Morrow Gary R, Andrews Paul L R, Hickok Jane T, Roscoe Joseph A, Matteson Sara
Cancer Control Program University of Rochester Cancer Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14641, USA.
Support Care Cancer. 2002 Jul;10(5):389-98. doi: 10.1007/s005200100293. Epub 2001 Aug 15.
Fatigue is often related to cancer, and that related to its treatment is the most commonly reported side effect of cancer treatment. It differs from that induced by other causes, such as sleep disturbance and exertion, as the latter are typically alleviated by a period of rest. In contrast to exercise-induced fatigue, the fatigue reported by cancer patients is usually described as an unusual, excessive, whole-body experience that is disproportionate or unrelated to activity or exertion and is not relieved by rest or sleep. Cancer-related fatigue is a subjective experience that has a clear detrimental effect on a cancer patient's quality of life and ability to sustain the usual personal, professional, and social relationships. The fatigue can be pervasive: cancer patients frequently report that fatigue begins with treatment, continues during the course of chemotherapy or radiation treatment, and declines somewhat - but frequently sustains at a higher-than-baseline rate - after treatment is over. It may also persist for several years even in patients with no apparent disease. While a number of researchers have speculated about the nature of cancer-related fatigue, there has been little systematic research on its etiology or treatment. In many aspects our knowledge of the fatigue mechanisms in cancer patients is at a similar stage to that reached in our understanding of anti-cancer therapy-induced nausea and vomiting about 20 years ago. This paper introduces four plausible hypotheses for the development of fatigue. Evidence available to support a role for anemia, adenosine triphosphate, vagal afferents, and the interaction of the HPA/cytokines and 5HT is discussed.
疲劳常与癌症相关，而与癌症治疗相关的疲劳是癌症治疗最常报告的副作用。它与其他原因引起的疲劳不同，比如睡眠障碍和劳累，因为后两者通常经过一段时间的休息就能缓解。与运动引起的疲劳相反，癌症患者报告的疲劳通常被描述为一种异常的、过度的、全身性的体验，与活动或劳累不成比例或无关，且休息或睡眠无法缓解。癌症相关疲劳是一种主观体验，对癌症患者的生活质量以及维持正常的个人、职业和社会关系的能力有明显的不利影响。这种疲劳可能无处不在：癌症患者经常报告说疲劳始于治疗，在化疗或放疗过程中持续存在，治疗结束后会有所减轻——但通常维持在高于基线的水平。即使在没有明显疾病的患者中，疲劳也可能持续数年。虽然一些研究人员对癌症相关疲劳的本质进行了推测，但关于其病因或治疗的系统性研究却很少。在许多方面，我们对癌症患者疲劳机制的了解，与大约20年前我们对抗癌治疗引起的恶心和呕吐的了解处于相似阶段。本文介绍了四种关于疲劳发生的合理假设。并讨论了支持贫血、三磷酸腺苷、迷走神经传入以及下丘脑-垂体-肾上腺轴/细胞因子与5-羟色胺相互作用所起作用的现有证据。
