Management of fatigue in cancer patients

Cancer-related fatigue (CRF) is either a symptom or a syndrome depending on criteria for diagnosis. CRF is present in 20% to 30% of long-term cancer survivors and 80% to 90% during treatment and at the end of life. Assessment requires determining the presence, severity, and interference with daily activities. Different descriptors for fatigue (eg, tiredness, lack of vigor) measure different patient experiences. Associated factors such as depression, pain, insomnia, dyspnea, anemia, and deconditioning worsen CRF and should be treated if present. Associated factors that contribute to the severity of fatigue differ depending on the stage of cancer. Pharmacologic interventions include recombinant erythropoietin, psychostimulants, corticosteroid, anti-inflammatory drugs other than steroids, and L-carnitine. Advances in the management of CRF will require an understanding of the underlying mechanism before target-specific therapies can be developed.

Palliative care in patients with brain metastases

PURPOSE OF REVIEW

With improvements in systemic therapy, central nervous system metastases have increased in incidence in patients with cancer. Patients with brain metastases from solid tumors often have a dismal prognosis, and supportive measures are often critical in improving patient outcome. They include treatments against vasogenic edema, seizures, symptomatic venous thrombosis, and pain, and the management of iatrogenic side effects. This article reviews all the supportive care measures in patients with brain metastases, with the exception of tumor-specific chemotherapy treatments that are also used in this patient population.

RECENT FINDINGS

Recently, improvement has been made in the management of the following complications of brain metastases: epilepsy and antiepileptic drug side effects, thromboembolic complications, fatigue and cognitive disorder of mixed (tumoral and/or iatrogenic) origin, pain, hematological side effects of chemotherapy, and steroids complications.

SUMMARY

Patients with brain metastases are particularly prone to develop severe side effects, increased fatigue, and cognitive deteriorations following apparently minor changes in symptomatic treatments. Palliative management of brain metastasis requires a multidisciplinary approach, and it is important to avoid any treatment that is useless or harmful or has a poor toxicity/efficacy ratio.