Abstract
Cancer-related fatigue (CrF) is the most common symptom in cancer patients with prevalence rate between 59% and 100%. CrF is an unusual feeling of exhaustion, weakness or a loss of activity due to cancer diagnosis or treatment and is described as a multidimensional construct including physical, cognitive and emotional dimensions. Although there have been a lot of research activities, there is no clear pathogenetic model to explain how the multicausal factors of CrF are interacting. Screening and assessment measures have been developed to identify the level of CrF in clinical routine or clinical trials. As in most cases the causes of CrF are not well known, the treatment approaches are primarily aimed to help the patient cope with the symptoms of CrF and the distress due to CrF. The treatment options include non-pharmacological interventions, for example, physical activity and exercise, psychosocial and mind-body interventions and pharmacological interventions.
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References
Wagner LI, Cella D. Fatigue and cancer: causes, prevalence and treatment approaches. Br J Cancer. 2004;91:822–8.
Henry DH, Viswanathan HN, Elkin EP, et al. Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional survey in the U.S. Support Care Cancer. 2008;16:791–801.
Cella D, Davis K, Breitbart W, Curt G. Fatigue coalition cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol. 2001;19:3385–91.
NCCN (National Comprehensive Cancer Network). Clinical practice guidelines in oncology: cancer-related fatigue. V.1.2021. National Comprehensive Cancer Network, Inc; 2020. Accessed 28 June 2021.
Servaes P, Gielissen MF, Verhagen S, Bleijenberg G. The course of severe fatigue in disease-free breast cancer patients: a longitudinal study. Psychooncology. 2007;16:787–95.
World Health Organization. ICD-11 International statistical classification of diseases and related health problems, 11th revision. Geneva: World Health Organization; 2019.
Noakes TD. Fatigue is a brain-derived emotion that regulates the exercise behavior to ensure the protection of whole body homeostasis. Front Physiol. 2012;3:82. https://doi.org/10.3389/fphys.2012.00082. Epub 2012 Apr 11.
Wessely S. Chronic fatigue: symptom and syndrome. Ann Intern Med. 2001;134(9 Pt 2):838–43.
Scott JA, Lasch KE, Barsevick AM, Piault-Louis E. Patients’ experiences with cancer-related fatigue: a review and synthesis of qualitative research. Oncol Nurs Forum. 2011;38(3):E191–203.
Smith SK, Herndon JE, Lyerly HK, Coan A, Wheeler JL, Staley T, Abernethy AP. Correlates of quality of life-related outcomes in breast cancer patients participating in the pathfinders pilot study. Psychooncology. 2011;20(5):559–64.
Ahlberg K, Ekman T, Gaston-Johansson F. Fatigue, psychological distress, coping resources, and functional status during radiotherapy for uterine cancer. Oncol Nurs Forum. 2005;32:633–40.
Oktay JS, Bellin MH, Scarvalone S, Appling S, Helzlsouer KJ. Managing the impact of posttreatment fatigue on the family: breast cancer survivors share their experiences. Fam Syst Health. 2011;29(2):127–37.
Mehnert A. Employment and work-related issues in cancer survivors. Crit Rev Oncol Hematol. 2011;77:109–30.
Tiedtke C, de Rijk A, Dierckx de Casterle B, Christiaens MR, Donceel P. Experiences and concerns about ‘returning to work’ for women breast cancer survivors: a literature review. Psychooncology. 2010;19:677–83.
Bruera E. Cancer-related fatigue: a multidimensional syndrome. J Support Oncol. 2010;8:175–6.
Bower JE. Cancer-related fatigue--mechanisms, risk factors, and treatment. Nat Rev Clin Oncol. 2014;11:597–609.
Bower JE, Bak K, Berger A, et al. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical Oncology clinical practice guideline adaptation. J Clin Oncol. 2014;32:1840–50. https://doi.org/10.1200/JCO.2013.53.4495.
Kenne Sarenmalm E, Browall M, Gaston-Johansson F. Symptom burden clusters: a challenge for targeted symptom management. A longitudinal study examining symptom burden clusters in breast cancer. J Pain Symptom Manage. 2014;47(4):731–41. https://doi.org/10.1016/j.jpainsymman.2013.05.012.
Ancoli-Israel S, Moore PJ, Jones V. The relationship between fatigue and sleep in cancer patients: a review. Eur J Cancer Care. 2001;10:245–55.
Dantzer R, Meagher MW, Cleeland CS. Translational approaches to treatment-induced symptoms in cancer patients. Nat Rev Clin Oncol. 2012;9(7):414–26.
Wood LJ, Weymann K. Inflammation and neural signaling: etiologic mechanisms of the cancer treatment-related symptom cluster. Curr Opin Support Palliat Care. 2013;7:54–9.
Schubert C, Hong S, Natarajan L, et al. The association between fatigue and inflammatory marker levels in cancer patients: a quantitative review. Brain Behav Immun. 2007;21:413–27.
Saligan LN, Kim HS. A systematic review of the association between immunogenomic markers and cancer-related fatigue. Brain Behav Immun. 2012;26(6):830–48. https://doi.org/10.1016/j.bbi.2012.05.004.
Brode S, Cooke A. Immune-potentiating effects of the chemotherapeutic drug cyclophosphamide. Crit Rev Immunol. 2008;28:109–26.
Elsea CR, Roberts DA, Wood LJ, et al. Inhibition of p38 MAPK suppresses inflammatory cytokine induction by etoposide, 5-fluorouracil, and doxorubicin without affecting tumoricidal activity. PLoS One. 2008;3:e2355.
Hei TK, Zhou H, Chai Y, et al. Radiation induced non-targeted response:mechanism and potential clinical implications. Curr Mol Pharmacol. 2011;4:96–105.
Mahoney SE, Davis JM, Murphy EA, et al. Effects of 5-fluorouracil chemotherapy on fatigue: role of MCP-1. Brain Behav Immun. 2013;27:155–61.
Wang XS, Williams LA, Krishnan S, et al. Serum sTNF-R1, IL-6, and the development of fatigue in patients with gastrointestinal cancer undergoing chemoradiation therapy. Brain Behav Immun. 2012;26:699–705.
Brown LF, Kroenke K. Cancer-related fatigue and its associations with depression and anxiety: a systematic review. Psychosomatics. 2009;50(5):440–7. https://doi.org/10.1176/appi.psy.50.5.440.
Ryan JL, Carroll JK, Ryan EP, Mustian KM, Fiscella K, Morrow GR. Mechanisms of cancer-related fatigue. Oncologist. 2007;12(suppl 1):22–34.
Cleeland CS, Bennett GJ, Dantzer R, et al. Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms. Cancer. 2003;97(11):2919–25.
Donovan KA, McGinty HL, Jacobsen PB. A systematic review of research using the diagnostic criteria for cancer-related fatigue. Psychooncology. 2013;22:737–44.
Fabi A, Falcicchio C, Giannarelli D, Maggi G, Cognetti F, Pugliese P. The course of cancer related fatigue up to ten years in early breast cancer patients: what impact in clinical practice? Breast. 2017;34:44–52. https://doi.org/10.1016/j.breast.2017.04.012. Epub 2017 May 11. PMID: 28500901.
Karthikeyan G, Jumnani D, Prabhu R, et al. Prevalence of fatigue among cancer patients receiving various anticancer therapies and its impact on quality of life: a cross-sectional study. Indian J Palliat Care. 2012;18(3):165–75.
Wang XS, Zhao F, Fisch MJ, et al. Prevalence and characteristics of moderate-to-severe fatigue: a multicenter study in cancer patients and survivors. Cancer. 2014;120(3):425–32. https://doi.org/10.1002/cncr.28434.
Bevilacqua LA, Dulak D, Schofield E, et al. Prevalence and predictors of depression, pain, and fatigue in older- versus younger-adult cancer survivors. Psycho-Oncology. 2018;27:900–7. https://doi.org/10.1002/pon.4605.
Servaes P, Verhagen C, Bleijenberg G. Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions. Eur J Cancer. 2002;38:27–43.
Gielissen MF, Schattenberg AV, Verhagen CA, et al. Experience of severe fatigue in long-term survivors of stem cell transplantation. Bone Marrow Transplant. 2007;39:595–603.
Naidoo J, Page DB, Li PT, et al. Toxicities of the anti-PD-1 and anti-PD-L1 immune checkpoint antibodies. Ann Oncol. 2015;26(12):2375–91. https://doi.org/10.1093/annonc/mdv383.
Linendoll N, Saunders T, Burns R, Nyce JD, Wendell KB, Evens AM, Parsons SK. Health-related quality of life in Hodgkin lymphoma: a systematic review. Health Qual Life Outcomes. 2016;14(1):114. https://doi.org/10.1186/s12955-016-0515-6. PMID: 27473596; PMCID: PMC4966803.
Heutte N, Flechtner HH, Mounier N, Mellink WA, Meerwaldt JH, Eghbali H, et al. Quality of life after successful treatment of early-stage Hodgkin’s lymphoma: 10-year follow-up of the EORTC-GELA H8 randomised controlled trial. Lancet Oncol. 2009;10:1160–70. https://doi.org/10.1016/S1470-2045(09)70258-X.
Sekse RJT, Hufthammer KO, Vika ME. Fatigue and quality of life in women treated for various types of gynaecological cancers: a cross-sectional study. J Clin Nurs. 2015;24:546–55.
Harrington CB, Hansen JA, Moskowitz M. It’s not over when it’s over: long-term symptoms in cancer survivors—a systematic review. Int J Psychiatry Med. 2010;40(2):163–81.
Wang XS, Woodruff JF. Cancer-related and treatment-related fatigue. Gynecol Oncol. 2015;136(3):446–52.
Arriba LN, Fader AN, Frasure HE, von Gruenigen VE. A review of issues surrounding quality of life among women with ovarian cancer. Gynecol Oncol. 2010;119(2):390–6.
Prue G, Allen J, Gracey J, Rankin J, Cramp F. Fatigue in gynecological cancer patients during and after anticancer treatment. J Pain Symptom Manage. 2010;39(2):197–210.
Williams AL, Heckler CE, Paterson CL, et al. Cancer-related fatigue in breast cancer survivors: a longitudinal analysis compared to matched controls. J Clin Oncol. 2017;35(15):10045. https://doi.org/10.1200/JCO.2017.35.15_suppl.10045.
Abrahams HJG, Gielissen MFM, Schmits IC, Verhagen CAHHVM, Rovers MM, Knoop H. Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12 327 breast cancer survivors. Ann Oncol. 2016;27(6):965–74. https://doi.org/10.1093/annonc/mdw099. Epub 2016.
Busson R, van der Kaaij M, Mounier N, Aleman BMP, et al. Fatigue level changes with time in long-term Hodgkin and non-Hodgkin lymphoma survivors: a joint EORTC-LYSA cross-sectional study. Health Qual Life Outcomes. 2019;17(1):115. https://doi.org/10.1186/s12955-019-1186-x. PMID: 31266501; PMCID: PMC6604328.
Teunissen SC, Wesker W, Kruitwagen C, et al. Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manag. 2007;34(1):94–104.
Olson K, Krawchuk A, Quddusi T. Fatigue in individuals with advanced cancer in active treatment and palliative settings. Cancer Nurs. 2007;30:E1–10.
Fabi A, Bhargava B, Fatigoni S, Jordan K, Ripamonti CI, et al. on behalf of the ESMO Guidelines Committee. Cancer-related fatigue: ESMO Clinical Practice Guidelines for diagnosis and treatment. Ann Oncol. 2020;31(6):713–23. https://doi.org/10.1016/j.annonc.2020.02.016.
Howell D, Keshavarz H, Broadfield L, et al. A pan Canadian practice guideline for screening, assessment, and management of cancer-related fatigue in adults version 2, 2015. Toronto: Canadian Association of Psychosocial Oncology; 2015. https://www.capo.ca/guidelines. Accessed 28 Nov 2020.
Butt Z, Wagner LI, Beaumont JL, Paice JA, Peterman AH, Shevrin D, Von Roenn JH, Carro G, Straus JL, Muir JC, Cella D. Use of a single-item screening tool to detect clinically significant fatigue, pain, distress, and anorexia in ambulatory cancer practice. J Pain Symptom Manag. 2008;35(1):20–30. https://doi.org/10.1016/j.jpainsymman.2007.02.040.
Minton O, Stone P. A systematic review of the scales used for the measurement of cancer-related fatigue (CRF). Ann Oncol. 2009;20:17–25.
Löwe B, Kroenke K, Herzog W, Gräfe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord. 2004;81:61–6.
Fisher MI, Davies C, Lacy H, et al. Oncology Section EDGE Task Force on cancer: measures of cancer-related fatigue – a systematic review. Rehabil Oncol. 2018;36:93–105.
Cella D. The Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol. 2019;34(3 Suppl 2):13–9.
Mendoza TR, Wang XS, Kugaya A, et al. The rapid assessment of fatigue severity in cancer patients; use of the Brief Fatigue Inventory. Cancer. 1999;85(5):1186–96.
Weis J, Tomaszewski KA, Hammerlid E, et al. International psychometric validation of an EORTC Quality of Life Module Measuring Cancer Related Fatigue (EORTC QLQ-FA12). J Natl Cancer Inst. 2017;109(5):273. Available at https://doi.org/10.1093/jnci/djw273. Accessed 13 Feb 2020.
Weis J, Wirtz MA, Tomaszewski KA, et al. EORTC Quality of Life Group. Sensitivity to change of the EORTC quality of life module measuring cancer-related fatigue (EORTC QlQ-Fa12): results from the international psychometric validation. Psychooncology. 2019;28(8):1753–61.
Mock V, Frangakis C, Davidson NE, et al. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psychooncology. 2005;14:464–77.
Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2008;(2):CD006145.
Schmidt ME, Wiskemann J, Armbrust P, Schneeweiss A, Ulrich CM, Steindorf K. Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: a randomized controlled trial. Int J Cancer. 2015;137(2):471–80. https://doi.org/10.1002/ijc.29383.
Puetz TW, Herring MP. Differential effects of exercise on cancer-related fatigue during and following treatment: a meta-analysis. Am J Prev Med. 2012;43:1–24.
Brown JC, Huedo-Medina TB, et al. Efficacy of exercise intervention in modulating cancer-related fatigue among adult cancer survivors: a meta analysis. Cancer Epidemiol Biomark Prev. 2011;20:123–33.
Mishra SI, Scherer RW, Geigle PM, et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012;15(8):CD007566.
Mustian K, Morrow G, Carroll J, et al. Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist. 2007;12:52–67.
Barsevick AM, Dudley W, Beck S, et al. A randomized clinical trial of energy conservation for patients with cancer-related fatigue. Cancer. 2004;100:1302–10.
Williams SA, Schreier AM. The role of education in managing fatigue, anxiety, and sleep disorders in women undergoing chemotherapy for breast cancer. Appl Nurs Res. 2005;18:138–47.
Reif K, de Vries U, Petermann F, Görres S. A patient education program is effective in reducing cancer-related fatigue: a multi-centre randomised two-group waiting-list controlled intervention trial. Eur J Oncol Nurs. 2013;17(2):204–13. https://doi.org/10.1016/j.ejon.2012.07.002.
Yates P, Aranda S, Hargraves M, et al. Randomized controlled trial of an educational intervention for managing fatigue in women receiving adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 2005;23:6027–36.
Stanton AL, Ganz PA, Kwan L, et al. Outcomes from the Moving Beyond Cancer psychoeducational, randomized, controlled trial with breast cancer patients. J Clin Oncol. 2005;23:6009–18.
Goedendorp MM, Gielissen MF, Verhagen CA, Bleijenberg G. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev. 2009(1):CD006953.
Given C, Given B, Rahbar M, et al. Effect of a cognitive behavioral intervention on reducing symptom severity during chemotherapy. J Clin Oncol. 2004;22:507–16.
Corbett TK, Groarke A, Devane D, Carr E, Walsh JC, McGuire BE. The effectiveness of psychological interventions for fatigue in cancer survivors: systematic review of randomised controlled trials. BMJ. 2019;8:324. https://doi.org/10.1186/s13643-019-1230-2.
Poort H, Peters M, Bleijenberg G, Gielissen MFM, Goedendorp MM, Jacobsen P, Verhagen S, Knoop H. Psychosocial interventions for fatigue during cancer treatment with palliative intent. Cochrane Database Syst Rev. 2017;7(7):CD012030. https://doi.org/10.1002/14651858.CD012030.pub2.
Spahrkäs SS, Looijmans A, Sanderman R, et al. Beating cancer-related fatigue with the Untire mobile app: results from a waiting-list randomized controlled trial. Psychooncology. 2020;29(11):1823–34. https://doi.org/10.1002/pon.5492.
Carlson LE, Bultz BD. Mind-body interventions in oncology. Curr Treat Options in Oncol. 2008;9:127–34.
Ledesma D, Kumano H. Mindfulness-based stress reduction and cancer: a meta-analysis. Psychooncology. 2009;18:571–9.
Shennan C, Payne S, Fenlon D. What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psychooncology. 2011;20:681–97.
Greenlee H, Balneaves LG, Carlson LE, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2014;50:346–58.
Danhauer SC, Addington EL, Cohen L, et al. Yoga for symptom management in oncology: a review of the evidence base and future directions for research. Cancer. 2019;125(12):1979–89.
Cramer H, Lauche R, Klose P, et al. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev. 2017;3:1.
Bruera E, Yennurajalingam S, Palmer JL, et al. Methylphenidate and/or nursing telephone intervention for fatigue in patients with advanced cancer: a randomized, placebo-controlled, phase II trial. J Clin Oncol. 2013;31:2421–7.
Roth AJ, Nelson C, Rosenfeld B, et al. Methylphenidate for fatigue in ambulatory men with prostate cancer. Cancer. 2010;116:5102–10.
Lasheen W, Walsh D, Mahmoud F, et al. Methylphenidate side effects in advanced cancer: a retrospective analysis. Am J Hosp Palliat Care. 2010;27(1):16–23. Epub 2009 Sept 10.
Escalante CP, Meyers C, Reuben JM, et al. A randomized, double-blind, 2-period, placebo-controlled crossover trial of a sustained-release methylphenidate in the treatment of fatigue in cancer patients. Cancer J. 2014;20:8–14.
Spathis A, Fife K, Blackhall F, et al. Modafinil for the treatment of fatigue in lung cancer: results of a placebo-controlled, double-blind, randomized trial. J Clin Oncol. 2014;32:1882–8.
Hovey E, de Souza P, Marx G, et al. Phase III, randomized, double-blind, placebo-controlled study of modafinil for fatigue in patients treated with docetaxel-based chemotherapy. Support Care Cancer. 2014;22:1233–42.
Peuckmann-Post V, Elsner F, Krumm N, Trottenberg R, Radbruch L. Pharmacological treatments for fatigue associated with palliative care (Review). Cochrane Database Syst Rev. The Cochrane Library. 2010;(11):CD006788.
Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;1:961–8.
Weis J, Horneber M. Definition and prevalence of cancer-related fatigue. In: Cancer-related fatigue. London: Springer; 2015.
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Weis, J. (2022). Quality of Life and Cancer-Related Fatigue: Prevalence, Assessment and Interventions. In: Kassianos, A.P. (eds) Handbook of Quality of Life in Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-84702-9_16
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