Recent advances in Chinese and western medicine for cancer-related fatigue: A review

Cancer-related fatigue (CRF) is a prevalent and debilitating condition experienced by up to 90% of cancer patients. Unlike the fatigue experienced by healthy individuals, CRF is persistent and distressing, adversely affecting physical, emotional, cognitive, and functional aspects of patients' lives, thereby impeding treatment outcomes and quality of life. This review examines the current understanding of CRF from the perspectives of both Western medicine and Traditional Chinese Medicine (TCM), focusing on its pathogenesis, screening and assessment, and treatment options. Understanding the complementary roles of Western and TCM approaches can provide a more holistic strategy for managing CRF.

Pathogenesis of CRF

The etiology of CRF is multifaceted and remains incompletely understood. Several key mechanisms have been identified:

1. Inflammatory Cytokines Dysregulation: The high metabolic activity of malignant tumors triggers an inflammatory response, releasing cytokines such as interleukin (IL)-6, IL-1β, tumor necrosis factor-alpha, and C-reactive protein. IL-6, in particular, has been implicated as a significant driver of CRF through the Janus kinase/signal transducer and activator of transcription (JAK-STAT) pathway. Elevated cytokine levels correlate with increased fatigue severity.
2. Mitochondrial Dysfunction: Mitochondrial autophagy and decreased adenosine triphosphate (ATP) production contribute to cellular energy deficits, correlating with physical fatigue. This energy deficit impairs the ability of cells to perform essential functions, leading to the sensation of fatigue.
3. Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysfunction: The HPA axis regulates oxidative stress and immune responses. Disruption of this axis due to stress leads to hormonal imbalances, immune dysfunction, and a vicious cycle of fatigue, insomnia, and depression. Stress-induced alterations in cortisol levels can exacerbate fatigue symptoms.
4. Gut Microbiota-Gut-Brain Axis Disruption: Alterations in gut microbiota influence brain function through the autonomic nervous system, immune system, and microbial metabolites, contributing to fatigue. Dysbiosis in the gut microbiota can lead to systemic inflammation and affect neurochemical pathways associated with fatigue.
5. Genetic Polymorphisms: Variations in genes related to inflammation and immune responses are associated with CRF. Specific genes like SEC61A2, ADCY6, and LPAR5 have been linked to the prognosis of cancers and the severity of CRF. Genetic predispositions can influence individual susceptibility to CRF.

TCM Syndrome Types

In TCM, CRF is not specifically named but is often classified under deficiency syndromes. CRF is viewed as a condition resulting from deficiencies in the liver, spleen, and kidney, leading to an imbalance of Qi and blood. Common TCM syndromes include:

• Qi and Blood Deficiency: Manifested by symptoms like fatigue, pale complexion, dizziness, and palpitations.
• Spleen and Kidney Deficiency: Characterized by symptoms such as lethargy, poor appetite, lower back pain, and nocturia.
• Liver Blood Deficiency: Presents with fatigue, insomnia, irritability, and dry eyes.

TCM treatment aims to address these deficiencies and restore balance. Herbal formulas and acupuncture are often employed to tonify Qi, nourish blood, and strengthen the organs involved.

Screening and Assessment

CRF assessment in Western medicine primarily utilizes self-reported scales, which vary based on demographics, disease stages, and cultural contexts. Commonly used scales include:

• EORTC-QLQ-C30: A reliable indicator of quality of life in cancer patients, assessing physical, emotional, and social functioning.
• MD Anderson Symptom Inventory (MDASI): A multisymptom scale validated for various cancer types, capturing both the severity and impact of symptoms.
• Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale: Verified for its internal consistency and reliability, it evaluates fatigue and its impact on daily activities.
• PROMIS: A comprehensive measurement system for both general and specific populations, offering a broad assessment of symptoms and quality of life.

TCM Diagnostic Evaluation

Currently, there is no standardized TCM diagnostic scale for CRF. The development of such a scale is essential to objectively quantify TCM syndromes and standardize diagnostic criteria. This would facilitate the integration of TCM into broader clinical practice and enhance its reliability and validity. Diagnostic evaluation in TCM involves detailed patient history, pulse diagnosis, and tongue inspection to identify the underlying syndromes.

Treatment

Western Medicine

Drug interventions for CRF have safety concerns and are not typically recommended. Non-drug treatments with proven efficacy and safety include:

• Exercise: Physical activity helps alleviate CRF symptoms. Regular, moderate exercise has been shown to improve energy levels and overall well-being.
• Psychological Interventions: Techniques like cognitive-behavioral therapy (CBT) and mindfulness improve mental health and reduce fatigue. Psychological support can help patients cope with the emotional burden of CRF.
• Diet Guidance: Nutritional support tailored to individual needs can mitigate CRF. A balanced diet rich in vitamins, minerals, and antioxidants supports overall health.
• Light Therapy: Exposure to bright light has shown benefits in reducing fatigue. Light therapy can regulate circadian rhythms and improve sleep quality.

Traditional Chinese Medicine

TCM offers various treatments with high efficacy and safety:

• Herbal Medicine: Customized herbal formulations address specific deficiencies and restore balance. Commonly used herbs include ginseng, astragalus, and licorice.
• Acupuncture and Moxibustion: These techniques stimulate energy flow and improve symptoms. Acupuncture points are selected based on the individual's TCM diagnosis.
• Traditional Exercises: Practices like Tai Chi and Qigong enhance physical and mental well-being. These exercises promote relaxation, improve circulation, and increase energy levels.

Conclusions

CRF significantly impacts the lives of cancer patients. Integrating the strengths of both Western medicine and TCM can provide comprehensive and effective management of CRF. Continued research and the development of standardized diagnostic and treatment protocols are essential for advancing the care of patients with CRF. By combining evidence-based practices from both medical traditions, healthcare providers can offer more holistic and personalized treatment strategies for those suffering from CRF.

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The study was recently published in the Future Integrative Medicine.

Future Integrative Medicine (FIM) publishes both basic and clinical research, including but not limited to randomized controlled trials, intervention studies, cohort studies, observational studies, qualitative and mixed method studies, animal studies, and systematic reviews.

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