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Cancer-related fatigue is a common side effect of cancer and its treatment, with around 80-100% of cancer patients experiencing it. It is often accompanied by muscle weakness, which can be caused by reduced muscle mass or function. This can be the result of cachexia, a severe muscle wasting syndrome that occurs in advanced cancer stages. Cachexia is characterized by weight loss and muscle atrophy, further contributing to fatigue. While there is no standard drug treatment for cancer fatigue, interventions such as respiratory therapy, physical therapy, and certain medications can help manage the condition.
| Characteristics | Values |
|---|---|
| Cancer fatigue | A condition caused by cancer or cancer treatment where one feels exhausted or extremely tired |
| Cancer-related fatigue | A symptom of cancer, but often a side effect of cancer treatments like chemotherapy and radiation therapy |
| Cancer treatment fatigue | Cancer treatments commonly associated with cancer fatigue include chemotherapy, radiation therapy, and surgery |
| Cancer-associated muscle weakness | Caused by loss of muscle mass, loss of muscle function, or a combination of both; there is currently no treatment |
| Cachexia | A wasting syndrome that causes muscle and weight loss in some people with cancer, leading to fatigue; occurs in late stages of cancer |
| Malnutrition | Loss of appetite due to symptoms caused by cancer or side effects of treatment, such as mouth sores from chemotherapy, can lead to muscle loss and fatigue |
| Low oxygen | Respiratory conditions associated with cancer, such as mesothelioma, can cause low oxygen levels, leading to fatigue as muscles need oxygen to function |
| Anemia | Chemotherapy and tumors spreading to the bone marrow can cause anemia, a decrease in red blood cells, resulting in fatigue |
| Cytokine production | Cancer can boost cytokine production, and high levels of cytokines can cause fatigue |
| Hormonal changes | Hormonal changes caused by tumors on glands or by cancer itself can lead to fatigue |
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What You'll Learn
Cancer-associated muscle weakness
In advanced cancer, tumour cells commonly metastasize to bone, disrupting normal bone remodelling and resulting in morbidity that includes muscle weakness. This occurs through the stimulation of excessive osteoclast activity, which releases growth factors stored in the mineralized bone matrix, fuelling tumour growth and bone destruction. Bone-derived growth factors, such as TGFβ, can act systemically to cause muscle weakness. Maladaptive modifications of RyR1 due to chronic oxidative stress, which is associated with cancer, may also contribute to cancer-associated muscle weakness by disrupting calcium handling and muscle force production.
Muscle weakness in cancer patients can be caused by a combination of reduced muscle mass and reduced muscle function. Malnutrition, a common issue in cancer patients, can lead to muscle loss and weakness. Certain cancer treatments, such as chemotherapy and radiation therapy, can also contribute to muscle weakness by causing inflammation, hormonal changes, and reducing red blood cell levels, leading to anemia and fatigue.
Currently, there is no standard treatment for cancer-associated muscle weakness. However, physical therapy and respiratory therapy may help relieve nerve or muscle problems and improve physical function and strength during and after cancer treatment. Additionally, while there are no drugs specifically for cancer-related fatigue, medications can be used to treat some of the underlying causes, such as depression or pain.
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Tumor-induced hypermetabolic state
Cancer-related fatigue is a common side effect of cancer and its treatment, with more than 80% of people with cancer experiencing fatigue while receiving chemotherapy or radiation therapy. It may also be a symptom of depression or stress from living with cancer.
Tumor-induced "hypermetabolic" state is a condition where tumor cells compete for nutrients, often at the expense of normal cell growth and metabolism. Weight loss, decreased appetite, and fatigue are common results.
Hypermetabolism is characterized by an increase in the body's basal metabolic rate and is noted in patients with burns, hyperthyroidism, sepsis, and those receiving steroid therapy. It is associated with increased peripheral insulin resistance, elevated protein catabolism, and a negative nitrogen balance. Hypermetabolic patients are more likely to have a negative energy balance, weight loss, performance status (PS) ≥2, and CRP concentrations ≥10 mg/L.
Cachexia, a wasting syndrome that causes muscle and weight loss, is a major cause of death in cancer patients. It is a multifactorial paraneoplastic syndrome commonly associated with advanced stages of cancer and is responsible for poor responses to antitumoral treatment. Cachexia affects most patients with advanced cancer and is more common and severe in patients with gastrointestinal tract or lung malignancies. It is characterized by progressive weight loss, fat and muscle wasting, and metabolic and hormonal alterations.
The development of therapeutic strategies that aim to blunt hypermetabolism and treat cachexia is warranted, but there is currently no treatment.
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Cachexia
Cancer-related fatigue is a common side effect of cancer and its treatment, with more than 80% of people with cancer experiencing fatigue while receiving chemotherapy or radiation therapy. Cancer-related fatigue can be caused by the cancer itself, as cancer cells use up calories and nutrients that the body needs for energy, or by cancer treatments, which can affect healthy cells and tissues.
The exact mechanisms underlying cachexia are not fully understood, but it is believed to be related to alterations in multiple organs, including adipose tissue, the brain, gut, cardiac muscle, and immune cells. Cachexia-inducing tumours secrete factors such as cytokines, which induce muscle wasting directly and affect other organs, aggravating the syndrome.
While there is no cure for cachexia, researchers are studying potential treatments. Anamorelin, a drug that improves appetite, has shown promising results in research. Other approaches include medicines, soft diets, adding calories to the diet, and tube feeding. However, it is important to note that tube feeding has not been effective in treating cachexia.
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Cancer treatment side effects
Cancer-related fatigue is a common side effect of cancer and its treatment, with more than 80% of people with cancer experiencing fatigue. This fatigue can be caused by the cancer itself or the treatment, and it may be experienced as a paralysing tiredness that does not go away with rest or sleep. Cancer-related fatigue can be caused by various factors, including the competition for nutrients between cancer cells and healthy cells, weight loss, decreased appetite, and the body's release of cytokines to fight the cancer. Additionally, certain types of cancer, such as blood cancers and gastrointestinal cancers, can affect the body's ability to produce healthy blood cells or process food, respectively, leading to fatigue. Treatments such as chemotherapy and radiation therapy can also contribute to fatigue by killing healthy cells and causing side effects like nausea and low energy.
Cancer-associated muscle weakness is another significant side effect, impacting patient well-being and outcomes. This muscle weakness can be caused by a loss of muscle mass or reduced muscle function and is often associated with cachexia, a severe wasting syndrome characterised by muscle and weight loss. Cachexia occurs in advanced stages of cancer and is estimated to be responsible for 20% of cancer-related deaths. Malnutrition and treatments like chemotherapy can also contribute to muscle loss and weakness. Additionally, bone metastases in advanced cancer can disrupt normal bone remodelling, leading to the release of growth factors that fuel tumour growth and bone destruction, further contributing to muscle weakness.
To manage cancer-related fatigue, respiratory therapy may be recommended to address breathing problems, and physical therapy can help relieve nerve or muscle issues and maintain physical function and strength during and after treatment. While there are no standard drug treatments for cancer fatigue, psychostimulants and antidepressants are being studied for their potential role in improving energy levels and mood.
Cancer-associated muscle weakness currently lacks effective therapies, highlighting the need for novel interventions. Research has focused on improving muscle mass and strength, but evidence suggests that loss of muscle function precedes atrophy. Understanding the underlying mechanisms and pathways involved in cancer-associated muscle weakness is crucial for developing effective treatments.
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Malnutrition
Cancer-related fatigue is a common side effect of cancer and its treatment, with more than 80% of people with cancer experiencing fatigue while undergoing chemotherapy or radiation therapy. Cancer-related fatigue may also be caused by the cancer itself, as cancer cells compete for nutrients, often at the expense of normal cell growth and metabolism. This can lead to weight loss, decreased appetite, and fatigue. Additionally, cancer can cause the body to release cytokines, substances that help fight infections and cancer but can lead to fatigue when released at high levels. Certain types of cancer, such as blood cancers and gastrointestinal cancers, can further contribute to fatigue by affecting the production of healthy blood cells and the body's ability to process and utilize food.
While cancer-related fatigue and malnutrition have distinct causes, they both share fatigue as a common symptom. Malnutrition, specifically undernutrition, can exacerbate the fatigue experienced by cancer patients by further depleting the body's nutrient stores and energy levels. This can hinder the body's ability to cope with the demands of cancer and its treatment. Therefore, addressing malnutrition through nutritional interventions and ensuring adequate nutrient intake can potentially help manage cancer-related fatigue and improve overall health in cancer patients.
To prevent malnutrition, it is crucial to maintain a well-balanced diet that includes a variety of nutritious whole foods. This helps ensure sufficient intake of all the necessary nutrients, reducing the likelihood of overeating to satisfy specific nutrient needs. Micronutrient deficiencies, even with a standard diet, can be addressed through micronutrient supplements, as determined by a healthcare provider. By prioritizing proper nutrition, individuals can lower their risk of malnutrition and its associated complications, including muscle fatigue.
In summary, cancer-related fatigue is a common side effect of cancer and its treatment, and malnutrition, particularly undernutrition, can aggravate this fatigue by impacting the body's nutrient reserves and energy levels. Addressing malnutrition through nutritional interventions can potentially help manage cancer-related fatigue and enhance the overall well-being of cancer patients.
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Frequently asked questions
Cancer fatigue is a condition caused by cancer or cancer treatment, making you feel exhausted or extremely tired. It is different from regular fatigue as it is not relieved by sleep or rest and may happen after no or minimal activity.
Cancer fatigue can be caused by the cancer itself, the treatment, or a combination of both. Cancer cells use calories and nutrients that your body needs for energy, and the body's immune system is working hard to fight the disease, resulting in fatigue. Certain treatments like chemotherapy can also cause fatigue by killing healthy cells and affecting red blood cell levels, leading to anemia.
While there is currently no treatment for cancer-associated muscle weakness, your healthcare team may recommend physical therapy to help maintain physical function and strength during and after cancer treatment. Respiratory therapy can also help with breathing problems that contribute to fatigue.
