CHAPTER FOURTEEN: DEALING WITH THE CONSEQUENCES OF CANCER: PAIN, CANCER-RELATED WEIGHT LOSS, FATIGUE

Your oncologist should be consulted about fatigue and may identify a specific factor associated with the disease or treatment. Depending on the severity, treatment may be changes, or dosage reduced to manage fatigue.

"A study of breast cancer patients demonstrated a reduction in fatigue in women who participated in a low intensity-walking program." (1) An advocate for exercise writes:

"Regular exercise has been shown to benefit most cancer patients, as discussed in a recent article in the Annals of Behavioral Medicine.[1] According to the 24 studies reviewed in this article, exercise contributes to improvement in quality of life, physical strength, and endurance; reduces fatigue and depression; and increases the number of immune cells which may have implications in actual cancer control." (3)

Any program should be approved by a physician and is dependent upon the patient’s physical status.

14.152 Support

Fatigue may be associated with depression. Providing support through family, friends, in-person and on-line support groups can help. Acor.org runs specific programs for lung cancer.

"About half of all cancer patients experience a wasting syndrome called cachexia in which the tumor induces metabolic changes in the host leading to loss of adipose tissue and skeletal muscle mass." (Tisdale 7). "When the problem is tumor-induced weight loss, increasing food intake isn't the answer, as the metabolic alterations that occur in these patients would appear to prevent the effective use of additional calories, resulting in ongoing wasting." Rogers (2) Substantial weight loss is a negative sign in a patient’s prognosis. "Tumor-induced weight loss (TIWL) is a common cause of morbidity and mortality in patients with advanced cancer. It differs from simple starvation in that it cannot be reversed by the provision of apparently adequate nutrition." Barber (5), Rogers, (6).

14.21 Distinguishing Cachexia from anorexia.

Anorexia is eating significantly less than normal requirements and should be distinguished from cachexia:

Unlike simple starvation, where body fat is lost preferentially, cancer cachexia is associated with depletion of both fat and skeletal muscle mass. Although anorexia is frequently associated with cachexia a reduction of nutrient intake alone could not explain the progressive wasting. Instead the process appears to be mediated by circulatory tumor-produced catabolic factors acting wither alone or in concert with certain cytokines. Various phenomenon are associated with cachexia. Tisdale (7).

14.22 Increased Consumption of Protein

"Whole body protein turnover has been found to be increased in the

majority of advanced cancer patients compared with starved normal individuals

and weight-losing noncancer patients and appears to increase further with

progression of disease." Barber (1) "Cachectic cancer patients exhibit relative

glucose intolerance and insulin resistance with an increased rate of glucose

production and recycling via lactate (the Cori cycle). These changes may become

more pronounced with progression of the disease." Barber (1)

The precise mechanisms are unclear. While weight loss is associated with poor prognosis and is frequently seen in advanced cancer patients, cachexia can occur early in the course of cancer. A clear correlation between, for example, cancer size and the extent of cachexia is not seen.

14.221 Influence of Cytokines

One theory is that cytokines such as tumor necrosis factor "mobilize fatty acids and amino acids from adipose tissue and skeletal muscle respectively."

14.23 Nutritional Programs

Increasing calorie intake can help mitigate the effects of cachexia. Helping the cancer patient to eat may mean some modifications. "If the patient indicates that they eat best in the morning, the largest meal should be served in the morning and small snacks eaten throughout the remainder of the day. Dietary restrictions should be eliminated since adherence to restrictions may decrease the caloric intake that is essential to the individual with cancer." Rogers (6).

One study found that "a nutritional supplement enriched with fish oil will reverse weight loss in patients with pancreatic cancer cachexia." Barber (5) " In animals bearing a murine colon adenocarcinoma, EPA one of the most important fish oil w-3 fatty acids, has been shown to inhibit cancer cachexia...Diets in which 50% of total energy was provided as fish oil also reversed tumor-associated weight loss in rats with an experimental prostate tumor." (Burns 11).

The problem is not easily solved. In one study a program of Total Perenteral Nutrition or (TPN) failed to produce significant improvement in small cell lung cancer patients. Some patients benefit from appetite stimulants like Megace. Disease combined with chemotherapy diminish many patient’s desire to eat. "The appetite stimulate megestrol acetate (Megace) has been reported to induce a weight gain of greater than 5% in 15% of the patients treated, although significant changes in lean body mass were not generally observed." (Tisdale 9).

14.31 Incidence

Approximately 40% of lung cancer patients encounter depression with the incidence related to the severity of the disease and its symptoms. Aldridge (13).

Various groups and people can provide support during this difficult time including: nurses and counseling professionals, psychologists and social workers, cancer organizations like the American Cancer Society and Alcase devoted to lung cancer, the lung online support groups like Acor, family and friends, and clergy.

1. Fatigue in Cancer Patients, Cancerbacup www.cancerbacup.org.uk/reports/fatigue-mac.htm

2. Winningham, Fatigue in Cancer (Jones & Bartlett 1999)

3. Exercises for People With Lung Cancer: A Suggested Exercise Program for Improving Quality of Life After Diagnosis, Vol. 20, No 10 (November/December 2000)

4. Hoseman, Fatigue: The Multidimensional Side Effect, M. D. ANDERSON ONCOLOG
Volume 44, Number 1 (January 1999)

5. Barber, Advances in the Management of Tumor-Induced Weight Loss,

Medscape.com (2002, Continuing education program).

6. Rogers, General Weight Loss in Cancer Patients: An Approach to Assessment and Care, Medscape.com (2002, Continuing education program).

7. Barber, Effect of a fish oil-enriched nutritional supplement on metabolic mediators in patients with pancreatic cancer cachexia,Nutr Cancer 2001;40(2):118-24

8. Evans, Limited impact of total parenteral nutrition on nutritional status during treatment for small cell lung cancer, Cancer Research, Vol 45, Issue 7 3347-3353.

9. Tisdale, Wasting in Cancer, Journal of Nutrition Vol. 129 No. 1 January 1999, pp. 243S-246S

10. Tisdale, Clinical Trials for the Treatment of Secondary Wasting and Cachexia, Presentation at the 1999 American Society for Nutritional Scienses Meeting.

11. Burns, Phase I Clinical Study of Fish Oil Fatty Acid Capsules for Patients with Cancer Cachexia: Cancer and Leukemia Group B Study 9473,Clinical Cancer Research Vol. 5, 3942-3947, December 1999

12. Klein S, Simes J, Blackburn G. Total parenteral nutrition and cancer clinical trials. Cancer. 1986;58:1378-1386.

13. Aldridge, Symptoms linked to depression in lung cancer, www healthandage.com

http://www.aboutincontinency.org

Home Page

Keywords cancer, fatigue, loss of weight, cancer-related fatigue, trials, lung cancer, fish oil, nutrition, cachexia. 

 Lung Cancer and Mesothelioma is a comprehensive overview of lung cancer treatment and research comprising 41 chapters and over 480 pages. The book reviews chemotherapy, gene therapy, radiation, experimental treatments and other topics, with excerpts available below.      
                       

REVIEWS  
 
Quality Books "This book provides an invaluable resource for anyone who has or who is caring others with Mesothelioma or other Lung cancers. Itprovides a wealth of relevant and useful information on various types of lung cancers, medical trials, treatments and medications. This well researched and comprehensive book is quite unique on the subject. This book also contains a detailed discussion on the emotional burden of Lung Cancer upon the patient and their families and ways to manage it."
                    
 Lorraine Kember. Author of "Lean on Me - Cancer through a Carer's Eyes", "The very mention of the word Cancer, strikes fear into all of us.... From personal experience I know that knowledge is the key to providing a better "quality of life" for the cancer patient. Better understanding of the stages of the disease and of methods and medications available to treat the pain and symptoms caused by it, allow for the patient and those who care for them, to make informed decisions regarding their care. In this way, they are able to regain some control over their lives. Rarely does one find all the information they need in one book, however I believe Howard's well researched and comprehensive book "Lung Cancer & Mesothelioma", is quite unique. It provides a wealth of relevant and useful information including; how various types of cancer are formed, medical trials, available treatments and medications, insight and discussion regarding the emotional burden of cancer upon the patient and their families and ways by which to manage grief. I believe this book will provide an invaluable resource for anyone who has or who is caring for someone with cancer.

Order from the publisher www.xlibris.com or amazon.com