Proactive fatigue screening and management called for in blood cancer patients

Blood cancers

By Natasha Doyle

8 Nov 2021

A study showing fatigue is common and enduring in non-Hodgkin lymphoma (NHL) survivors has highlighted the need for more proactive screening and management in blood cancer patients, an Australian occupational therapist says.

The US study, which assessed fatigue’s prevalence and persistence in 555 NHL survivors, found it occurred in more than a quarter of patients at baseline and worsened in a third over time.

The disproportionate sense of physical, emotional and/or cognitive tiredness or exhaustion clung to 19% of patients at five years post-diagnosis and could affect around 30% at 10 to 15 years, the study read, noting that female patients and those with less education, past chemotherapy, increased co-morbidities and post-traumatic stress symptoms were most at risk.

The symptom is often associated with weakness and ‘brain fog’ and is “commonly cited” as having “the greatest impact on daily life”, occupational therapist and Peter MacCallum Cancer Centre health services researcher, Dr Elizabeth Pearson wrote in an accompanying editorial.

Moderate fatigue can reduce stamina and “cause frustration due to being unable to do as much as expected”, while severe levels prevent patients from doing many tasks and have been “significantly associated with reduced employment, financial problems and increased health care utilisation among Hodgkin lymphoma survivors”.

Despite fatigue’s considerable impact on patients’ lives and the availability of evidence-based guidelines, it tends to be poorly managed during and after cancer treatment, Dr Pearson wrote.

International cancer-related fatigue guidelines recommend moderate or severely-affected patients receive “comprehensive assessment and management of modifiable contributing factors including pain and other symptoms, depression and co-morbid conditions” to help “lower fatigue to the point where other highly effective interventions such as exercise conditioning become feasible”.

Yet, perceived lack of knowledge about cancer-related fatigue and its underlying mechanisms, competing priorities and lack of time prevent health professionals from implementing these guidelines, she suggested.

“There is no ‘quick fix’ drug remedy, and health professionals can be reluctant to ask about fatigue, knowing that a comprehensive fatigue assessment and management plan is simply not possible within a standard consultation,” she wrote.

“This can be compounded by survivors’ perceptions that fatigue must be accepted, with a reluctance to raise the issue, or reveal the true extent of their fatigue.”

To combat this, haematologists and primary care clinicians should prioritise symptom management, including co-morbidities and mood, and “promote strategies to maintain body structure and function, including physical activity and optimal nutrition”, during and after blood cancer treatment, Dr Pearson suggested.

Severely fatigued survivors may need additional support from haematologists or palliative care, she noted.

“Fatigue remains a significant problem for many patients and survivors of haematological and solid malignancies, largely due to the necessary focus on treatment to survive, and less on life after survival. But there is good news — something can be done,” Dr Pearson concluded.

Both articles are available in Leukaemia and Lymphoma.

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