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Query: UMLS:C0392674 (exhaustion)
 13,658 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Senescence of the lympho-haemopoietic system is associated with an increased incidence of neoplasia, autoimmune diseases and infections. Myelosuppression, either in the context of cancer chemotherapy or in the face of severe infections, commonly manifests as pancytopenia, and has an adverse impact on the prognosis of the elderly cancer patient by increasing infection and bleeding-related morbidity. The physiological basis of this blunted haemopoietic response is unclear, and has been ascribed to age-related deficits in marrow progenitor cell numbers, changes in the marrow microenvironment, decreased production of regulatory growth factors, or a combination of these mechanisms. These age-related deficits tend to be subtle and are only of clinical importance either when present cumulatively or under conditions of extreme haemopoietic stress. Furthermore, some of these deficits can be circumvented with the use of haemopoietic growth factors (HGFs). Thus, the availability in the clinic of various HGFs has had a tremendous impact on the care of the elderly cancer patient. The HGFs currently approved for use are: granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor and epoetin-alpha (recombinant human erythropoietin). However, we still need to better elucidate age-related changes in the early stages of haemopoiesis. The question of haemopoietic exhaustion, particularly under prolonged growth factor stimulation, is real and still unanswered.
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PMID:Aging and haemopoiesis. Implications for treatment with haemopoietic growth factors. 881 84

The study examined incidence of burnout syndrome, psychopathology, and job satisfaction in bone marrow transplant nurses, in relation to existence of an informal psychosocial support programme for staff needs. Forty nurses participated in the study completing four standardised measures related to burnout, anxiety, depression, satisfaction with aspects of their job, and social support. Results indicated that burnout among these nurses was low, and high personal accomplishment from working with marrow transplant patients was the response of the majority. Job satisfaction was also found to be high, with outpatient nurses scoring significantly higher than inpatient nurses in most aspects of job satisfaction. One out of four subjects presented with the psychic manifestations of the anxiety neurosis, suggesting the stressfullness of the marrow transplant environment, which requires a high degree of responsibility and advanced nursing skills. Social support was not found to influence burnout, psychopathology, or job satisfaction. Presence of depression, low personal accomplishment, and dissatisfaction with pay were the variables predicting high emotional exhaustion, one of the main components of burnout. These results were suggestive of less burned out and more satisfied nurses compared to marrow transplant nurses working in environments with no formal or informal staff support programmes. This highlights the need for development of support services for the nursing staff, allowing them to ventilate their feelings, discuss issues of concern to them and seek professional support where necessary.
Cancer Nurs 1996 Oct
PMID:Evaluation of burnout and job satisfaction in marrow transplant nurses. 888 84

Exhaustion syndrome is a potential risk for palliative-care workers and families because of their special contact with suffering. In this article we review its manifestations, the ways it affects every member of the team and other carers. It is possible to prevent it through an early recognition of job stress and the developing of strategies of self-control. It can be treated by improving the relationships among the different members of the team and families, by administrative measures to provide support when difficult matters have to be addressed, by creating support teams and by providing a stimulus for improving the quality of work.
Support Care Cancer 1996 Nov
PMID:Exhaustion syndrome in palliative care. 896 68

One enigma in tumor immunology is why animals bearing malignant grafts can reject normal grafts that express the same nonself-antigen. An explanation for this phenomenon could be that different T cell clones react to the normal graft and the malignant cells, respectively, and only the tumor-reactive clonotypes may be affected by the growing tumor. To test this hypothesis, we used a T cell receptor transgenic mouse in which essentially all CD8(+) T cells are specific for a closely related set of self-peptides presented on the MHC class I molecule Ld. We find that the tumor expressed Ld in the T cell receptor transgenic mice but grew, while the Ld-positive skin was rejected. Thus, despite an abundance of antigen-specific T cells, the malignant tissue grew while normal tissue expressing the same epitopes was rejected. Therefore, systemic T cell exhaustion or anergy was not responsible for the growth of the antigenic cancer cells. Expression of costimulatory molecules on the tumor cells after transfection and preimmunization by full-thickness skin grafts was required for rejection of a subsequent tumor challenge, but there was no detectable effect of active immunization once the tumor was established. Thus, the failure of established tumors to attract and activate tumor-specific T cells at the tumor site may be a major obstacle for preventive or therapeutic vaccination against antigenic cancer.
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PMID:Antigenic cancer cells grow progressively in immune hosts without evidence for T cell exhaustion or systemic anergy. 922 52

Amphibian tissues seem to resist oncogenesis in proportion to their regenerative capacity, a phenomenon most easily seen in relation to limb regeneration. There is evidence that mammalian tissues also possess, in addition to and distinct from the capacity for physiological renewal, a limited and not always overtly evident degree of amphibian-like capacity for regeneration (epimorphic regeneration). It is the thesis of this paper that cancer in mammals would seldom occur were it not for a local destruction or exhaustion, secondary to injury or aging, of this normal amphibian-like regenerative capacity.
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PMID:Regeneration versus neoplastic growth. 927 13

The paper describes the main adaptive mechanisms involved in the carcinogenic process. As a result of the action of carcinogenic agents (physical, chemical, biological), and in relation to the functional status of the affected cells, a number of systems are triggered off: detoxification and conjugation systems, the metabolisation of the said agents, DNA repairing enzymes, increased shock proteins (HSP), the induction of clonal proliferation. All these systems are valuable to the survival of the body and the species and culminate in the apoptosis of damaged cells as the last attempt at adaptation of a social kind for the good of the body. When these compensation mechanisms prove ineffective, imprecise or are exceeded by cell adaptive capacity, the resulting structural and functional alterations trigger off (induction) a very long process which often lasts between one and two thirds of the body's life, in various stages, multistep and multifactorial: this neoplastic transformation leads to a purposeless, egoistic, anarchic proliferation of cells which wish to survive at all costs, even to the detriment of the body of which they form part. Following the exhaustion of cell adaptive defences, there is an accumulation of additional genetic alterations (promotion and progression), the cells become manifestly neoplastic and continue their egoistic adaptation, according to the laws of natural selection: the cells which survive are those which adapt best to the hostile environment of the host's body, which are unaffected by proliferation control mechanisms (contact inhibition, differentiation factors, apoptosis, etc.), which make the best of the growth factors present in their microenvironment, which accomplish the so-called decathlon of the metastatization process, namely acquiring new capacities which can overcome the basal membrane, invade tissues to which they are attracted and continue to proliferate. Manifestly neoplastic cells become not self at a later stage, managing to escape the immune system using various adaptive mechanisms which induce immune tolerance/anergy. From this point of view, cancer may be regarded as an incidental factor in the host's cell adaptation processes; the latter are much more important from a biological point of view and their absence is incompatible with life: cancer might therefore be regarded as a cell adaptation pathology.
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PMID:[Cellular adaptation and cancerogenesis]. 973 55

Many patients with solid tumours or haematological malignancies develop anaemia, and the use of chemotherapy aggravates this condition. Red blood cell transfusions are often necessary but are associated with many risks, including immunosuppressive effects that may increase the risk of tumour recurrence. Many clinical studies have shown that epoetin (recombinant human erythropoietin) therapy can ameliorate, or even prevent, the anaemia associated with chemotherapy and cancer (including solid tumours as well as multiple myeloma or lymphoma). Response, defined as a significant (>50%) reduction in the rate of transfusions and/or a significant (>2 g/dl) elevation of haemoglobin levels, is usually observed in about 60% of the patients, irrespective of the type of standard chemotherapy given. The decrease in transfusion requirements is the major objective of epoetin therapy, because they are costly, inconvenient and are associated with potential adverse effects. Epoetin therapy also brings about substantial improvements in various indices of quality of life that are proportional to changes in haemoglobin level. However, large dosages of epoetin are generally required and about 40% of patients do not respond even to very high dosages. A number of adverse effects of epoetin therapy have been observed in patients with renal failure. The most prominent include hypertension, headaches, seizures and thrombotic events. These complications can also occur in patients with renal failure who are not receiving epoetin. Their exact incidence has been assessed in placebo-controlled studies, which have demonstrated that there is no increased risk of thrombosis or seizure with epoetin. However, it is now generally accepted that 10 to 20% of haemodialysis patients will experience an elevation of blood pressure because of epoetin and there is no doubt that a rapid elevation of blood pressure may cause generalised seizures. In other settings, including anaemia associated with cancer, very few adverse effects have been attributed to epoetin. However, close monitoring of blood pressure should be implemented in patients with hypertension. There is no evidence that epoetin stimulates tumour growth. With the dosages of epoetin currently used, there is no evidence of stem cell competition, resulting in thrombocytopenia or neutropenia, or of stem cell exhaustion, producing secondary anaemia when treatment is stopped. Epoetin is a remarkably well tolerated drug that offers significant benefits in patients with cancer.
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PMID:A risk-benefit assessment of epoetin in the management of anaemia associated with cancer. 980 42

The union of a healthy egg and a healthy sperm is required for propagation of mammalian species, and thus any factor that disrupts the normal production of female or male gametes is a potential threat to reproductive performance. These hazards to gonadal function are derived from both clinical and environmental sources, and can affect either somatic cell or germ cell lineages, or in some cases both, with equal consequences, i.e. the loss of fertility. Females of the species are particularly at risk to gonadal toxicants since, unlike males, females are born with an irreplaceable stockpile of germ cells in their ovaries at the time of birth. Natural selection processes further dwindle this precious reserve such that by the time of puberty, when eggs could actually be used for fertilization and pregnancy, the number of remaining oocytes has been depleted to less than three-quarters of the starting cohort. In the human female, this completely normal loss of oocytes eventually leads to near-exhaustion of the germ cell reserve around the fifth decade of life, and the menopause ensues. Consequently, exposure of women to potentially damaging agents, such as anti-cancer drugs, industrial chemicals or even cigarette smoke, can have a dramatic and irreparable effect on the ovary by accelerating the natural process of germ cell depletion and, as a direct consequence, advance the time to menopause. This mini-review attempts to bring together these concepts from a molecular biological standpoint, and further offers the hypothesis that many gonadal toxicants exert their effects via modulation of discrete signaling pathways linked to apoptotic cell death in the female germline.
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PMID:Molecular and genetic basis of normal and toxicant-induced apoptosis in female germ cells. 1002 2

Fatigue is a subjective state of overwhelming, sustained exhaustion and decreased capacity for physical and mental work that is not relieved by rest. Cancer-related fatigue has many causes. Included in the causes are the illness itself, the side effects of virtually every treatment, depression, and other biopsychosocial factors. As a result, fatigue is the most common symptom reported by cancer patients in most descriptive studies. In addition to arising from multiple etiologies, fatigue is also multidimensional in its manifestation and impact. Its effect on the quality of life of the patient is comparable to that of pain. Experienced by most patients as an extremely frustrating state of chronic energy depletion, it leads to loss of productivity which can reduce self-esteem. As a subtle and chronic symptom, it also places people at risk for being questioned about the veracity of their complaints, particularly during the post-treatment, disease-free survival period. Patients themselves are reluctant to complain of fatigue, perhaps because they believe little can be done about it, or they wish to avoid drawing attention away from treating their cancer.
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PMID:Progress toward guidelines for the management of fatigue. 1002 20

Vital exhaustion, defined as a combination of fatigue, lack of energy, feelings of hopelessness, loss of libido, and increased irritability, has been proposed as a risk indicator for the development of coronary heart disease (CHD). It is unclear if the association between vital exhaustion and CHD is independent of sleep behavior, depression, and physical activity. We ascertained sense of exhaustion among 5,053 male college alumni who were free of cardiovascular disease, cancer, and chronic obstructive pulmonary disease by asking, "How often do you experience sense of exhaustion (except after exercise)?" on a health survey in 1980. Eight hundred fifteen men died during 12 years of follow-up, 25% due to CHD. After adjustment for age, body mass index, smoking status, and history of physician-diagnosed diabetes and hypertension, frequent sense of exhaustion was associated with a twofold increase in CHD mortality (rate ratio 2.07; 95% confidence interval 1.08 to 3.96). After additional adjustment for insomnia, sleep duration, use of sleeping pills and tranquilizers, physical activity, history of physician-diagnosed depression, and alcohol intake, the rate ratio was not appreciably altered; however, the association now was of borderline significance (rate ratio 2.06; 95% confidence interval: 0.98 to 4.36) because there were only 10 deaths from CHD among men who were frequently exhausted. In a prospective observational study, frequent sense of exhaustion appeared to be independently associated with increased risk of CHD mortality in men.
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PMID:Sense of exhaustion and coronary heart disease among college alumni. 1060 12


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