Tumorassoziierte Fatigue in der Palliativsituation

Tumorassoziierte Fatigue (Cancer-related Fatigue, CrF) ist, auch in der Palliativsituation, ein häufiger, die Alltagsfunktionalität, die Lebensqualität und die Lebenserwartung schwer beeinträchtigender Zustand von Müdigkeit und Erschöpfung. Um das Chronifizierungsrisiko zu reduzieren, sollte CrF frühzeitig wahrgenommen und behandelt werden. Die diagnostischen Möglichkeiten und die Therapieoptionen werden in diesem Beitrag vorgestellt.

Abstract

Cancer-related fatigue (CRF) is a subjective, frequent condition of physical, affective and cognitive tiredness and exhaustion, which has a negative impact on every-day-activities, quality of life and overall survival. To reduce the risk of chronification, CrF should be recognized and treated early. (Differential-) diagnosis can be made by a structured anamnesis, CrF-self-evaluation questionnaires and using the proposed diagnostic criteria of the former Fatigue Coalition for admission to the ICD 10. To treat CrF symptomatically, treatment options with evidence from randomized controlled clinical trials (RCT), systematic reviews and meta-analysis are available.

Kernaussagen

• CrF ist ein häufiges und für viele Patienten das schwerwiegendste Symptom, besonders in der Palliativsituation.

• CrF kann vor, während und nach der Tumorerkrankung bzw. deren Therapie in Erscheinung treten. Der Zeitpunkt der Erstmanifestation ist differenzialdiagnostisch relevant.

• Gute Informationen über CrF helfen den Betroffenen, Ängste abzubauen und mit den Beschwerden besser umzugehen.

• Zur (Differenzial-)Diagnostik stehen ein Anamneseleitfaden, psychometrische Fragebögen sowie zur Aufnahme in die ICD-10 vorgeschlagene Diagnosekriterien zur Verfügung.

• Zur Behandlung kommen nicht medikamentöse und medikamentöse Therapien mit Evidenz aus randomisierten Studien, systematischen Reviews und Metaanalysen infrage.

• Entsprechend der multikausalen Genese der CrF ist eine multimodale Behandlung am erfolgversprechendsten. Dabei sind Kontraindikationen und individuelle Patientenmerkmale zu berücksichtigen. Die Entscheidung, welche der möglichen Maßnahmen im Einzelfall umgesetzt werden, soll im Sinne der partizipatorischen Entscheidungsfindung gemeinsam mit dem Patienten getroffen werden.

• Speziell am Lebensende sollte bedacht werden, dass CrF eine Schutzfunktion für den Patienten darstellen kann. Eine CrF sollte daher nur dann therapiert werden, wenn der Patient sehr darunter leidet, eine effektive Behandlungsoption besteht und der Betroffene eine Behandlung wünscht.

Schlüsselwörter

tumorassoziierte Fatigue - Diagnostik - Therapie - medikamentöse Therapie - nicht medikamentöse Therapie - palliative Versorgung

Keywords

cancer-related fatigue - diagnostics - treatment - management - pharmacological treatment - non pharmacological treatment - palliative care

• Literatur

• 1 NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. 2017. http://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf (last accessed on 8. Febr. 2017)
• 2 NCCN Clinical Practice Guidelines in Oncology: Palliative Care: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2016; 14: 82-113
• 3 Radbruch L, Strasser F, Elsner F. et al. Fatigue in palliative care patients – an EAPC approach. Palliat Med 2008; 22: 13-32
• 4 Fischer I, Riedner C, Bojko P. et al. Consultation program from the Bavarian Cancer Society for patients with cancer-related fatigue: A systematic evaluation of the experiences of the Bavarian Cancer Society. Oncol Res Treat 2016; 39: 646-651
• 5 Fischer I, Heim ME, Besseler M. et al. Tumor-Fatigue-Sprechstunde der Bayerischen Krebsgesellschaft e.V.: Was passiert da eigentlich? Teil I: (Differential-) Diagnostik. Forum 2017;
• 6 Weis J. Diagnostik und Erfassung der tumorassoziierten Fatigue. Forum 2013; 28: 39-42
• 7 Moens K, Higginson IJ, Harding R. Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review. J Pain Symptom Manage 2014; 48: 660-677
• 8 van Lancker A, Velghe A, van Hecke A. et al. Prevalence of symptoms in older cancer patients receiving palliative care: a systematic review and meta-analysis. J Pain Symptom Manage 2014; 47: 90-104
• 9 Cuhls H, Mücke M, Mochamat M. et al. Fatigue bei Palliativpatienten Unterschätztes Symptom: Häufiger und belastender als Schmerzen. Angew Schmerzther Palliativmed 2014; 7: 28-35
• 10 Weidenhammer W, Wessel A, Hutter A. et al. Das chronische Erschöpfungssyndrom in der naturheilkundlichen Rehabilitation – Prädiktoren des Behandlungsergebnisses. Rehabilitation (Stuttg) 2006; 45: 299-308
• 11 Efficace F, Gaidano G, Breccia M. et al. Prognostic value of self-reported fatigue on overall survival in patients with myelodysplastic syndromes: a multicentre, prospective, observational, cohort study. Lancet Oncol 2015; 16: 1506-1514
• 12 Trajkovic-Vidakovic M, de Graeff A. et al. Symptoms tell it all: A systematic review of the value of symptom assessment to predict survival in advanced cancer patients. Crit Rev Oncol Hematol 2012; 84: 130-148
• 13 Pearson E, Morris ME, McKinstry CE. Cancer-related fatigue: a survey of health practitioner knowledge and practice. Support Care Cancer 2015; 23: 3521-3529
• 14 Fischer I, Besseler M. Tumor-Fatigue-Sprechstunde der BKG e.V.: Mögliche Hinderungsgründe für die Inanspruchnahme aus Sicht von Selbsthilfegruppenleitern. Forum 2016; 31: 72-75
• 15 Horneber M, Fischer I, Dimeo F. et al. Tumor-assoziierte Fatigue: Epidemiologie, Pathogenese, Diagnostik und Therapie. Dtsch Ärztebl Int 2012; 109: 161-172
• 16 Fischer I, Horneber M, Heim ME. et al. Anamneseleitfaden. In: Heim ME, Weis J. Hrsg. Fatigue bei Krebserkrankungen. Stuttgart: Schattauer; 2015
• 17 Zlott DA, Byrne M. Mechanisms by which pharmacologic agents may contribute to fatigue. PM R 2010; 2: 451-455
• 18 Golomb BA, Evans MA, Dimsdale JE. et al. Effects of statins on energy and fatigue with exertion: results from a randomized controlled trial. Arch Intern Med 2012; 172: 1180-1182
• 19 Cella D, Peterman A, Passik S. et al. Progress toward guidelines for the management of fatigue. Oncology 1998; 12: 369-377
• 20 Fischer I, Kuhnt S. Psychodiagnostik und neuropsychologische Diagnostik. In: Heim ME, Weis J. Hrsg. Fatigue bei Krebserkrankungen. 1. Aufl. Stuttgart: Schattauer; 2015
• 21 Radbruch L. Validation of the German Version of the Brief Fatigue Inventory. J Pain Symptom Manage 2003; 25: 449-458
• 22 Kröz M, Zerm R, Reif M. et al. Validation of the German version of the Cancer Fatigue Scale (CFS-D). Eur J Cancer Care 2008; 17: 33-41
• 23 Weis J, Tomaszewski K, Hammerlid E. et al. International psychometric validation of an EORTC quality of life module measuring cancer related fatigue (EORTC QLQ-FA12). J Natl Cancer Inst; im Druck
• 24 Yennurajalingam S, Bruera E. Palliative management of fatigue at the close of life: „it feels like my body is just worn out“. JAMA 2007; 297: 295-304
• 25 Olson K, Krawchuk A, Quddusi T. Fatigue in individuals with advanced cancer in active treatment and palliative settings. Cancer Nurs 2007; 30: 10
• 26 de Raaf PJ, de Klerk C, Timman R. et al. Systematic monitoring and treatment of physical symptoms to alleviate fatigue in patients with advanced cancer: a randomized controlled trial. J Clin Oncol 2013; 31: 716-723
• 27 Rief H, Akbar M, Keller M. et al. Quality of life and fatigue of patients with spinal bone metastases under combined treatment with resistance training and radiation therapy – a randomized pilot trial. Radiat Oncol 2014; 9: 151
• 28 Baumann FT, Hallek M, Meyer J. et al. Onkologische Trainings- und Bewegungstherapie (OTT). Dtsch Med Wochenschr 2015; 140: 1457-1461
• 29 Schmitz KH, Courneya KS, Matthews C. et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 2010; 42: 1409-1426
• 30 Heim ME, Elsner v d Malsburg ML, Niklas A. Randomized controlled trial of a structured training program in breast cancer patients with tumor-related chronic fatigue. Onkologie 2007; 30: 429-434
• 31 Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 2012; 11 CD006145
• 32 Oldervoll LM, Loge JH, Paltiel H. et al. The effect of a physical exercise program in palliative care: A phase II study. J Pain Symptom Manage 2006; 31: 421-430
• 33 McNeely ML, Courneya KS. Exercise Programs for cancer-related fatigue: Evidence and clinical guidelides. J Natl Compr Canc Netw 2010; 8: 945-953
• 34 Mustian KM, Morrow GR, Carroll JK. et al. Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist 2007; 12 (Suppl. 01) 52-67
• 35 Wang XS, Woodruff JF. Cancer-related and treatment-related fatigue. Gynecol Oncol 2015; 136: 446-452
• 36 Lorenzen H. Fatigue Management: Umgang mit chronischer Müdigkeit und Erschöpfung. Idstein: Schulz-Kirchner; 2010
• 37 de Vries U, Reif K, Petermann F. et al. Fatigue individuell bewältigen (FIBS): Schulungsmanual und Selbstmanagementprogramm für Menschen mit Krebs. Bern: Hans Huber, Hogrefe; 2011
• 38 Jacobsen PB, Donovan KA, Vadaparampil ST. et al. Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychol 2007; 26: 660-667
• 39 Kangas M, Bovbjerg DH, Montgomery GH. Cancer-related fatigue: A systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull 2008; 134: 700-741
• 40 Du S, Hu L, Dong J. et al. Patient education programs for cancer-related fatigue: A systematic review. Patient Educ Couns 2015; 98: 1308-1319
• 41 Mustian KM, Morrow GR, Carroll JK. et al. Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist 2007; 12 (Suppl. 01) 52-67
• 42 Buffart LM, van Uffelen JG, Riphagen II. et al. Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials. BMC Cancer 2012; 12: 559
• 43 Ohlmann CH, Duensing S, Eichenauer R. et al. Metastasiertes Prostatakarzinom. Urologe 2015; 54: 998-1001
• 44 Zeng Y, Luo T, Finnegan-John J. et al. Meta-Analysis of Randomized Controlled Trials of Acupuncture for Cancer-Related Fatigue. Integr Cancer Ther 2014; 13: 193-200
• 45 Zick SM, Sen A, Wyatt GK. et al. Investigation of 2 Types of Self-administered Acupressure for Persistent Cancer-Related Fatigue in Breast Cancer Survivors: A Randomized Clinical Trial. JAMA Oncol 2016; 2: 1470-1476
• 46 Prommer E. Methylphenidate: established and expanding roles in symptom management. Am J Hosp Palliat Care 2012; 29: 483-490
• 47 Lower EE, Fleishman S, Cooper A. et al. Efficacy of Dexmethylphenidate for the Treatment of Fatigue After Cancer Chemotherapy: A Randomized Clinical Trial. J Pain Symptom Manage 2009; 38: 650-662
• 48 Roth AJ, Nelson C, Rosenfeld B. et al. Methylphenidate for fatigue in ambulatory men with prostate cancer. Cancer 2010; 116: 5102-5110
• 49 Richard PO, Fleshner NE, Bhatt JR. et al. A Phase II, Randomized, Double-blind, Placebo-Controlled Trial of Methylphenidate for Reduction of Fatigue in Prostate Cancer Patients Receiving LHRH-Agonist Therapy. BJU Int 2015; 116: 744-752
• 50 Heim ME, Kuhnt S, Schwarz W. et al. Randomized placebo-controlled double-blind study of modified methylphenidate on cancer-related fatigue (CRF). J Cancer Res Clin Oncol 2012; 138 (Suppl. 01) 13 (Abstr. B25-0058)
• 51 Qu D, Zhang Z, Yu X. et al. Psychotropic drugs for the management of cancer-related fatigue: a systematic review and meta-analysis. Eur J Cancer Care 2016; 25: 970-979
• 52 Mücke M, Cuhls H, Peuckmann-Post V. et al. Pharmacological treatments for fatigue associated with palliative care. Cochrane Database Syst Rev 2015 5. CD006788
• 53 Onishi E, Biagioli F, Safranek S. Methylphenidate for Management of Fatigue in the Palliative Care Setting. Am Family Physician 2014; 89: 124-127
• 54 Jean-Pierre P, Morrow GR, Roscoe JA. et al. A phase 3 randomized, placebo-controlled, double-blind, clinical trial of the effect of modafinil on cancer-related fatigue among 631 patients receiving chemotherapy: a University of Rochester Cancer Center Community Clinical Oncology Program Research base study. Cancer 2010; 116: 3513-3520
• 55 Day J, Yust-Katz S, Cachia D. et al. Interventions for the management of fatigue in adults with a primary brain tumour. Cochrane Database Syst Rev 2016; 4 CD011376
• 56 Barton DL, Liu H, Dakhil SR. et al. Wisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. J Natl Cancer Inst 2013; 105: 1230-1238
• 57 Barton D, Soori GS, Bauer BA. et al. Pilot study of Panax quinquefolius (American ginseng) to improve cancer-related fatigue: a randomized, double-blind, dose-finding evaluation: NCCTG trial N03CA. Support Care Cancer 2010; 18: 179-187
• 58 Greenlee H, Balneaves LG, Carlson LE. et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2014; 2014: 346-358
• 59 Horneber M and the Cam Cancer Consortium. Ginseng in the management of cancer. http://www.cam-cancer.org/The-Summaries/Herbal-products/Ginseng-Panax-ginseng-P.-quinquefolium (last accessed on 30 November 2016)
• 60 Younus J. A double blind placebo controlled pilot study to evaluate the effect of ginseng on fatigue and quality of life in adult chemo-naïve cancer patients. J Clin Oncol 2003; 22: 733
• 61 Yennurajalingam S. High-dose Asian ginseng (Panax ginseng) for cancer-related fatigue (CRF): A preliminary report. Integr Cancer Ther 2015; 14: 419-427
• 62 Shergis JL, Zhang AL, Zhou W. et al. Panax ginseng in Randomised Controlled Trials: A Systematic Review. Phytother Res 2013; 27: 949-965
• 63 Posadzki P, Watson LK, Ernst E. Adverse effects of herbal medicines: an overview of systematic reviews. Clin Med 2013; 13: 7-12
• 64 Malati CY, Robertson SM, Hunt JD. et al. Influence of Panax ginseng on cytochrome P450 (CYP)3A and P-glycoprotein (P-gp) activity in healthy participants. J Clin Pharmacol 2012; 52: 932-939
• 65 Campos O, Maira Paschoin de, Riechelmann R. et al. Guarana (Paullinia cupana) Improves Fatigue in Breast Cancer Patients Undergoing Systemic Chemotherapy. J Altern Complement Med 2011; 17: 505-512
• 66 Del Giglio A, Cubero IG, Serpa A. et al. Paulinia cupana (Guarana) for the treatment of cancer-related fatigue in patients undergoing radiation therapy or chemotherapy: A meta-analysis of three clinical trials. J Clin Oncol 2011 29. (suppl; abstr e19706)
• 67 Yennurajalingam S, Frisbee-Hume S, Palmer JL. et al. Reduction of Cancer-Related Fatigue With Dexamethasone: A Double-Blind, Randomized, Placebo-Controlled Trial in Patients With Advanced Cancer. J Clin Oncol 2013; 31: 3076-3082
• 68 Prommer EE. Palliative Pharmacotherapy: State-of-the-Art Management of Symptoms in Patients With Cancer. Cancer Control 2015; 22: 403-411
• 69 Strasser F. Innovative Therapien in der Palliativmedizin: Therapie von Kachexie und Fatigue. Arzneimittelforschung 2011; 61: 645-647
• 70 Fischer I, Kuhnt S, Heim ME. Grundlagen der Diagnostik und Erfassung. In: Heim ME, Weis J. Hrsg. Fatigue bei Krebserkrankungen. 1. Aufl. Stuttgart: Schattauer; 2015
• 71 Given B, Given CW, Sikorskii A. et al. Establishing Mild, Moderate, and Severe Scores for Cancer-Related Symptoms: How Consistent and Clinically Meaningful Are Interference-Based Severity Cut-Points?. J Pain Symptom Manage 2008; 35: 126-135