Chordoma Foundation

2021 Virtual Chordoma Community Conference: Dealing with cancer-related fatigue

On June 2, we hosted the second webinar in our 2021 Virtual Chordoma Community Conference (CCC) Series: entitled Dealing with cancer-related fatigue. Fatigue is an extreme feeling of tiredness or lack of energy not caused by a specific activity, and it is one of the most common side effects of cancer treatment. From responses to our ongoing Chordoma Survivorship Survey, we know that nearly 60 percent of chordoma patients and survivors have experienced fatigue since being treated.

During this 60-minute webinar, Eric Roeland, MD, a medical oncologist and palliative care specialist at Oregon Health and Science University, and Pouneh Fazeli, MD, a neuroendocrinologist at the University of Pittsburgh Medical Center, explained what fatigue is, the possible causes and triggers, how to manage it, and ways to find care.

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Possible causes of cancer-related fatigue

Dr. Roeland explained that the causes of cancer-related fatigue are complicated to determine because there are often many factors involved, and those factors vary from person to person. As a result, the level of fatigue someone with cancer experiences can range from a mild lack of energy to complete exhaustion.

How cancer and cancer treatments cause and contribute to fatigue is still being studied, said Dr. Roeland, but common contributing factors include:

  • Side effects from treatment (surgery, radiation, etc.)
  • Medication side effects
  • Poorly controlled symptoms
  • Advanced disease
  • Anemia 
  • Thyroid abnormalities
  • High calcium levels
  • Inactivity
  • Nutritional deficiencies
  • And more …

Managing cancer-related fatigue

 

Although there is no way to know if you will experience fatigue, how bad it will be, or how long it will last, there are many ways to help manage it if it occurs. Dr. Roeland noted that most clinicians start by assessing an individual’s fatigue to identify possible causes and treat the ones they can. There is no specific test to diagnose fatigue, but your care team may conduct a physical exam, ask you questions that can help rate the level of your fatigue, categorize your fatigue by time (acute or chronic), or conduct blood tests to check for anemia and other contributing conditions. Because the symptoms of fatigue are usually caused by more than one problem, Dr. Roeland explained that it is likely that an individual experiencing fatigue will need to interact with more than one care provider to create a management plan. This care team can help assess which of the following evidence-based interventions may work best for you.

  • Physical or occupational therapy
  • Low to moderate exercise
  • Pharmacologic approaches (such as stimulants, corticosteroids, or American Ginseng)
  • Cognitive Behavioral Therapy (talk therapy)
  • Nutritional counseling
  • Others

Palliative care experts can help address fatigue, pain, mobility and functional issues, mental and emotional health, nutrition, and many other concerns to help you feel well and live fully while managing your chordoma. They make a valuable addition to your fatigue management team.

Read more about palliative care »

Role of hormonal imbalances in cancer-related fatigue

Dr. Fazeli explained how the pituitary gland, which is at the base of the brain and is connected to the hypothalamus, signals other glands in the body to make or release hormones. She noted that clival chordomas can grow into the pituitary and lead to pituitary hormone insufficiency. In addition, radiation for clival tumors almost always affects the endocrine system.

With several potential neuroendocrine causes of fatigue, from adrenal insufficiency to hypothyroidism to hyperprolactinemia and beyond, it is critical that patients be evaluated for pituitary hormone deficiency at the time of diagnosis and at the time of surgery or radiation as well as at regular intervals for many years after. During the Q&A portion of the webinar, Dr. Fazeli also noted that hormone deficiencies can happen to anyone, particularly as they get older, so all patients should be aware of the signs and symptoms.

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