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Fatigue (PDQ®): Supportive care - Health Professional Information [NCI] - Intervention

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It is often helpful to consider discontinuation of drugs that may be safely withheld. There is no agreed-upon approach for the evaluation and treatment of fatigue, but an increasing number of clinical trials are designed to address this issue in cancer patients.

Treatment of Anemia

Anemia in patients with cancer is best managed by treatment of the underlying cause. When the cause is obscure or there is no specific remedy, then treatment is supportive. Nutritional interventions, including the intake of nutrient-rich foods and supplements, are considered in addition to other treatment modalities. Transfusion of packed red blood cells is the most widely used and most rapid way to alleviate symptoms in cancer patients with symptomatic anemia. The likelihood of success in raising the level of hemoglobin is very high with transfusion, and the risks of complications are low. Nevertheless, repeated transfusions can be cumbersome, and the risks of blood-borne infection can be worrisome for patients. Other risks include an acute transfusion reaction, transfusion-associated graft-versus-host disease, subtle immune modulation that occurs with transfusion, and iron overload in patients who receive repeated transfusions.[6]

Several large, community-based studies have examined the effectiveness of epoetin alfa and darbepoetin alfa [7][Level of evidence: I];[8][Level of evidence: I] in the treatment of cancer-related anemia in patients receiving chemotherapy.[2][Level of evidence: II];[9][Level of evidence: III];[10][Level of evidence: I] A few of the studies of epoetin alfa employed an open-label, nonrandomized design and included objective endpoints (hemoglobin response, transfusion requirements) and subjective evaluation of fatigue and quality of life. In this setting, epoetin alfa has been effective at increasing hemoglobin levels and decreasing transfusion requirements. In addition, epoetin alfa has been associated with improved functional status and quality of life, independent of tumor response. Several studies of epoetin alfa and darbepoetin alfa employed a randomized, controlled design. These studies varied in terms of medication dosage and frequency of administration. A review and meta-analysis of randomized and open-label studies concluded that these agents are effective in the management of CRF [11] but also raised serious concerns about safety data and adverse outcomes associated with these agents. The authors concluded that the risks associated with these agents outweigh their benefits for the treatment of CRF and therefore are not to be used.

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