Cancer‐Related Fatigue: State of the Science

Abstract

Cancer-related fatigue (CRF) is a disabling and distressing symptom that is highly prevalent across the cancer continuum from a patient's diagnosis and treatment through survivorship and end of life. It has a multifactorial etiology and significant individual variability in its clinical expression, determinants, and sequelae. Despite the significance of CRF, it is often underdiagnosed, and management is frequently suboptimal. This review synthesizes the state of the science concerning the features, possible mechanisms, and predictors of CRF; offers recommendations for the evaluation of CRF; and appraises the strength of the evidence for a wide range of pharmacologic and nonpharmacologic interventions to prevent and manage fatigue during and after cancer and its treatment. There is evidence from methodologically rigorous controlled trials that exercise, psycho-educational interventions, and cognitive-behavioral therapy for insomnia are effective in the treatment of CRF, and a wide range of pharmacologic and nonpharmacologic interventions has shown initial promise in single-arm pilot studies with small, heterogeneous samples. Rigorously designed and adequately powered randomized trials are warranted to (1) determine the effectiveness of promising approaches and (2) identify the interventions that are most effective in treating CRF in specific subpopulations (eg, stem cell transplant recipients, older adults, patients with lung or colorectal cancers, survivors, and those at the end of life). Studies to elucidate the biologic expression profiles of CRF, to explicate the mechanisms through which particular interventions impact CRF, and to identify the mediators and moderators of fatigue outcomes will ultimately permit individually tailored approaches for the treatment of CRF.

The Effectiveness of a Deep Water Aquatic Exercise Program in Cancer-Related Fatigue in Breast Cancer Survivors: A Randomized Controlled Trial

“…Aquatic exercise could improve the fitness level of participants, which is known as one of the pillars to attenuate CRF. 5,7 Hydrostatic pressure during water exercise redistributes blood from the limbs to the thoracic cavity; this redistribution may have reduced the heart rate and transiently increased the blood pressure. 40 Unfortunately, we did not use a heart rate monitor during immersion to provide support to these speculations.…”

“…2 Close to 20% of breast cancer survivors can suffer CRF several years after finishing their curative treatment. 3,4 A moderate to high level of CRF is associated with reduced quality of life in these patients 1,[5][6][7] and is perceived as a barrier to include exercise in their lifestyle, 8 justifying the need to seek different methods of treatment for these patients. Previous research has investigated the effects of exercise as nonpharmacologic treatment for CRF, [9][10][11] with clinical impact ranging from small to moderate effect sizes on CRF.…”

“…[10][11][12] There continues to exist limited research examining the effects of exercise for patients with cancer who experience CRF. 7,12,13 New studies are necessary to identify optimal treatment options for individuals with CRF to improve their quality of life.…”

The relationship between fatigue and play activities of children with acute lymphoblastic leukemia receiving chemotherapy

“…The other reason commonly acknowledged by both patients and health professionals is that fatigue is assumed to be a non-lifethreatening, subjective feeling and an unavoidable consequence of cancer therapy. 16 Without appropriate management, fatigue could reduce children's quality of life. 13 In children who enter remission from cancer, the effects of fatigue are identified as growth disorder, reduced memory capacity, limited short-term memory (becoming forgetful), difficulties in learning, hormonal changes and complications with other diseases, including secondary cancer.…”

Acupuncture and Moxibustion for Cancer-related Fatigue: a Systematic Review and Meta-analysis

“…Fortunately, with the notable improvement of biological-psychological-social medical model, extension of the overall survival time and much more confirmed pursuit towards higher QOL, CRF has aroused stronger concern among medical personnel, patients and corresponding relatives. Regretfully, faced with the absence of any official guidelines on how to manage CRF, it is essential to explore alternative therapies for CRF (Mitchell, 2010;Berger et al, 2012;Saibul et al, 2012).…”