Kanser İlişkili Yorgunluk
Özet
Kanser ilişkili yorgunluk (KİY), kanser hastalarının en yaygın ve zorlu semptomlarından biridir. Hastalığın her aşamasında ortaya çıkabilen bu durum; kanser veya tedavi süreçlerinden kaynaklanan, hastaların işlevselliğini engelleyen, fiziksel, duygusal ve bilişsel açıdan belirgin bir yorgunluk halidir. KİY, hastaların yaşam kalitesini düşürmekle kalmaz, aynı zamanda tedaviye uyumlarını ve genel prognozlarını olumsuz etkiler. Bu nedenle, KİY'in doğru bir şekilde tanınması ve yönetilmesi kritik öneme sahiptir.
KİY’in patofizyolojisi karmaşık ve çok faktörlüdür. İnflamatuar yanıtların, enerji metabolizmasındaki bozuklukların ve nörolojik değişikliklerin bir kombinasyonu olarak ortaya çıktığı düşünülmektedir. Ayrıca, kemoterapi, radyoterapi ve hedefe yönelik tedavilerin yanı sıra psikososyal stres faktörleri de KİY’yi şiddetlendiren temel etmenler arasındadır.
Tedavi süreçlerinde KİY'in tarama ve yönetimi giderek daha fazla önem kazanmaktadır. Bu semptomun fiziksel, psikolojik ve sosyal yönlerini ele alan multidisipliner yaklaşımlar KİY yönetiminde kritik öneme sahiptir. KİY’in tedavisinde farmakolojik ve non-farmakolojik yöntemler bir arada kullanılmalıdır. Egzersiz, psikososyal müdahaleler ve bazı farmakolojik tedaviler KİY'i yönetmeye yardımcı olabilir. Takip ve izleme süreçleri, tedaviye yanıtı değerlendirmek ve semptomları yönetmek için önemlidir. Sonuç olarak, KİY doğru şekilde tanımlanmalı ve bireyselleştirilmiş tedavi yaklaşımları ile yönetilmelidir.
Cancer-related fatigue (CRF) is one of the most common and challenging symptoms for cancer patients. This condition, which can occur at any stage of the disease, results from cancer or treatment processes and leads to significant physical, emotional, and cognitive fatigue that impairs patients' functionality. CRF not only reduces the quality of life but also negatively affects treatment adherence and overall prognosis. Therefore, the accurate recognition and management of CRF are of critical importance.
The pathophysiology of CRF is complex and multifactorial, believed to result from a combination of inflammatory responses, disturbances in energy metabolism, and neurological changes. Additionally, chemotherapy, radiotherapy, and targeted therapies, as well as psychosocial stress factors, are key contributors that exacerbate CRF.
During treatment, the screening and management of CRF have become increasingly important. Multidisciplinary approaches addressing the physical, psychological, and social aspects of CRF are essential for its management. Both pharmacological and non-pharmacological methods should be combined in the treatment of CRF. Regular follow-up and monitoring processes are crucial to evaluate treatment responses and manage symptoms. In conclusion, CRF should be effectively managed through individualized treatment approaches and a multidisciplinary strategy.
Referanslar
Bower JE. Cancer-related fatigue–mechanisms, risk factors, and treatment. Nat Rev Clin Oncol. 2014;11:597e609.
Horneber M, Fischer I, Dimeo F, et al. Cancer-related fatigue: epidemiology, pathogenesis, diagnosis, and treatment. Dtsch Arztebl. 2012;109:161e167.
Bower JE, Ganz PA, Desmond KA, et al. Fatigue in breast cancer survivors: occurrence,correlates, and impact on quality of life. J Clin Oncol 2000; 18:743.
Servaes P, Verhagen S, Bleijenberg G. Determinants of chronic fatigue in disease-freebreast cancer patients: a cross-sectional study. Ann Oncol 2002; 13:589.
Stone P, Richardson A, Ream E, et al. Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer Fatigue Forum. Ann Oncol2000; 11:971.
Howell D, Keller-Olaman S, Oliver TK, et al. A pan-Canadian practice guideline andalgorithm: screening, assessment, and supportive care of adults with cancer-relatedfatigue. Curr Oncol 2013; 20:e233.
Stasi R, Abriani L, Beccaglia P, et al. Cancer-related fatigue: evolving concepts inevaluation and treatment. Cancer 2003; 98:1786.
Naidoo J, Page DB, Li BT, et al. Toxicities of the anti-PD-1 and anti-PDL1 immune checkpoint antibodies. Ann Oncol. 2015;26:2375e2391.
Oxnard GR, Ramalingam SS, Ahn M, et al. Preliminary results of TATTON, a multiarm phase Ib trial of AZD9291 combined with MEDI4736, AZD6094 or selumetinib in EGFR-mutant lung cancer. J Clin Oncol. 2015;33:15s.
Janda M, Gerstner N, Obermair A, et al. Quality of life changes during conformalradiation therapy for prostate carcinoma. Cancer 2000; 89:1322.
Geinitz H, Zimmermann FB, Stoll P, et al. Fatigue, serum cytokine levels, and blood cellcounts during radiotherapy of patients with breast cancer. Int J Radiat Oncol Biol Phys2001; 51:691.
Bower JE, Bak K, Berger A, et al. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical Oncology clinical practiceguideline adaptation. J Clin Oncol 2014; 32:1840.
NCCN Guidelines for Cancer related fatigue (v1.2025) availabe online at https://www.nccn.org/guidelines/ (Accessed on November 11, 2024).
Morrow GR. Cancer-related fatigue: causes, consequences, and management. Oncologist. 2007;12(Suppl 1):1e3.
Ryan JL, Carroll JK, Ryan EP, et al. Mechanisms of cancer-related fatigue. Oncologist. 2007;12(Suppl 1):22e34.
Barsevick AM, Irwin MR, Hinds P, et al. Recommendations for highpriority research on cancer-related Fatigue in children and adults. J Natl Cancer Inst. 2013;105:1432e1440.
ICD-11 (International Statistical Classification of Diseases and Related Health Problems, 11th Revision). Geneva, Switzerland: World Health Organization; 2019.
Stone P, Hardy J, Broadley K. Fatigue in cancer patients: A review of measurement tools. J Pain Symptom Manage. 2000;19(1):34-40.
Fisher MI, Davies C, Lacy H, et al. Oncology Section EDGE Task Force on cancer: measures of cancer-related fatigue - a systematic review. Rehabil Oncol. 2018;36:93e105.
Mendoza TR, Wang XS, Kugaya A, et al. The rapid assessment of fatigue severity in cancer patients; use of the Brief Fatigue Inventory. Cancer. 1999;85:1186e1196.
Given B, Given CW, Sikorskii A, et al. Establishing mild, moderate, and severe scores for cancer-related symptoms: how consistent and clinically meaningful are interference-based severity cutpoints? J Pain Symptom Manage. 2008;35:126e135.
Weis J, Wirtz MA, Tomaszewski KA, EORTC Quality of Life Group, et al. Sensitivity to change of the EORTC quality of life module measuring cancer-related fatigue (EORTC QLQ-Fa12): results from the international psychometric validation. Psychooncology. 2019;28(8):1753e-1761.
Stone P, Richards M, Hardy J. Fatigue in patients with cancer. Eur J Cancer 1998; 34:1670.
Brown P, Clark MM, Atherton P, et al. Will improvement in quality of life (QOL) impact fatigue in patients receiving radiation therapy for advanced cancer? Am J Clin Oncol2006; 29:52.
Jereczek-Fossa BA, Santoro L, Alterio D, et al. Fatigue during head-and-neckradiotherapy: prospective study on 117 consecutive patients. Int J Radiat Oncol Biol Phys2007; 68:403.
Romito F, Montanaro R, Corvasce C, et al. Is cancer-related fatigue more stronglycorrelated to haematological or to psychological factors in cancer patients? SupportCare Cancer 2008; 16:943.
Mystakidou K, Parpa E, Tsilika E, et al. The relationship of subjective sleep quality, pain,and quality of life in advanced cancer patients. Sleep 2007; 30:737.
Basch E, Schrag D, Henson S, et al. Effect of Electronic Symptom Monitoring on Patient-Reported Outcomes Among Patients With Metastatic Cancer: A Randomized ClinicalTrial. JAMA 2022; 327:2413.
Patrick DL, Ferketich SL, Frame PS, et al. National Institutes of Health State-of-the-Science Conference Statement: Symptom Management in Cancer: Pain, Depression, andFatigue, July 15-17, 2002. J Natl Cancer Inst 2003; 95:1110.
de Raaf PJ, de Klerk C, Timman R, et al. Systematic monitoring and treatment of physicalsymptoms to alleviate fatigue in patients with advanced cancer: a randomizedcontrolled trial. J Clin Oncol 2013; 31:716.
Littlewood TJ, Kallich JD, San Miguel J, et al. Efficacy of darbepoetin alfa in alleviatingfatigue and the effect of fatigue on quality of life in anemic patients withlymphoproliferative malignancies. J Pain Symptom Manage 2006; 31:317.
Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;1:961e968.
Puetz TW, Herring MP. Differential effects of exercise on cancerrelated fatigue during and following treatment: a meta-analysis. Am J Prev Med. 2012;43:1e24.
Kampshoff CS, Chinapaw MJ, et al. Randomized controlled trial of the effects of high intensity and low-to-moderate intensity exercise on physical fitness and fatigue in cancer survivors: results of the Resistance and Endurance exercise after chemotherapy (REACT) study. BMC Med. 2015;13:275e281.
Mustian K, Morrow G, Carroll J, et al. Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist. 2007;12:52e67.
Barsevick AM, Dudley W, Beck S, et al. A randomized clinical trial of energy conservation for patients with cancer-related fatigue. Cancer. 2004;100:1302e1310.
Williams SA, Schreier AM. The role of education in managing fatigue, anxiety, and sleep disorders in women undergoing chemotherapy for breast cancer. Appl Nurs Res. 2005;18:138e147.
Given C, Given B, Rahbar M, et al. Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy. J Clin Oncol. 2004;22:507e516.
Goedendorp MM, Gielissen MF, Verhagen CA, et al. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev. 2009;(1):CD006953.
Roth AJ, Nelson C, Rosenfeld B, et al. Methylphenidate for fatigue in ambulatory men with prostate cancer. Cancer. 2010;116:5102e5110.
Kerr CW, Drake J, Milch RA, et al. Effects of methylphenidate on fatigue and depression: a randomized, double-blind, placebo-controlled trial. J Pain Symptom Manage. 2012;43:68e77.
Richard PO, Fleshner NE, Bhatt JR, et al. Phase II, randomised, doubleblind, placebo-controlled trial of methylphenidate for reduction of fatigue levels in patients with prostate cancer receiving LHRH-agonist therapy. BJU Int. 2015;116:744e752.
Lower EE, Fleishman S, Cooper A, et al. Efficacy of dexmethylphenidate for the treatment of fatigue after cancer chemotherapy: a randomized clinical trial. J Pain Symptom Manage. 2009;38:650e652.
Stone PC. Methylphenidate in the management of cancer-related fatigue. J Clin Oncol 2013; 31:2372.
Morrow GR, Hickok JT, Roscoe JA, et al. Differential effects of paroxetine on fatigue and depression: a randomized, double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program. J Clin Oncol. 2003;21:4635e4641.
Roscoe JA, Morrow JR, Hickok JT, et al. Effect of paroxetine hydrocloride (paxil) on fatigue and depression in breast cancer patients receiving chemotherapy. Breast Cancer Res Treat. 2005;89:243e249.
Yennurajalingam S, Frisbee-Hume S, Palmer L, et al. Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer. J Clin Oncol. 2013;31:3076e3082.
Paulsen O, Klepstad P, Rosland JH, et al. Efficacy of methylprednisolone on pain, fatigue, and appetite loss in patients with advanced cancer using opioids: a randomized, placebo-controlled, double-blind trial. J Clin Oncol. 2014;32:3221e3228.
Cruciani RA, Zhang JJ, Manola J, et al. L-carnitine supplementation for the management of fatigue in patients with cancer: an Eastern Cooperative Oncology Group phase III, randomized, double-blind, placebo-controlled trial. J Clin Oncol. 2012;30:3864e3869.
Lesser GJ, Case D, Stark N, et al. A randomized, double-blind, placebocontrolled study of oral coenzyme Q10 to relieve self-reported treatment-related fatigue in newly diagnosed patients with breast cancer. J Support Oncol. 2013;11:31e42.
