in the guidelines 1.
From the Research
Fatigue in Metastatic Cancer
- Fatigue is a common and distressing symptom experienced by patients with cancer, particularly those with locally advanced or metastatic incurable disease 2.
- The prevalence of fatigue in patients with cancer is approximately 49%, with significant heterogeneity between studies 3.
- Fatigue can have profound effects on quality-of-life and physical functioning, and is often associated with other symptoms such as anxiety, depression, and poor sleep quality 4.
Metastatic Cancer to the Liver
- While there is no specific evidence on the relationship between metastatic cancer to the liver and waxing/waning fatigue, it is likely that patients with liver metastases experience fatigue due to the advanced nature of their disease 2, 5.
- Fatigue in patients with advanced cancer is often multifactorial, and may be related to factors such as inflammation, poor quality of sleep, anxiety, and depression 4.
- The management of fatigue in patients with advanced cancer, including those with liver metastases, typically involves a combination of physical, psychological, and pharmacological interventions 2, 5.
Waxing/Waning Fatigue
- Waxing/waning fatigue is not specifically addressed in the available evidence, but it is possible that this pattern of fatigue may be experienced by patients with metastatic cancer, including those with liver metastases.
- Further research is needed to fully understand the relationship between metastatic cancer to the liver and waxing/waning fatigue, as well as to develop effective strategies for managing this symptom in patients with advanced cancer 6, 3.