Anemia Is an Important, But Often Ignored, Cause of Fatigue in Cancer Patients

BALTIMORE—Fatigue is a universally recognized complication of cancer, caused by both the disease itself and its treatment, but the role of anemia in causing fatigue has received insufficient attention, according to MiKaela Olsen, RN, MS. This oversight has led to undertreatment of anemia, but proper evaluation and treatment can reduce anemia and the fatigue and other troubling symptoms it causes, she said at an industry-sponsored symposium held in conjunction with the Oncology Nursing Society annual meeting. Ms. Olsen is an oncology/bone marrow transplant/hematology clinical nurse specialist at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins in Baltimore.

In recent years, important progress has been made in pain control, but cancer patients report that fatigue has a greater influence on their lives than pain, nausea, or depression, according to Ms. Olsen.

Fatigue can arise from depression and sleep deprivation, both common among cancer patients. The rapid division of cancer cells and the damage to tissues caused by chemotherapy are also important contributing factors. Because chemotherapy agents and radiation appear to target better-oxygenated cells, patients with higher red blood cell counts have higher quality of life and better medical outcomes than those with lower counts, Ms. Olsen explained. During the 1990s, however, concerns about the risks of blood transfusions focused attention more on fatigue thresholds and tolerance than on increasing red blood cell count.

Anemia Is Universal Fact

Anemia is a universal fact of cancer treatment, Ms. Olsen noted. All patients receiving chemotherapy suffer from at least grade 1 or 2 anemia, she said, and 8% suffer from grade 3 or 4. Symptoms of anemia can include dyspnea, headache, weakness, and tachycardias.

Hypothermia, chills, and pallor can result as the body compensates for hypoxia by diverting blood from small vessels to major organs. In addition, the increased cardiac output needed to counter hypoxia can have serious consequences including heart failure, myocardial infarction, and even death, she added.

The signs and symptoms of anemia should be monitored and, if indicated, laboratory tests should be performed to check hemoglobin, hematocrit, reticulocyte count, and red blood cell indicators, Ms. Olsen advised.

When anemia occurs, epoetin alfa (Procrit, Epogen) helps augment red blood cell production and thus lessens the requirement for blood transfusions. Other interventions including vitamin B12, lifestyle modifications, and psychological counseling can also help reduce fatigue, she added.