Fatigue et activité physique

Laurent Zelek, CHU Avicenne, BOBIGNY

AMGEN “regards croisés” study

• 77% of patients reported fatigue as most common symptom– 67% patients reported that fatigue had a major impact on their

QoL

• 93% of physicians and 100% of nurses felt it was important to treat fatigue

• 85% of patients felt treatment of fatigue was important

Patients’ Perception of Fatigue by Cancer Type

Mitry E et al. Oncologie 2010;12:709–717

10 point scale of fatigue: 1 (not intense at all) – 10 (very intense); this is the total of patients who answered from 6–10 on the scale

Fatigue is Attributable to Several Causes

Patients (n=300)

Physicians (n=250)

Nurses (n=109)

Chemotherapy treatment (%) 78 84a 82

Cancer (%) 68 77b 65

Secondary effects of chemotherapy (%) 31 46a 55a

Anaemia (%) 27 79a 79a

ND (%) 6 1 0aSignificant difference based on the 95% confidence interval for the patient groupbSignificant difference based on the 95% confidence interval for the group of physiciansND: Data not provided. The question posed to the patients was: ‘what, according to you, is the cause of your fatigue?’ The data posed to health professionals was: ‘what, according to you, is the cause of the fatigue experienced by your patients (who have non-myeloid malignancy, are receiving chemotherapy, and have an Hb <11 g/dL)?’

Mitry E et al. Oncologie 2010;12:709–717

Perception of the Intensity of Fatigue

Chouaïd et al. Oncologie 2010;12:239–244

Adverse Effects of Chemotherapy that Most Impact Daily Life

All patients (n=300)

Tumour type Age group

Breast cancer (n=70)

Lung cancer (n=73)

Colorectal cancer(n=72)

Haematological malignancyb

(n=82)

<70 years of age

(n=230)

≥70 years of age (n=70)

Fatigue (%) 67 63 71 63 72 68 63

Skin/ aesthetic effectsa (%)

39 69 25* 24* 38 44 21*

Nausea/ vomiting (%)

34 26 36 39 34 36 27

Anaemia (%) 18 9* 16 13 32* 17 21

Pain (%) 17 9* 25 14 20 18 14

Patients were questioned on 30 possible adverse effects, five categories of which are presented above (totals are more than 100% – more than one response possible)aPatients with alopecia, loss of fingernails, aesthetic effects, skin toxicity and/ or long-term cutaneous signsbNon-myeloid haematological malignancy*Significant difference vs. total population of patients

Mitry E et al. Oncologie 2010;12:709–717

Fatigue: Risk factors and mechanisms

• Cytokines (TNFa and IL6)• Genetic polymorphisms• BMI • Pretreatment fatigue

• Fatigue, depression and cognitive disorders are linked

Physical activity and fatigue: what do weknow?

• Physical activity is decereased in pts with fatigue• Deconditionning ? • After therapy low PA is correlated to fatigue• Is AP lowering BMI ?

• Coping

Association between physical activity and markers o f quality of life (measured by SF-36) in patients with cancer.

Fong D Y T et al. BMJ 2012;344:bmj.e70

©2012 by British Medical Journal Publishing Group

Association between physical activity and fatigue a nd depression in patients with cancer .

Fong D Y T et al. BMJ 2012;344:bmj.e70

©2012 by British Medical Journal Publishing Group

Conclusion

• Fatigue still underestimated in cancer patients• Physical activity among the few effective interventions

• Numerous questions remain to be answered– What kind of PA ?– For which patient ?– How can we overcome barriers to PA ?