Fatigue Pain and Anemia

Fatigue is extraordinarily common in cancer patients and is now recognized as a more widespread and problematic symptom than pain. Cancer-related fatigue is defined as an unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning. It can occur during active cancer treatment and it can persist long after treatment has ended. The causes are myriad and overlap considerably with those that can cause cognitive disorders. Fatigue may be physical in that the person has very little stamina or energy to perform usual activities. Fatigue can also be mental. Similar to patients with cognitive dysfunction, patients who suffer from mental fatigue often report that they are easily overwhelmed, that they have difficulty being organized and efficient in their daily activities, and that they have difficulty meeting deadlines or getting things done on time. Activities that used to be automatic now require more effort so that the patients become exhausted even performing routine tasks.

A similar situation exists for patients who experience pain. Patients in pain also suffer from deficits in attention and concentration, multitasking, and speed and efficiency of thinking. They may be on medications that are sedating and contribute to cognitive problems, and they are likely to be suffering from fatigue as well.

Anemia is very common in cancer patients undergoing active treatment. Cognitive deficits have been reported in well-dialyzed patients with end-stage renal disease who are anemic but do not have elevated uremia. Cognitive deficits are also exhibited by patients who have anemia due to iron deficiency. The cognitive problems observed on neuropsychological testing include deficits in attention, perceptual motor speed, memory, and verbal fluency and are accompanied by slowed auditory evoked potentials. There is a high degree of correlation between hemoglobin levels and fatigue. However, patients with anemia may experience cognitive difficulties separately from those due to fatigue alone, possibly due to reduced cerebral blood flow. These cognitive deficits and slowed evoked potentials often improve following reversal of anemia with erythropoietin or blood transfusion.

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