Screening, evaluation, and management of cancer‐related fatigue: Ready for implementation to practice?

Abstract

Answer questions and earn CME/CNE Evidence regarding cancer-related fatigue (fatigue) has accumulated sufficiently such that recommendations for screening, evaluation, and/or management have been released recently by 4 leading cancer organizations. These evidence-based fatigue recommendations are available for clinicians, and some have patient versions; but barriers at the patient, clinician, and system levels hinder dissemination and implementation into practice. The underlying biologic mechanisms for this debilitating symptom have not been elucidated completely, hindering the development of mechanistically driven interventions. However, significant progress has been made toward methods for screening and comprehensively evaluating fatigue and other common symptoms using reliable and valid self-report measures. Limited data exist to support the use of any pharmacologic agent; however, several nonpharmacologic interventions have been shown to be effective in reducing fatigue in adults. Never before have evidence-based recommendations for fatigue management been disseminated by 4 premier cancer organizations (the National Comprehensive Cancer, the Oncology Nursing Society, the Canadian Partnership Against Cancer/Canadian Association of Psychosocial Oncology, and the American Society of Clinical Oncology). Clinicians may ask: Are we ready for implementation into practice? The reply: A variety of approaches to screening, evaluation, and management are ready for implementation. To reduce fatigue severity and distress and its impact on functioning, intensified collaborations and close partnerships between clinicians and researchers are needed, with an emphasis on system-wide efforts to disseminate and implement these evidence-based recommendations.

Modifiable and non-modifiable characteristics associated with sleep disturbance in oncology outpatients during chemotherapy

“…Consistent with findings that fatigue is highly prevalent during and after cancer treatment [37] and that associations exist between fatigue and sleep disturbance [33,38], higher levels of both morning and evening fatigue were associated with both initial levels (i.e., morning and evening fatigue) and trajectories (i.e., morning fatigue) of sleep disturbance. Recent findings suggest that morning and evening fatigue are distinct but related symptoms that warrant separate assessments in oncology patients [7].…”

Inflammatory pathway genes associated with inter-individual variability in the trajectories of morning and evening fatigue in patients receiving chemotherapy

“…During chemotherapy (CTX), over 45% of patients experience clinically meaningful levels of fatigue that decrease their ability to tolerate treatments, engage in social relationships, and maintain regular work activities [1]. However, a growing body of evidence demonstrates that inter-individual variability exists in fatigue severity across cancer diagnosis [2–4] and treatments [5, 6].…”

Prevalence and determinants of fatigue in patients with moderate to severe chronic GvHD

“…28 Risk factors for fatigue following cancer treatment can include anemia, comorbidities, concurrent symptoms, impaired sleep quality, mood disturbance, cachexia, sarcopenia, deconditioning and treatment with medications with sedating side effects. 29 Evidence also links fatigue with gene polymorphisms, circadian rhythm disruption, immune dysregulation, abnormal cortisol secretion and/or proinflammatory cytokine activity. 30,31 Other models emphasize imbalanced energy intake, metabolism and expenditure, 32,33 or propose dysregulation in the function of immune-neuroendocrine-based regulatory systems.…”