Radbruch Lukas, Strasser Florian, Elsner Frank, Gonçalves Jose Ferraz, Løge Jon, Kaasa Stein, Nauck Friedemann, Stone Patrick
Department of Palliative Medicine, RWTH Aachen University, Aachen, Germany.
Palliat Med. 2008 Jan;22(1):13-32. doi: 10.1177/0269216307085183.
Fatigue is one of the most frequent symptoms in palliative care patients, reported in .80% of cancer patients and in up to 99% of patients following radio- or chemotherapy. Fatigue also plays a major role in palliative care for noncancer patients, with large percentages of patients with HIV, multiple sclerosis, chronic obstructive pulmonary disease or heart failure reporting fatigue. This paper presents the position of an expert working group of the European Association for Palliative Care (EAPC), evaluating the available evidence on diagnosis and treatment of fatigue in palliative care patients and providing the basis for future discussions. As the expert group feels that culture and language influence the approach to fatigue in different European countries, a focus was on cultural issues in the assessment and treatment of fatigue in palliative care. As a working definition, fatigue was defined as a subjective feeling of tiredness, weakness or lack of energy. Qualitative differences between fatigue in cancer patients and in healthy controls have been proposed, but these differences seem to be only an expression of the overwhelming intensity of cancer-related fatigue. The pathophysiology of fatigue in palliative care patients is not fully understood. For a systematic approach, primary fatigue, most probably related to high load of proinflammatory cytokines and secondary fatigue from concurrent syndromes and comorbidities may be differentiated. Fatigue is generally recognized as a multidimensional construct, with a physical and cognitive dimension acknowledged by all authors. As fatigue is an inherent word only in the English and French language, but not in other European languages, screening for fatigue should include questions on weakness as a paraphrase for the physical dimension and on tiredness as a paraphrase for the cognitive dimension. Treatment of fatigue should include causal interventions for secondary fatigue and symptomatic treatment with pharmacological and nonpharmacological interventions. Strong evidence has been accumulated that aerobic exercise will reduce fatigue levels in cancer survivors and patients receiving cancer treatment. In the final stage of life, fatigue may provide protection and shielding from suffering for the patient and thus treatment may be detrimental. Identification of the time point, where treatment of fatigue is no longer indicated is important to alleviate distress at the end of life.
疲劳是姑息治疗患者最常见的症状之一，80%的癌症患者以及高达99%接受放疗或化疗后的患者都有此症状。疲劳在非癌症患者的姑息治疗中也起着重要作用，很大比例的艾滋病毒感染者、多发性硬化症患者、慢性阻塞性肺疾病患者或心力衰竭患者都报告有疲劳症状。本文介绍了欧洲姑息治疗协会（EAPC）一个专家工作组的立场，评估了姑息治疗患者疲劳诊断和治疗的现有证据，并为未来的讨论提供了基础。由于专家小组认为文化和语言会影响不同欧洲国家对疲劳的处理方式，因此重点关注了姑息治疗中疲劳评估和治疗的文化问题。作为一个工作定义，疲劳被定义为一种主观的疲倦、虚弱或精力不足的感觉。有人提出癌症患者的疲劳与健康对照者的疲劳在质上存在差异，但这些差异似乎只是癌症相关疲劳压倒性强度的一种表现。姑息治疗患者疲劳的病理生理学尚未完全了解。对于一种系统的方法，可以区分主要疲劳（很可能与促炎细胞因子的高负荷有关）和并发综合征及合并症引起的继发性疲劳。疲劳通常被认为是一个多维度的概念，所有作者都承认其具有身体和认知维度。由于“疲劳”这个词仅在英语和法语中有，而在其他欧洲语言中没有，因此疲劳筛查应包括关于虚弱（作为身体维度的释义）和疲倦（作为认知维度的释义）的问题。疲劳的治疗应包括针对继发性疲劳的因果干预以及药物和非药物干预的对症治疗。已有大量证据表明有氧运动将降低癌症幸存者和接受癌症治疗患者的疲劳水平。在生命的最后阶段，疲劳可能为患者提供免受痛苦的保护和屏蔽，因此治疗可能有害。确定不再需要治疗疲劳的时间点对于缓解生命末期的痛苦很重要。
