Teenage and Young Adult Cancer-Related Fatigue Is Prevalent, Distressing, and Neglected: It Is Time to Intervene. A Systematic Literature Review and Narrative Synthesis

Abstract

Purpose: Cancer-related fatigue in adults has been the subject of considerable recent research, confirming its importance as a common and debilitating symptom, and establishing a number of evidence-based interventions. There has, however, been limited focus on the fatigue suffered by teenagers and young adults with cancer, a group recognized as having unique experiences and developmental needs. We have undertaken a systematic review of the literature to provide a comprehensive overview of studies evaluating fatigue in this younger patient group in order to guide clinical practice and future research. Method: We searched MEDLINE, EMBASE, PsycINFO, and CINAHL databases for literature containing data relating to any aspect of fatigue in patients aged 13-24 at cancer diagnosis or treatment. Results: Sixty articles were identified, of which five described interventional clinical trials. Cancer-related fatigue was consistently one of the most prevalent, severe, and distressing symptoms, and it persisted long-term in survivors. It was associated with a number of factors, including poor sleep, depression, and chemotherapy. There was little evidence for the effectiveness of any intervention, although exercise appears to be the most promising. Importantly, fatigue was itself a significant barrier to physical and social activities. Conclusion: Cancer-related fatigue is a major and disabling problem in young cancer patients. Effective management strategies are needed to avoid compounding the dependence and social isolation of this vulnerable patient group. Future research should focus on providing evidence for the effectiveness of interventions, of which activity promotion and management of concurrent symptoms are the most promising.

Reimagining care for adolescent and young adult cancer programs: Moving with the times

“…Regardless of age or sex, fatigue is a highly prevalent symptom as a result of cancer and cancer‐related treatments . As per the National Comprehensive Cancer Network (NCCN), cancer‐related fatigue has been described as a “persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning.” A recent systematic literature review examining AYA patients with cancer demonstrated mixed findings and characterized fatigue as prevalent, often severe, and distressing …”

“…Psychosocial interventions also are an important consideration for managing fatigue . Interventions such as cognitive behavioral therapy, counseling, supportive expressive therapy, and educational models have a small to moderate effect on improving feelings of vigor and vitality in adults, and this is comparable to the effect that exercise can have on fatigue . A psychosocial intervention using a self‐coping strategy in AYA patients demonstrated no clear benefit with regard to fatigue .…”

“…15 A recent systematic literature review examining AYA patients with cancer demonstrated mixed findings and characterized fatigue as prevalent, often severe, and distressing. 16 Fatigue can result from multiple etiologies, thereby adding to management challenges. 17 It is often difficult to distinguish whether fatigue is a result of cancer, its treatment, and/or other causes.…”

Anticancer chemotherapy in teenagers and young adults: managing long term side effects

“…42 A recent systematic review highlighted that fatigue can be a disabling problem in younger patients with cancer, and that urgent research is needed to identify effective management strategies. 43 Fatigue affects 17-29% of all cancer survivors, 44 and can have a great effect on quality of life and function. 44 Reversible causes should be explored (see infographic).…”

Web-Based Patient-Reported Outcomes Using the International Consortium for Health Outcome Measurement Dataset in a Major German University Hospital: Observational Study (Preprint)

“…Breast cancer specific mortality in Europe was reduced from 17.9 per one hundred thousand women in 2002 to 15.2 women in 2012 [4]. However, survival gains are often associated with a loss in physical functioning, increased morbidity and new challenges regarding the emotional, social and financial aspects of life [5,6,7,8]. Therefore, this increase in life expectancy for cancer patients must lead to an increased scrutiny regarding the long-term side effects of new and existing cancer treatments [9,10].…”