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Improving Palliative Care for Cancer
may be caused by treatment. Other mechanisms that contribute to fatigue include sleep disturbance, environmental conditions, level of activity, nutritional status, and the demands of treatment (Nail and Winningham, 1993). Treatment-related anemia is well known for its impairment of quality of life and function and is often associated with severe fatigue in cancer patients (Glaspy et al., 1997). In a survey of cancer patients at M.D. Anderson Cancer Center using the Brief Fatigue Inventory (BFI), patients with hematologic malignancies reported greater fatigue than patients with solid tumors (47 percent of the hematologic group reported “worst fatigue” of 7 or greater versus 28 percent of the solid-tumor group) (Mendoza et al., 1999). In patients with hematologic malignancies, low levels of both hemoglobin and albumin were predictive of severe fatigue (Cleeland and Wang, 1999).
Hormonal deficiencies occur in large numbers of patients treated with IFN-a, and the possibility that hypothyroidism or other adrenal or gonadal dysfunction may be associated with fatigue in these patients should be investigated (Jones et al., 1998). IFN-a and other agents used in treating cancer also excite or inhibit the production of cytokines that are known to be related to fatigue. For example, IL-6 is a proinflammatory cytokine that has been shown to mediate endocrine and neural activity. In normal subjects, IL-6 induces fatigue and inactivity as well as poor concentration (Spath-Schwalbe et al., 1998). Future research should explore the role of proinflammatory cytokines in the production of fatigue experienced by patients treated with IFN-a (Dalakas et al., 1998).
Basic Research Needs
Explore new agents for treating fatigue (anticytokines).
Develop animal models for fatigue.
Explore “common pathways” for fatigue and other symptoms.
Clinical Research Needs
There are needs for trials of the following:
Review of Current Funding: CRISP Listings
Searching the CRISP database of current federal funding using the terms cancer and fatigue produced 34 hits. Eleven relate to basic or clinical research that might have relevance to clinical cancer fatigue. Of these stud-