From the Guidelines
Fatigue is a common symptom in virtually all types of cancer, including lung, breast, colorectal, prostate, pancreatic, ovarian, leukemia, lymphoma, and neuroendocrine tumors, as reported in the most recent study 1. Cancer-related fatigue can occur due to the disease itself, as cancer cells compete with healthy cells for nutrients, or as a side effect of cancer treatments like chemotherapy, radiation, or immunotherapy. Neuroendocrine symptoms are indeed often vague and nonspecific, making neuroendocrine tumors challenging to diagnose. These tumors can produce hormones that cause a wide range of symptoms including fatigue, flushing, diarrhea, wheezing, heart palpitations, and unexplained weight changes. The vagueness of these symptoms often leads to delayed diagnosis, with patients frequently being misdiagnosed with irritable bowel syndrome, menopause, or anxiety disorders before the correct diagnosis is made. Some key points to consider include:
- Fatigue is a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning, as defined in 1.
- The prevalence of cancer-related fatigue exceeds 75% in patients with metastatic disease, and it can persist into posttreatment periods, as noted in 1.
- Effective management of cancer-related fatigue involves an informed and supportive oncology care team that assesses patients’ fatigue levels regularly, counsels and educates patients regarding strategies for coping with fatigue, and refers patients with unresolved fatigue to institutional experts, as recommended in 1. If experiencing persistent, unexplained fatigue or other vague symptoms, it's essential to consult a healthcare provider, as early detection of any cancer type significantly improves treatment outcomes and quality of life, as emphasized in 1.
From the Research
Cancers that Cause Fatigue as a Symptom
- Fatigue is a common symptom of advanced cancer, limiting one's activity and affecting the quality of life 2
- Cancer-related fatigue (CRF) is a problem for a significant proportion of cancer survivors during and after active cancer treatment 3
- The prevalence of cancer-related fatigue in individual studies varied from 14.03% to 100%, with a pooled prevalence of 52% 4
Neuroendocrine Symptoms
- Neuroendocrine symptoms can be vague, but there is no direct evidence in the provided studies to support this statement
- However, it is mentioned that components of fatigue often merge with other 'disease states' as anemia, depression and so on, compounding difficulty to assess it separately 2
- Neuroticism is identified as a risk factor for cancer-related fatigue, which may be related to neuroendocrine symptoms 4
Risk Factors for Cancer-Related Fatigue
- Poor performance status, chemoradiotherapy, female sex, insomnia, neuroticism, pain, and depression are identified as risk factors for cancer-related fatigue 4
- Anemia is also a risk factor for cancer-related fatigue, and epoetin alfa has been shown to improve anemia and anemia-related, patient-reported outcomes in patients with breast cancer receiving myelotoxic chemotherapy 5