Zusammenfassung
Hintergrund
Obwohl die subjektive Todesbedrohung von Betroffenen und Nichtbetroffenen kaum abgenommen hat, überleben heute mehr als die Hälfte aller Tumorpatienten ihre Erkrankung. Auch wenn die Anstrengungen zur Verbesserung der Therapieergebnisse nicht nachlassen dürfen, rücken nun vermehrt Fragen zur Qualität des Überlebens, Quality of Survivorship, in den Fokus der Behandler. Dabei spielt die Tumorerschöpfung als schwerwiegende Nebenwirkung, die mit einer Krebserkrankung einhergeht, eine zentrale Rolle.
Ziel
Darstellung der aktuellen Ansichten der Ursachen, Symptomatik und Behandlung der Fatigue.
Material und Methoden
Die Übersicht basiert auf Literaturrecherchen und Erfahrungen und Erkenntnissen der Deutschen Fatigue Gesellschaft.
Ergebnisse
Nahezu bei allen Patienten unter Therapie und bei bis zu 40 % der Patienten, je nach Entität, auch Jahre nach erfolgreicher Therapie tritt eine Erschöpfung auf, die eine erhebliche Auswirkung auf die Lebensqualität hat und wahrscheinlich auch den Therapieverlauf beeinflusst. Wesentlich ist die möglichst exakte Diagnose und klare Abgrenzung zur Depression oder des chronischen Fatigue-Syndroms (CFS) nach Ausschluss somatischer Ursachen. Erfreulicherweise gelingt es mittels der zur Verfügung stehenden Fragebogeninstrumente zuverlässig und reproduzierbar das Vorliegen und den Verlauf einer tumorbedingten Fatigue zu erfassen.
Schlussfolgerungen
Die Behandlung des Syndroms umfasst neben der Korrektur zugrunde liegender Stoffwechselstörungen v. a. körperliches Training und psychoonkologische Maßnahmen zur Verbesserung der Krankheitsbewältigung. Die medikamentösen Behandlungsansätze sind in den letzten Jahren fundierter geworden. Allerdings besteht noch kein Konsens über ein klar definiertes Therapieregime.
Abstract
Background
More than a half of all cancer patients survive their malignant disease, but the fear of pending death for a patient and their relatives has changed little. Maintaining the efforts to improve treatment results, issues on quality of survivorship should be increasingly addressed by those providing treatment. The cancer-related exhaustion, as a severe side effect, plays a central role.
Objective
Description of current views of causes, symptoms and treatment of fatigue.
Materials and methods
The review is based on a literature search and on the expertise and knowledge of the German Fatigue Society.
Results
Almost all tumor patients undergoing treatment and even years after successful treatment approximately 40 % of tumor patients, depending on entity, report fatigue as having a significant impact on quality of life and perhaps also on prognosis. A precise diagnosis, exclusion of somatic causes and differentiation between the tumor-associated fatigue, depression or chronic fatigue syndrome are essential for further treatment. Fortunately, available questionnaires allow an evaluation of manifestation and course of the tumor-related fatigue.
Conclusion
The treatment of this syndrome comprises, after adjusting metabolic disorders, physical exercise and psycho-oncological care for improvement of disease coping. During recent years, pharmacological treatment approaches have become more evidence based. However, general agreement on a treatment strategy is still not available.
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Rüffer, J., Adamietz, I. Fatigue – Tumorerschöpfung. Onkologe 19, 279–289 (2013). https://doi.org/10.1007/s00761-012-2408-6
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DOI: https://doi.org/10.1007/s00761-012-2408-6