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. 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’. 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. There is now a significant literature dealing with interventions, including exercise, for cancer-related fatigue. It includes two recent systematic reviews. 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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