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John Glaspy, MD, UCLA Professor, Medical Oncologist and Researcher; Director, UCLA Oncology Center; Associate Chief, Division of Hematology-Oncology; Associate Director, Medical Oncology Program Area

Fatigue and "Chemo Brain" after Cancer Treatments

This is part of a summary of a lecture presented on January 13, 2004.

While fatigue is a problem for many patients during and after chemotherapy, it still has a limited understanding. In a survey of patients, approximately 12% indicated their fatigue was so significant they would rather be dead than be fatigued. Fortunately this is not the majority of patients; however, it underscores the importance of energy and fatigue in the day-to-day quality of life for cancer patients.

Approximately 15-20% of fatigue is associated with anemia. Scientists have learned that some patients have low levels of a hormone that stimulates red blood cell production in the bone marrow. A synthetic version of this hormone, called erythropoietin (EPO), corrects this problem. Patients who receive injections of EPO increase their red blood cell production and, in turn, have higher hemoglobin levels. When their hemoglobin improves they often feel considerably better. Several recent studies determined that there were significant improvements in energy level, activity and quality of life in cancer patients with anemia who were treated with EPO. This improvement was found even in patients who had progression of their tumor. Patients who have low hemoglobin and are experiencing fatigue should talk with their physicians about this intervention. However, patients who have fatigue and normal hemoglobin do not benefit from EPO injections.

Since fatigue is not completely understood, it is not surprising there are few interventions. Individual physicians are making efforts to try other clinical interventions. For example, some activating drugs such as Ritalin (methylphenidate) and Provigil (modafinil) are being given to patients to increase energy. These drugs are used most often with severely fatigued patients with metastatic disease. No research studies have studied these interventions in a systematic way.