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What Causes Fatigue
Ernest H Rosenbaum, MD; Barbara F. Piper, RN, OCN, DNSc.; Marilyn Dodd RN, PhD; Kathleen Dzubur, MS; Michael Glover, Pat Kramer, RN, MSN, AOCN; RoseAnn Kurshner, RN, BSN, MEd; Francine Manuel, RPT

Fatigue - What a Patient Needs to Know
Fatigue Facts
Fatigue Problems

What Physicians Need to Know
Fatigue Associated with Medical Therapy: Causes and Solutions
Tips For Reducing Fatigue

Fatigue Reduction Program for Improved Quality of Life
Fatigue Diagram

Age, sex and genetics, socio-economic and environmental factors, as well as prior experiences with weakness and fatigue have been implicated with fatigue, as have sleep disturbances and depression. But with cancer, many other factors involved in both the disease and its treatment may also contribute. These may include:

1) Changes in energy production or the lack of available nutrients. The tumor itself may make the body function in an overactive or hyper-metabolic state. Tumor cells compete for nutrients, often at the expense of normal cells' growth and metabolism. Weight loss, reduced appetite and fatigue are often the result.

2) Disease complications and/or treatment side effects such as anemia, nausea, infection and fever can create additional energy needs that your usual food intake cannot supply alone. Nutritional supplements and therapy may be needed.

3) Diagnostic tests, anesthesia, surgery, radiation therapy, chemotherapy, biotherapy, and drugs used to control symptoms and side effects (such as nausea, vomiting, pain and insomnia).

For example, drugs such as vincristine, vinblastine, navelbine, taxol and taxotere may cause fatigue because of their toxic effects on nerves (neurotoxicity). With cisplatin, low magnesium levels, along with neurotoxicity, may cause fatigue.

Fatigue that increases over time (cumulative fatigue) occurs in radiotherapy patients regardless of the part of the body being treated. This usually improves within one month, but may last up to three months or more, after treatment stops.

Fatigue may become so severe during immunotherapy or biotherapy. The biotherapy drugs (interferon, and/or Interleukin) that treatment dosages may need to be reduced. As cancer cells die in response to therapy, they release certain toxic metabolic substances (cytokines) that may contribute to fatigue. response to therapy, they release certain toxic substances that may contribute to fatigue. More attention has recently been paid to the possible role of cytokines in the development of fatigue.

4) Cytokines are natural cell products or proteins, such as the interferons and interleukins, that are normally released by white blood cells, lymphocytes and macrophages in response to infection. These cytokines carry messages that regulate other elements of the immune and neuroendocrine systems to control cancer growth. In high amounts, these cytokines can be toxic and lead to persistent fatigue.

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