Cancer-related fatigue—mechanisms, risk factors, and treatments

Abstract

Fatigue is one of the most common and distressing side effects of cancer and its treatment, and may persist for years after treatment completion in otherwise healthy survivors. Cancer-related fatigue causes disruption in all aspects of quality of life and may be a risk factor for reduced survival. The prevalence and course of fatigue in cancer patients has been well characterized, and there is growing understanding of underlying biological mechanisms. Inflammation has emerged as a key biological pathway for cancer-related fatigue, with studies documenting links between markers of inflammation and fatigue before, during, and particularly after treatment. There is considerable variability in the experience of cancer-related fatigue that is not explained by disease- or treatment-related characteristics, suggesting that host factors may play an important role in the development and persistence of this symptom. Indeed, longitudinal studies have begun to identify genetic, biological, psychosocial, and behavioral risk factors for cancer-related fatigue. Given the multi-factorial nature of cancer-related fatigue, a variety of intervention approaches have been examined in randomized controlled trials, including physical activity, psychosocial, mind-body, and pharmacological treatments. Although there is currently no gold standard for treating fatigue, several of these approaches have shown beneficial effects and can be recommended to patients. This report provides a state of the science review of mechanisms, risk factors, and interventions for cancer-related fatigue, with a focus on recent longitudinal studies and randomized trials that have targeted fatigued patients.

Muscle mass as a target to reduce fatigue in patients with advanced cancer

“…Cancer‐related fatigue is one of the most prevalent symptoms experienced by patients with cancer, both during and after treatment 2, 3. Although advances are being made, the aetiology of CRF is not yet fully understood, and treatment is mostly symptomatic 4, 5. The pathophysiology of CRF is determined by central and peripheral aspects of fatigue 4, 6, 7.…”

Kronisk tretthet hos voksne kreftoverlevere

“…Also in the general Norwegian population, sociodemographic and health-related factors were associated with chronic fatigue (12). Living alone, having a low income or experiencing psychological discomfort such as anxiety, pessimism and low mood/depression are associated with chronic fatigue in cancer survivors (3,15).…”

“…There is broad agreement that chronic fatigue among cancer survivors cannot be explained only by disease-and treatment-related factors, and that chronic fatigue is a multifactorial phenomenon that is affected by somatic, demographic and psychosocial factors (3). Also in the general Norwegian population, sociodemographic and health-related factors were associated with chronic fatigue (12).…”

“…In most cases, this tiredness will gradually disappear after treatment cessation, but not everyone experiences improvement. Up to 35 % of those who have completed curative treatment, and who are without known cancer, will experience persistent tiredness after completion of treatment (3,4). Other cancer survivors may experience a brief period of time without this symptom after treatment completion, but later on feel declining energy levels.…”

“…Pronounced tiredness, exhaustion and lack of energy are among the most common symptoms during oncological treatment (1)(2)(3). In most cases, this tiredness will gradually disappear after treatment cessation, but not everyone experiences improvement.…”