Fatigue is the most common side effect of cancer treatment with chemotherapy, radiation therapy, or selected biologic response modifiers. Cancer treatment–related fatigue generally improves after treatment is completed, but some level of fatigue may persist for months or years following treatment. Fatigue is also seen as a presenting symptom in cancers that produce problems such as anemia, endocrine changes, and respiratory obstruction and is common in people with advanced cancer who are not receiving active cancer treatment. Most of the research on fatigue in people with cancer has been conducted on samples of people undergoing cancer treatment, with a few studies focused on people receiving palliative care for terminal cancer and some research on samples of people after treatment is completed. Cancer treatment–related fatigue is reported in 14% to 96% of people undergoing cancer treatment.[1-7]

Fatigue, like pain, is viewed as a self-perceived state. Patients may describe fatigue as feeling tired, weak, exhausted, lazy, weary, worn-out, heavy, slow, or like they do not have any energy or any get-up-and-go. Health professionals have included fatigue within concepts such as asthenia, lassitude, malaise, prostration, exercise intolerance, lack of energy, and weakness. The research on fatigue in people with cancer focuses on fatigue as a self-preceived state; objective tests of variables such as muscle weakness, exercise performance, speed of task performance, and total daily movement have not been examined in relation to the sensation of fatigue.

The fatigue experienced as a side effect of cancer treatment is differentiated from the fatigue experienced by healthy people in their daily lives. Healthy fatigue is frequently described as acute fatigue that is eventually relieved by sleep and rest; cancer treatment–related fatigue is categorized as chronic fatigue because it is present over a long period of time and is not completely relieved by sleep and rest. Although the label chronic fatigue is accurate, using this label does not mean that people with cancer who experience fatigue have chronic fatigue syndrome. Using the phrase chronic fatigue can be confusing to both patients and health professionals. Terms such as cancer fatigue, cancer-related fatigue, and cancer treatment–related fatigue have all been used in the clinical literature, research literature, and educational materials for patients and the public.

Fatigue has a negative impact on all areas of function, including mood, physical function, work performance, social interaction, family care,[8] cognitive performance, school work, community activities, and sense of self.[9-12] The pattern of fatigue associated with cancer treatment varies according to type and schedule of treatment. For example, people treated with cyclic chemotherapy regimens generally exhibit peak fatigue in the days following treatment, then report lower levels of fatigue until the next treatment; however, those receiving external beam radiation therapy report gradually increasing fatigue over the course of treatment of the largest treatment field. Few studies of people receiving cancer treatment have addressed the issue of fatigue as a result of the emotional distress associated with undergoing a diagnostic evaluation for cancer and the effects of medical and surgical procedures used for that evaluation and for initial treatment. Because most adults enter the cancer care system following at least one surgical procedure and because surgery and emotional distress are both associated with fatigue, it is likely that most people beginning nonsurgical treatment are experiencing fatigue at the beginning of treatment.[13,14]

Fatigue assessment in clinical practice takes many forms, most relying on a single-item fatigue intensity rating similar to that used for initial pain assessment. A number of multiple-item tools originally developed for fatigue research have also been used in clinical practice. Most of these tools include symptom dimensions other than fatigue intensity, such as the impact or consequences of fatigue, timing of fatigue, related symptoms, and self-care actions.[15-21] Basic recommendations for fatigue assessment in clinical practice include the following:

• Assessment should include self-report of fatigue intensity.



• The timeframe for the rating should have relevance to a patient’s current treatment status and the likely timing of fatigue if that patient is receiving treatment.



• The same approach to assessment should be used at each assessment point to detect changes in fatigue over time.

Recommendations for fatigue management focus on identifying factors that may be contributing to fatigue. Because the only causal mechanism demonstrated through research is chemotherapy-induced anemia, most clinical recommendations for managing fatigue caused by something other than chemotherapy-induced anemia rely on careful development of clinical hypotheses, as outlined in the National Comprehensive Cancer Network guidelines on fatigue.[22]

References

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22. National Comprehensive Cancer Network.: NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. Version 1.2008. Rockledge, Pa: National Comprehensive Cancer Network, 2008. Available online. Last accessed May 7, 2009. 
    
    

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