Do you experience exceptional tiredness, exhaustion, or weakness? Your treatment provider has probably already asked you this question to find out whether fatigue was caused by cancer or chemotherapy.
In this case, this is also referred to as tumor-related or tumor-induced fatigue, which occurs in cancer patients.

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Fatigue in cancer patients: tumor-induced fatigue

Fatigue describes a persistent, subjective feeling of physical, emotional and/or cognitive exhaustion that is out of proportion to current activity. If we now add the aspect of “tumor-induced”, i.e. tumor-related, this is such a feeling of exhaustion associated with cancer or even its treatment.

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Up to 90% of cancer patients suffer from fatigue as a result of the disease. Fatigue is the most common symptom of this disease, or the most common side effect of cancer treatment. Fatigue can disappear over time, but 20-50% of patients experience fatigue.

According to the German Cancer Society, tumor-related fatigue is common in leukemias, lymphoma, metastatic breast cancer and in connection with chemotherapy and radiotherapy.

Unfortunately, the majority of patients suffering from fatigue are not adequately treated. Why? Many patients regard the feeling of exhaustion as a “normal” side effect of therapy and doctors often lack knowledge and skills in treating this condition.

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symptoms: How does tumor-related fatigue manifest in everyday life?

Tumour-related fatigue is versatile and can have long-lasting effects on the body, emotions and cognitive functions. Patients often suffer from

• reduced physical performance
• increased need for sleep that cannot be satisfied
• persistent tiredness and exhaustion, even during the day
• feeling heavy limbs
• Lack of motivation and drive
• Difficulties in completing everyday tasks
• declining interest, sadness, anxiety, increased distractibility, word finding disorders, difficulty concentrating

The American Fatigue Coalition defines the condition as the occurrence of several of the above symptoms, which cannot be alleviated or only slightly alleviated by rest and sleep and significantly impair everyday life, over more than 2 weeks. There is currently no specific biomarker for diagnosing fatigue syndrome, which is why doctors use various questionnaires to record these specific symptoms.

And when does all of this occur?

The first symptoms, such as severe, persistent fatigue in everyday life, can actually occur before diagnosis; however, it also happens that fatigue only develops during therapy, during a relapse or even years after successful treatment.

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Causes: How does tumor-related fatigue develop?

At present, the complex causes are not yet fully understood, but there are some hypotheses.

One hypothesis is based on the division of tumor-related fatigue into a primary and a secondary form, which differ in their causes.

Possible concomitant diseases caused by the tumor or the therapy can

• cachexia/malnutrition (due to reduced food intake)
• anaemia/anaemia
• fevers
• infections
• depression
• Electrolyte and hormone balance imbalances

be.

These two forms have in common an inflammatory/inflammatory process, which current researchers suspect to be a serious cause with regard to the origin of the disease.

Other causes such as

• genetic risk factors
• psychosocial factors (pre-therapy fatigue, depression, sleep disorder, dysfunctional coping, loneliness)
• biobehavioral factors (physical inactivity, high BMI)

are discussed.

In the end, however, no specific psychosocial or physical cause can often be identified.

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How do you know that it is really tumor-related fatigue?

Depression and cachexia/malnutrition in particular have many similarities with tumor-related fatigue.

Since there is no reliable laboratory parameter for a diagnosis, we also rely on the subjective description of the symptoms by patients when differentiating.

Depression and fatigue lead to listlessness, tiredness, weakness and depressive moods. Depression, on the other hand, often also shows a persistent feeling of worthlessness, unreasonable feelings of guilt, hopelessness and recurring thoughts of death, which are not common with fatigue. In addition, depression usually shows an improvement in symptoms over the course of the day; in contrast, fatigue results in a drop in performance over the course of the day.

Cachexia can be the cause of fatigue, but should be perceived and treated as a separate illness.

It is also particularly important to rule out diseases which can trigger symptoms such as tumour-related fatigue but are potentially treatable (e.g. anemia, electrolytes, organic dysfunction, hypothyroidism, infection, hormones, vitamin deficiencies).

The many overlaps make it clear that fatigue cannot be treated as a single symptom, but should be a symptom cluster in the context of treatment.

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Therapy: What can be done against tumor-related fatigue?

There is currently no cure for fatigue in cancer, but there are some measures that have proven effective in treating it.

Starting treatment early is beneficial to prevent chronicity over the course.

The treatment concept is often based on two pillars: the non-pharmacological and the medicinal pillar.

Non-drug therapy focuses on advising patients and their environment, showing options for dealing with the disease (dosage of activity and rest, prioritization, assistance).

Meta-analyses and reviews have shown that endurance and strength training, yoga and qigong in particular can be helpful in reducing fatigue in the area of physical activity. Fatigue could also be reduced with cognitive behavioral therapy and relaxation techniques, such as the so-called Mindfulness Based Stress Reduction (MBSR). Multimodal treatment approaches and combined interventions seem to make sense here.

Drug therapy is currently not officially approved for this condition, but treatment with psychostimulants (methylphenidate, modafinil) or corticosteroids may be considered. In any case, this should be discussed with your doctor! Other drugs are being discussed, but no specific recommendation has yet been made.

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Summary: What do you know now about tumor-related fatigue?

Tumour-related fatigue is a persistent, subjective feeling of physical, emotional and/or cognitive exhaustion and tiredness in people with cancer. The causes are manifold and partly unclear. Tumour-related fatigue can be triggered by the tumour, tumour therapy or even by concomitant diseases.

There is currently no curative therapy available. For this reason, the focus is on providing patients with detailed advice, in which they learn ways to best experience everyday life with the disease. On the other hand, other non-drug measures can be used, such as behavioral therapy or physical endurance and strength training.

The aim is to help you individually deal with symptoms in everyday life, to activate your strengths and resources, and to alleviate fatigue-increasing effects.

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