In men with advanced prostate cancer, what interventions may ameliorate or minimise the symptoms of fatigue?

From Cancer Guidelines Wiki

In men with advanced prostate cancer, what interventions may ameliorate or minimise the symptoms of fatigue?

Fatigue remains the most prevalent symptom in patients with advanced cancer.[1] Fatigue in this setting is defined as ‘An unusual, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning’.[2] A feature of fatigue in advanced cancer is that it is not relieved by rest or sleep.

In men with metastatic prostate cancer and extensive bone involvement with metastatic disease, fatigue may be secondary to anaemia due to bone marrow failure. If red cell transfusion is undertaken, it should be seen as a trial of therapy, where relief of fatigue rather than correction of blood figures should be the aim of the therapy.

In men receiving hormone therapy, a randomised controlled trial has shown that resistance exercise can reduce fatigue.[3] There is now a significant literature dealing with interventions, including exercise, for cancer-related fatigue. It includes two recent systematic reviews.[4][5] Many of the studies covered in these reviews did not include prostate cancer patients and were complicated by differing or unclear disease stages and continuing treatments that may not be applicable to prostate cancer patients. As a result it was not possible to develop specific recommendations about interventions that may ameliorate or minimise the symptoms of fatigue in men with more metastatic prostate cancer.

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References

  1. Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A. Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manage 2007 Jul;34(1):94-104 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17509812.
  2. Mock V, Atkinson A, Barsevick A, Cella D, Cimprich B, et al. NCCN Practice Guidelines for Cancer-Related Fatigue. Oncology (Williston Park) 2000 Nov 1;14(11A):151-61 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11195408.
  3. Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, et al. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 2003 May 1;21(9):1653-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12721238.
  4. Minton O, Stone P, Richardson A, Sharpe M, Hotopf M. Drug therapy for the management of cancer related fatigue. Cochrane Database Syst Rev 2008 Jan 23;(1):CD006704 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18254112.
  5. Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2008 Apr 16;(2):CD006145 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18425939.

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Appendices