TMC PULSE

t m c » p u l s e | j u ly 2 0 1 6 22 Fighting Fatigue Surviving cancer is a feat in itself, but for many, thriving after treatment is another battle W hile much of the media and pub- lic attention focuses on exciting new horizons and breakthroughs in cancer research and treatments, one cancer-related topic in particular has been pushed off to the periphery of medical discussion. However, over the past 18 years, Carmelita P. Escalante, M.D., professor and department chair of general internal medicine at The University of Texas MD Anderson Cancer Center, and Ellen Manzullo, M.D., clinical deputy division head of Internal Medicine at MD Anderson, have led the charge to alleviate this potentially debilitating and common symptom of cancer. "Fatigue is the most common and distressing symptom in cancer patients. This is a fact that is really not well known," said Manzullo, who evaluates and treats patients at the MD Anderson Cancer-Related Fatigue Clinic along with Escalante. "A lot of times, when patients come to our institution, the focus is really on the treatment of the cancer, so many times the fatigue is the backdrop. A lot of times, clinicians are very busy and they're not able to really focus on that." "It's a very prominent symptom, and patients now are surviving longer and doing better, either without cancer or with cancer as a chronic disease, but this symptom can be prohibitive in their daily activities," Escalante added. Since its inception in 1998, the Fatigue Clinic, which comprises a modest three-person team of Escalante, Manzullo and a clinic nurse, has treated more than 2,500 patients to help allevi- ate the burden of cancer-related fatigue. Using a qualitative "brief fatigue inven- tory" measurement tool developed by Charles Cleeland, Ph.D., McCullough professor of cancer research in the department of symptom research at MD Anderson, shortly before the clinic opened its doors, Escalante and Manzullo were able to assess the sever- ity of patients' fatigue that, for a long time, wasn't always at the forefront of patient care discussions. "Fatigue is very nonspecific, and B y S h a n l e y C h i e n PATIENTS TYPICALLY EXPERIENCE WORSENED FATIGUE DURING THEIR CHEMOTHERAPY OR RADIATION THERAPY, BUT CANCER-RELATED FATIGUE OFTEN CONTINUES EVEN AFTER THE TREATMENT CONCLUDES, POTENTIALLY LASTING ANYWHERE FROM MONTHS TO YEARS. Pancreatic cancer survivor and retired radiologist Jorge Albin, M.D., is a patient at the Cancer-Related Fatigue Clinic. it's not like blood count or hemoglobin where you can get a blood test. We needed some type of measurement so that, if we implemented interventions, we would be able to measure it and see on a follow-up what was happening to the patient's fatigue," Escalante said. "Using that measurement tool, we were able to develop or begin the clinic and focus on fatigue, which, at that time, patients weren't talking about as much as now." Patients typically experience worsened fatigue during their che- motherapy or radiation therapy, but cancer-related fatigue often continues even after the treatment concludes, potentially lasting anywhere from months to years. "It's not only physical, but it's men- tal and emotional, and it's not relieved with usual rest," Manzullo said. While normal fatigue is character- ized as a state of temporarily feeling physically and cognitively exhausted with less energy throughout the day, cancer-related fatigue persists for lon- ger periods and interferes with people's daily life because it leaves them with little to no energy to perform simple, everyday tasks, such as eating or even using the bathroom. "During the chemotherapy, [the fatigue] was very severe," said 60-year- old pancreatic cancer survivor Jorge Albin, M.D., adding that although he tolerated the chemotherapy treatment well and the fatigue associated with it improved, the unrelenting fatigue never went away completely. "Getting out from the bed and to the couch and back to the bed was [considered] a very good day, and it got to the point where getting up to pee was a major ordeal. "Sometimes the fatigue gets you, grabs you by the back and you just have to stop. [It feels like] there's nothing you can do," he added. Albin, who retired from his career as the head of radiology at St. Joseph Hospital when he was diagnosed with pancreatic cancer, was referred to the

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