David Cella, PhD, and Lisa Wu, PhD, both of Northwestern University in Chicago, discuss fatigue and sleep disturbance related to cancer – its prevalence and possible treatments -- in this episode of Blood & Cancer.
In Clinical Correlation (29:45), Ilana Yurkiewicz, MD, of Stanford (Calif.) University, shares a case that highlights the resilience that patients show in the face of cancer, and asks: Can a positive attitude improve outcomes?
By Hitomi Hosoya, MD, PhD, resident in the department of internal medicine, University of Pennsylvania, Philadelphia
- Cancer-related fatigue is prevalent in cancer patients and cancer survivors.
- Sleep disturbance also is prevalent in this population and can be related to fatigue.
- In breast cancer patients, for instance, fatigue during treatment can be as high as 80%.
- Even after 7-9 years of treatment, more than 50% of breast cancer patients reported sleep disturbances, according to one study.
- Cancer-related fatigue is different from usual daily fatigue; it is more severe, more distressing, and not relieved by rest.
- Cancer-related fatigue and sleep disturbance are thought to be related to pro-inflammatory cytokines, endocrine dysfunction, and possibly to circadian rhythm.
- Cancer-related fatigue should be evaluated from treatment regimen perspectives, metabolic perspectives, or other underlying medical problems.
- If the above conditions are ruled out, psychosocial therapy (exercise, cognitive behavioral therapy) should be considered.
- Recently, light therapy using broad-spectrum bright light to correct circadian rhythm has been studied.
- The gold standard treatment for sleep issues in cancer is cognitive behavioral therapy for insomnia.