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At the end of March 2020, a gastric cancer patient admitted to Professor Ji Chushu from the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital)
.
It was an 80-year-old grandfather who was diagnosed with gastric cancer after admission.
After a detailed examination by Professor Ji, he finally confirmed the treatment plan (immune drugs plus anti-angiogenesis drugs).
The medication has a good effect for one year.
According to the results of follow-up It can be seen that the tumor in the stomach is controlled very well
.
It can be seen that the old man usually looks ruddy and takes care of himself.
On the surface, he cannot tell that he is a cancer patient
.
However, with the prolonged medication time, Uncle Zhang always feels inexplicably tired, not interested in anything, and self-perceived to be extremely fatigued, which seriously affects normal life
.
Knowing that it was an adverse reaction after the medication, Uncle Zhang couldn’t bear the physical and psychological damage caused by fatigue.
He had to make a decision to stop the medication and completely abandon the effective treatment.
The family did not expect it.
The tumor did not knock the old man down, but fatigue made him lose confidence in treatment
.
Professor Ji told reporters that in the process of tumor treatment, there will be many accompanying symptoms, such as common adverse reactions such as nausea, vomiting, and hair loss caused by chemotherapy and radiotherapy
.
In recent years, with the continuous update of the concept of tumor treatment and the continuous expansion of tumor treatment methods, especially with the widespread use of targeted therapies and immunotherapy in clinics, more and more patients have continued to live longer.
In the past, long-term surviving patients have new accompanying symptoms, of which the higher incidence is cancer-related fatigue, which is not less than 40% in clinical practice
.
Professor Ji Chushu Palliative care has changed from a supporting role to the protagonist of comprehensive cancer treatment.
Since joining the work in 1985, Professor Ji has devoted himself to cancer treatment for more than 30 years.
He has a profound experience in the development of cancer palliative care.
It can be said that he has witnessed the history of development and changes in palliative care in China
.
When Professor Ji just became an oncologist, he encountered many patients with cancer pain.
At that time, the only drugs used to treat cancer pain were powerful opioids such as Du Lengding.
As fine anesthetics, the national control was quite strict, resulting in Many patients are often in pain due to insufficient dosage, and doctors have to use placebo (normal saline) instead
.
Professor Ji said frankly that due to lack of cognition, doctors dare not use medicines for patients.
Looking at patients with terminal tumors in pain, they often feel weak as a doctor
.
With the start of palliative cancer care in China in the 1980s, under the leadership of Academician Sun Yan, Professor Li Tongdu, Professor Yu Shiying, Professor Wang Jiejun and other generations, palliative care has made great progress after decades of development.
In particular, cancer pain treatment has received standardized and effective treatment at this stage
.
The tumor itself and the adverse reactions in the course of tumor treatment are all accompanying symptoms, including the well-known nausea, vomiting, hair loss, etc.
, but these symptoms will basically disappear when the patient stops chemotherapy, and there are many in clinical practice.
Effective drug response will not trouble patients for a long time
.
Professor Ji pointed out that targeted therapy and immunotherapy for tumors require long-term uninterrupted application of patients.
For patients who use this type of regimen, adverse reactions will inevitably exist for a long time.
Fatigue has become a relatively high-incidence accompanying symptom, so new treatments are used.
The patients of the program are a high-risk group of fatigue
.
Some people will say, isn’t tiredness just tired? Let the patient rest as long as there is no need for treatment at all
.
In fact, cancer-related fatigue is not simply "tired"
.
In the latest international authoritative guidelines, cancer-related fatigue is defined as: “a painful, persistent, subjective feeling, which is the physical, emotional and/or cognitive fatigue and fatigue caused by the tumor itself or anti-tumor therapy.
A sense of exhaustion, and inconsistent with the amount of recent exercise, and affect the daily function of the patient
.
"So compared with the fatigue of healthy people, the "tired" of the two cannot be confused
.
The diagnostic criteria for cancer-related fatigue are: fatigue symptoms occur repeatedly for more than 2 weeks, and 5 or more of the following 10 symptoms can be diagnosed as fatigue
.
1.
Weakness or heavy body; 2.
Inability to concentrate; 3.
Lack of passion, low mood, lack of energy; 4.
Insomnia or lethargy; 5.
Feeling of energy failure after sleep; 6.
Difficulty in activities; 7.
The following Emotional reactions such as sadness, frustration or irritability; 8.
Inability to complete daily activities that were originally competent; 9.
Short-term memory loss; 10.
After the activity, the fatigue symptoms persist for several hours and cannot be relieved
.
Fatigue causes cancer patients to suffer both physical and psychological blows.
"In the early stage of cancer treatment, the main energy of patients and doctors was to attack the tumor.
They only wanted to control the tumor in a state of operable or clinical remission as soon as possible, and clinical patient fatigue occurred.
The cause of the disease is complicated and there is no objective evaluation system, so the accompanying symptoms of patients are often not paid enough attention
.
" Professor Ji said
.
Professor Ji believes that before fatigue treatment, we must first analyze the cause, because fatigue-inducing factors include not only tumor treatment, but also tumor itself (weight loss, fever, anemia, etc.
)
.
Tumor causes changes in patient hormone levels (abnormal thyroid function, hormone deprivation, etc.
).
For such fatigue patients, adjustment of hormone levels and replacement therapy can be effectively improved; in addition, tumor brain metastasis can also cause similar fatigue; such as worsening infections, kidneys Complications such as insufficiency and heart failure can cause different degrees of fatigue.
There is also a type of fatigue caused by multiple factors, which may be related to the treatment of the tumor itself.
The cause of this fatigue is often difficult to find and it is more difficult to intervene
.
Therefore, fatigue requires comprehensive evaluation by experienced doctors in order to carry out symptomatic treatment
.
In addition, fatigue can not only cause physical changes in patients, but more importantly, affect patients' mental health.
The psychological impact on patients should not be underestimated.
Just as Uncle Zhang suffered in the previous article, patients have to give up treatment
.
In the clinic, Professor Ji has encountered many patients who have achieved complete pathological remission after tumor treatment, but are still unable to live a normal life due to fatigue.
Mental symptoms such as depression and anxiety occur from time to time, causing the patients to suffer both physically and mentally
.
Professor Ji believes that at this stage, clinicians’ perception of fatigue is still in its infancy, just like the initial recognition of cancer pain
.
Doctors and patients do not pay attention to mild and moderate fatigue, and patients do not actively seek help, and only start seeking medical advice after severe fatigue.
This directly leads to delays in a large number of patients with mild and moderate fatigue in the clinic.
Treatment
.
In recent years, more and more doctors in the clinic have begun to pay attention to fatigue.
However, given that doctors, including patients’ cognition is still in its infancy, there is an urgent need for more standardized guidelines to guide clinical practice
.
Professor Ji introduced that at present, China is introducing fatigue-related guidelines.
In the near future, doctors will continue to pay more attention to them, give full play to their subjective initiative, take proactive measures, continue to learn, and strengthen fatigue screening, evaluation and management.
To further improve fatigue patients
.
Every oncologist should be an all-rounder.
It is understood that so far, the NCCN guidelines in the United States and the CSCO guidelines in China have not yet issued a standard treatment plan for related fatigue.
There are only related interventions, which are mainly divided into non-drug and drug interventions.
Non-pharmacological interventions include sleep management, nutrition management, exercise management, etc.
It is recommended that each patient stay active for 15 to 30 minutes a day based on their own conditions and without contraindications to exercise
.
For drug intervention, clinical Chinese and Western medicines do not have specific drugs for fatigue.
At present, there are only a few studies and most of them are the results of open trials, and the benefit of patients is weak
.
In recent years, the treatment of fatigue with traditional Chinese medicine has been attracting attention
.
After years of clinical verification, Professor Ji believes that Chinese medicine not only has therapeutic effects on its own, but also has psychological effects that conform to the national conditions and follow the traditional concept of tonic conditioning, which is very important for tired patients
.
However, not all drugs are suitable for cancer patients at different stages of treatment
.
Professor Ji specially reminded that in the case of good tumor control, the first principle of choosing anti-fatigue drugs should not bring more impact to the patient.
For example, if the tumor is very well controlled, hormones will cause the curative effect to decrease, so it needs to be based on the patient’s The specific situation depends on the plan
.
As cancer patients live longer and longer, the "chronic disease management" of cancer patients becomes particularly important.
Many accompanying symptoms require patients to identify themselves and carry out effective management
.
Fatigue, as a potential prognostic factor, can run through the entire course of cancer patients and will continue to exist after the end of anti-tumor treatment
.
Professor Ji believes that at this stage, in order to truly manage the symptoms of patients, doctors and patients should be screened and evaluated from the initial visit to the end of the treatment, and evaluated at any time when they have symptoms
.
In this process, doctors must face up to fatigue, because only doctors pay attention to fatigue in order to convey correct information to patients
.
Therefore, the doctor must accurately and promptly inform the patient of the possible consequences of fatigue, and be good at observing the patient's invisible changes in the outpatient or ward, and effectively find the cause of fatigue, which is beneficial to the overall treatment of the tumor
.
As an veteran expert who has been dealing with tumors for more than 30 years, she hopes that every oncologist will be a generalist, not only to contain the tumors of patients, but also to help patients return to society and families
.
Expert profile Ji Chushu, master tutor, chief physician of the Department of Oncology, has been engaged in oncology clinical work for many years, especially in the field of palliative care for tumors for many years; major social part-time jobs: Director of the Palliative Care Professional of Anhui Anti-Cancer Association, Palliative Care Professional of the Chinese Anti-Cancer Association Member, member of the Oncology Support Rehabilitation Therapy Group of the Oncology Branch of the Chinese Medical Association
.
Typesetting: Xin Ya Editor: Qin Miao Review: Xu Fengyan For more information, please click: Over 60% of newly diagnosed patients have insufficient understanding of cataract diseases | China Cataract Awareness and Diagnosis and Treatment Status Survey Report Released 2021 China Atrial Fibrillation Day | Professor Ma Changsheng: Atrial Fibrillation Rhythm The era of control is coming.
"Physician Daily" submission public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments Dear image authors, hello, the doctor’s newspaper has prepared the contribution fee for you, please contact the editor on duty ：010-58302828-6808 Currently 1130000+ doctors have been paying attention to join us
.
It was an 80-year-old grandfather who was diagnosed with gastric cancer after admission.
After a detailed examination by Professor Ji, he finally confirmed the treatment plan (immune drugs plus anti-angiogenesis drugs).
The medication has a good effect for one year.
According to the results of follow-up It can be seen that the tumor in the stomach is controlled very well
.
It can be seen that the old man usually looks ruddy and takes care of himself.
On the surface, he cannot tell that he is a cancer patient
.
However, with the prolonged medication time, Uncle Zhang always feels inexplicably tired, not interested in anything, and self-perceived to be extremely fatigued, which seriously affects normal life
.
Knowing that it was an adverse reaction after the medication, Uncle Zhang couldn’t bear the physical and psychological damage caused by fatigue.
He had to make a decision to stop the medication and completely abandon the effective treatment.
The family did not expect it.
The tumor did not knock the old man down, but fatigue made him lose confidence in treatment
.
Professor Ji told reporters that in the process of tumor treatment, there will be many accompanying symptoms, such as common adverse reactions such as nausea, vomiting, and hair loss caused by chemotherapy and radiotherapy
.
In recent years, with the continuous update of the concept of tumor treatment and the continuous expansion of tumor treatment methods, especially with the widespread use of targeted therapies and immunotherapy in clinics, more and more patients have continued to live longer.
In the past, long-term surviving patients have new accompanying symptoms, of which the higher incidence is cancer-related fatigue, which is not less than 40% in clinical practice
.
Professor Ji Chushu Palliative care has changed from a supporting role to the protagonist of comprehensive cancer treatment.
Since joining the work in 1985, Professor Ji has devoted himself to cancer treatment for more than 30 years.
He has a profound experience in the development of cancer palliative care.
It can be said that he has witnessed the history of development and changes in palliative care in China
.
When Professor Ji just became an oncologist, he encountered many patients with cancer pain.
At that time, the only drugs used to treat cancer pain were powerful opioids such as Du Lengding.
As fine anesthetics, the national control was quite strict, resulting in Many patients are often in pain due to insufficient dosage, and doctors have to use placebo (normal saline) instead
.
Professor Ji said frankly that due to lack of cognition, doctors dare not use medicines for patients.
Looking at patients with terminal tumors in pain, they often feel weak as a doctor
.
With the start of palliative cancer care in China in the 1980s, under the leadership of Academician Sun Yan, Professor Li Tongdu, Professor Yu Shiying, Professor Wang Jiejun and other generations, palliative care has made great progress after decades of development.
In particular, cancer pain treatment has received standardized and effective treatment at this stage
.
The tumor itself and the adverse reactions in the course of tumor treatment are all accompanying symptoms, including the well-known nausea, vomiting, hair loss, etc.
, but these symptoms will basically disappear when the patient stops chemotherapy, and there are many in clinical practice.
Effective drug response will not trouble patients for a long time
.
Professor Ji pointed out that targeted therapy and immunotherapy for tumors require long-term uninterrupted application of patients.
For patients who use this type of regimen, adverse reactions will inevitably exist for a long time.
Fatigue has become a relatively high-incidence accompanying symptom, so new treatments are used.
The patients of the program are a high-risk group of fatigue
.
Some people will say, isn’t tiredness just tired? Let the patient rest as long as there is no need for treatment at all
.
In fact, cancer-related fatigue is not simply "tired"
.
In the latest international authoritative guidelines, cancer-related fatigue is defined as: “a painful, persistent, subjective feeling, which is the physical, emotional and/or cognitive fatigue and fatigue caused by the tumor itself or anti-tumor therapy.
A sense of exhaustion, and inconsistent with the amount of recent exercise, and affect the daily function of the patient
.
"So compared with the fatigue of healthy people, the "tired" of the two cannot be confused
.
The diagnostic criteria for cancer-related fatigue are: fatigue symptoms occur repeatedly for more than 2 weeks, and 5 or more of the following 10 symptoms can be diagnosed as fatigue
.
1.
Weakness or heavy body; 2.
Inability to concentrate; 3.
Lack of passion, low mood, lack of energy; 4.
Insomnia or lethargy; 5.
Feeling of energy failure after sleep; 6.
Difficulty in activities; 7.
The following Emotional reactions such as sadness, frustration or irritability; 8.
Inability to complete daily activities that were originally competent; 9.
Short-term memory loss; 10.
After the activity, the fatigue symptoms persist for several hours and cannot be relieved
.
Fatigue causes cancer patients to suffer both physical and psychological blows.
"In the early stage of cancer treatment, the main energy of patients and doctors was to attack the tumor.
They only wanted to control the tumor in a state of operable or clinical remission as soon as possible, and clinical patient fatigue occurred.
The cause of the disease is complicated and there is no objective evaluation system, so the accompanying symptoms of patients are often not paid enough attention
.
" Professor Ji said
.
Professor Ji believes that before fatigue treatment, we must first analyze the cause, because fatigue-inducing factors include not only tumor treatment, but also tumor itself (weight loss, fever, anemia, etc.
)
.
Tumor causes changes in patient hormone levels (abnormal thyroid function, hormone deprivation, etc.
).
For such fatigue patients, adjustment of hormone levels and replacement therapy can be effectively improved; in addition, tumor brain metastasis can also cause similar fatigue; such as worsening infections, kidneys Complications such as insufficiency and heart failure can cause different degrees of fatigue.
There is also a type of fatigue caused by multiple factors, which may be related to the treatment of the tumor itself.
The cause of this fatigue is often difficult to find and it is more difficult to intervene
.
Therefore, fatigue requires comprehensive evaluation by experienced doctors in order to carry out symptomatic treatment
.
In addition, fatigue can not only cause physical changes in patients, but more importantly, affect patients' mental health.
The psychological impact on patients should not be underestimated.
Just as Uncle Zhang suffered in the previous article, patients have to give up treatment
.
In the clinic, Professor Ji has encountered many patients who have achieved complete pathological remission after tumor treatment, but are still unable to live a normal life due to fatigue.
Mental symptoms such as depression and anxiety occur from time to time, causing the patients to suffer both physically and mentally
.
Professor Ji believes that at this stage, clinicians’ perception of fatigue is still in its infancy, just like the initial recognition of cancer pain
.
Doctors and patients do not pay attention to mild and moderate fatigue, and patients do not actively seek help, and only start seeking medical advice after severe fatigue.
This directly leads to delays in a large number of patients with mild and moderate fatigue in the clinic.
Treatment
.
In recent years, more and more doctors in the clinic have begun to pay attention to fatigue.
However, given that doctors, including patients’ cognition is still in its infancy, there is an urgent need for more standardized guidelines to guide clinical practice
.
Professor Ji introduced that at present, China is introducing fatigue-related guidelines.
In the near future, doctors will continue to pay more attention to them, give full play to their subjective initiative, take proactive measures, continue to learn, and strengthen fatigue screening, evaluation and management.
To further improve fatigue patients
.
Every oncologist should be an all-rounder.
It is understood that so far, the NCCN guidelines in the United States and the CSCO guidelines in China have not yet issued a standard treatment plan for related fatigue.
There are only related interventions, which are mainly divided into non-drug and drug interventions.
Non-pharmacological interventions include sleep management, nutrition management, exercise management, etc.
It is recommended that each patient stay active for 15 to 30 minutes a day based on their own conditions and without contraindications to exercise
.
For drug intervention, clinical Chinese and Western medicines do not have specific drugs for fatigue.
At present, there are only a few studies and most of them are the results of open trials, and the benefit of patients is weak
.
In recent years, the treatment of fatigue with traditional Chinese medicine has been attracting attention
.
After years of clinical verification, Professor Ji believes that Chinese medicine not only has therapeutic effects on its own, but also has psychological effects that conform to the national conditions and follow the traditional concept of tonic conditioning, which is very important for tired patients
.
However, not all drugs are suitable for cancer patients at different stages of treatment
.
Professor Ji specially reminded that in the case of good tumor control, the first principle of choosing anti-fatigue drugs should not bring more impact to the patient.
For example, if the tumor is very well controlled, hormones will cause the curative effect to decrease, so it needs to be based on the patient’s The specific situation depends on the plan
.
As cancer patients live longer and longer, the "chronic disease management" of cancer patients becomes particularly important.
Many accompanying symptoms require patients to identify themselves and carry out effective management
.
Fatigue, as a potential prognostic factor, can run through the entire course of cancer patients and will continue to exist after the end of anti-tumor treatment
.
Professor Ji believes that at this stage, in order to truly manage the symptoms of patients, doctors and patients should be screened and evaluated from the initial visit to the end of the treatment, and evaluated at any time when they have symptoms
.
In this process, doctors must face up to fatigue, because only doctors pay attention to fatigue in order to convey correct information to patients
.
Therefore, the doctor must accurately and promptly inform the patient of the possible consequences of fatigue, and be good at observing the patient's invisible changes in the outpatient or ward, and effectively find the cause of fatigue, which is beneficial to the overall treatment of the tumor
.
As an veteran expert who has been dealing with tumors for more than 30 years, she hopes that every oncologist will be a generalist, not only to contain the tumors of patients, but also to help patients return to society and families
.
Expert profile Ji Chushu, master tutor, chief physician of the Department of Oncology, has been engaged in oncology clinical work for many years, especially in the field of palliative care for tumors for many years; major social part-time jobs: Director of the Palliative Care Professional of Anhui Anti-Cancer Association, Palliative Care Professional of the Chinese Anti-Cancer Association Member, member of the Oncology Support Rehabilitation Therapy Group of the Oncology Branch of the Chinese Medical Association
.
Typesetting: Xin Ya Editor: Qin Miao Review: Xu Fengyan For more information, please click: Over 60% of newly diagnosed patients have insufficient understanding of cataract diseases | China Cataract Awareness and Diagnosis and Treatment Status Survey Report Released 2021 China Atrial Fibrillation Day | Professor Ma Changsheng: Atrial Fibrillation Rhythm The era of control is coming.
"Physician Daily" submission public email: yishibao2017@163.
com [Note] Some pictures are from the Internet and WeChat Moments Dear image authors, hello, the doctor’s newspaper has prepared the contribution fee for you, please contact the editor on duty ：010-58302828-6808 Currently 1130000+ doctors have been paying attention to join us
