Skip to main content

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
Cancel
×
×
Home
  • Home
Chapter
  • Print publication year: 2010
  • Online publication date: August 2011

10 - Cancer-related fatigue: clinical science

from Section 2 - Cancer Symptom Mechanisms and Models: Clinical and Basic Science
Export citation
Summary

Fatigue is one of the most common, yet complex, symptoms reported by cancer patients and survivors. When fatigue is severe, it can be disabling. Because of ongoing debate about the definition of fatigue, inconclusive evidence about underlying pathophysiological mechanisms, and lack of effective pharmacological therapies, fatigue is a controversial and challenging subject for both researchers and those who manage patient care.

In this chapter, we introduce current understanding of cancer-related fatigue (CRF) and research on the mechanisms underlying CRF, discuss methodological issues for measuring CRF and then interpreting fatigue assessment results, and review innovations in CRF intervention.

Why address cancer-related fatigue?

The high prevalence and significant burden of fatigue in patients with cancer indicate the importance of understanding and managing it. The various methods used to measure fatigue in population-based studies have shown it to be the most common symptom that patients with cancer experience. In one study, outpatients with a variety of cancers treated in a tertiary-care cancer center reported that “severe fatigue,” “feeling weak,” and “not getting things done” were the most severe of the 26 symptoms included in the study. The percentage of patients with severe fatigue (fatigue rated 7 or higher on a 0–10 scale) is significantly greater than the percentage of healthy individuals with fatigue (34% and 17%, respectively). In a study of outpatients with hematological malignancies, 50% of the respondents reported having severe fatigue. Persistent cancer-related fatigue may be present among a subset of cancer survivors who have no evidence of active disease.

Recommend this book

Email your librarian or administrator to recommend adding this book to your organisation's collection.

Cancer Symptom Science
  • Online ISBN: 9780511780868
  • Book DOI: https://doi.org/10.1017/CBO9780511780868
Please enter your name
Please enter a valid email address
Who would you like to send this to *

CAPTCHA *

Skip to the audio challenge
×
References
Prue, G, Rankin, J, Allen, J, Gracey, J, Cramp, F. Cancer-related fatigue: a critical appraisal. Eur J Cancer 42(7):846–863, 2006.
Cleeland, CS, Mendoza, TR, Wang, XS, et al. Assessing symptom distress in cancer patients: the M. D. Anderson Symptom Inventory. Cancer 89(7):1634–1646, 2000.
Mendoza, TR, Wang, XS, Cleeland, CS, et al. The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85(5):1186–1196, 1999.
Wang, XS, Giralt, SA, Mendoza, TR, et al. Clinical factors associated with cancer-related fatigue in patients being treated for leukemia and non-Hodgkin's lymphoma. J Clin Oncol 20:1319–1328, 2002.
Bower, JE, Ganz, PA, Desmond, KA, Rowland, JH, Meyerowitz, BE, Belin, TR. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 18(4):743–753, 2000.
Servaes, P, Gielissen, MF, Verhagen, S, Bleijenberg, G. The course of severe fatigue in disease-free breast cancer patients: a longitudinal study. Psychooncology 16(9):787–795, 2007.
Vogelzang, NJ, Breitbart, W, Cella, D, et al. Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol 34(3 Suppl 2):4–12, 1997.
Gibson, F, Garnett, M, Richardson, A, Edwards, J, Sepion, B. Heavy to carry: a survey of parents' and healthcare professionals' perceptions of cancer-related fatigue in children and young people. Cancer Nurs 28(1):27–35, 2005.
Meeske, KA, Siegel, SE, Globe, DR, Mack, WJ, Bernstein, L. Prevalence and correlates of fatigue in long-term survivors of childhood leukemia. J Clin Oncol 23(24):5501–5510, 2005.
Mock, V, Atkinson, A, Barsevick, AM, et al. Cancer-related fatigue. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 5(10):1054–1078, 2007.
Cleeland, CS, Wang, XS. Measuring and understanding fatigue. Oncology 13(11A):91–97, 1999.
Olson, K. A new way of thinking about fatigue: a reconceptualization. Oncol Nurs Forum 34(1):93–99, 2007.
Wang, XS. Pathophysiology of cancer-related fatigue. Clin J Oncol Nurs 12(5 Suppl):11–20, 2008.
Wang, XS, Fairclough, DL, Liao, Z, et al. Longitudinal study of the relationship between chemoradiation therapy for non-small-cell lung cancer and patient symptoms. J Clin Oncol 24(27):4485–4491, 2006.
Hickok, JT, Morrow, GR, Roscoe, JA, Mustian, K, Okunieff, P. Occurrence, severity, and longitudinal course of twelve common symptoms in 1129 consecutive patients during radiotherapy for cancer. J Pain Symptom Manage 30(5):433–442, 2005.
Knobel, H, Loge, JH, Nordøy, T, et al. High level of fatigue in lymphoma patients treated with high dose therapy. J Pain Symptom Manage 19(6):446–456, 2000.
Jacobsen, PB, Hann, DM, Azzarello, LM, Horton, J, Balducci, L, Lyman, GH. Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. J Pain Symptom Manage 18(4):233–242, 1999.
Wang, XS, Shi, Q, Williams, , et al. Serum interleukin-6 predicts the development of multiple symptoms at nadir of allogeneic hematopoietic stem cell transplantation. Cancer 113(8):2102–2109, 2008.
Anderson, KO, Giralt, SA, Mendoza, TR, et al. Symptom burden in patients undergoing autologous stem-cell transplantation. Bone Marrow Transplant 39(12):759–766, 2007.
Rubin, GJ, Hotopf, M. Systematic review and meta-analysis of interventions for postoperative fatigue. Br J Surg 89(8):971–984, 2002.
Jones, TH, Wadler, S, Hupart, KH. Endocrine-mediated mechanisms of fatigue during treatment with interferon-alpha. Semin Oncol 25(1 Suppl 1):54–63, 1998.
Stone, P, Hardy, J, Huddart, R, A'Hern, R, Richards, M. Fatigue in patients with prostate cancer receiving hormone therapy. Eur J Cancer 36(9):1134–1141, 2000.
Chaudhuri, A, Behan, PO. Fatigue and basal ganglia. J Neurol Sci 179(S 1–2):34–42, 2000.
Ryan, JL, Carroll, JK, Ryan, EP, Mustian, KM, Fiscella, K, Morrow, GR. Mechanisms of cancer-related fatigue. Oncologist 12(Suppl 1):22–34, 2007.
Dantzer, R, Kelley, KW. Twenty years of research on cytokine-induced sickness behavior. Brain Behav Immun 21(2):153–160, 2007.
Cleeland, CS, Bennett, GJ, Dantzer, R, et al. Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism?Cancer 97(11):2919–2925, 2003.
Kurzrock, R. The role of cytokines in cancer-related fatigue. Cancer 92(6 Suppl):1684–1688, 2001.
Lee, BN, Dantzer, R, Langley, KE, et al. A cytokine-based neuroimmunologic mechanism of cancer-related symptoms. Neuroimmunomodulation 11(5):279–292, 2004.
Collado-Hidalgo, A, Bower, JE, Ganz, PA, Cole, SW, Irwin, MR. Inflammatory biomarkers for persistent fatigue in breast cancer survivors. Clin Cancer Res 12(9):2759–2766, 2006.
Bower, JE, Ganz, PA, Aziz, N, Fahey, JL. Fatigue and proinflammatory cytokine activity in breast cancer survivors. Psychosom Med 64(4):604–611, 2002.
Schubert, C, Hong, S, Natarajan, L, Mills, PJ, Dimsdale, JE. The association between fatigue and inflammatory marker levels in cancer patients: a quantitative review. Brain Behav Immun 21(4):413–427, 2007.
Monk, JP, Phillips, G, Waite, R, et al. Assessment of tumor necrosis factor alpha blockade as an intervention to improve tolerability of dose-intensive chemotherapy in cancer patients. J Clin Oncol 24(12):1852–1859, 2006.
Wang, XS, Shi, Q, Mao, L, Cleeland, CS, Liao, Z. Association between inflammatory cytokines and the development of multiple symptoms in patients with non-small cell lung cancer undergoing chemoradiation therapy [abstract]. American Society of Clinical Oncology 44th Annual Meeting, Chicago IL, May 30–June 3, 2008. J Clin Oncol 26(15 Suppl), 2008. Abstract 9638.
Payne, JK, Piper, B, Rabinowitz, I, Zimmerman, B. Biomarkers, fatigue, sleep, and depressive symptoms in women with breast cancer: a pilot study. Oncol Nurs Forum 33(4):775–783, 2006.
Raison, CL, Capuron, L, Miller, AH. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol 27(1):24–31, 2006.
Dantzer, R, Capuron, L, Irwin, MR, et al. Identification and treatment of symptoms associated with inflammation in medically ill patients. Psychoneuroendocrinology 33(1):18–29, 2008.
Miller, AH, Ancoli-Israel, S, Bower, JE, Capuron, L, Irwin, MR. Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 26(6):971–982, 2008.
Davis, JM, Bailey, SP. Possible mechanisms of central nervous system fatigue during exercise. Med Sci Sports Exerc 29(1):45–57, 1997.
Mills, PJ, Parker, BA, Dimsdale, JE, Sadler, GR, Ancoli-Israel, S. The relationship between fatigue, quality of life and inflammation during anthracycline-based chemotherapy in breast cancer. Biol Psychol 69(1):85–96, 2005.
Rich, T, Innominato, PF, Boerner, J, et al. Elevated serum cytokines correlated with altered behavior, serum cortisol rhythm, and dampened 24-hour rest-activity patterns in patients with metastatic colorectal cancer. Clin Cancer Res 11(5):1757–1764, 2005.
Hurter, B, Bush, NJ. Cancer-related anemia: clinical review and management update. Clin J Oncol Nurs 11(3):349–359, 2007.
,US Food and Drug Administration, Center for Drug Evaluation and Research, Center for Biologics Evaluation and Research, Center for Devices and Radiological Health. Guidance for industry. Patient-reported outcome measures: use in medical product development to support labeling claims. Available from: URL: http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM071975.pdf. Accessed Dec 18, 2009.
Lawrence, DP, Kupelnick, B, Miller, K, Devine, D, Lau, J. Evidence report on the occurrence, assessment, and treatment of fatigue in cancer patients. J Natl Cancer Inst Monogr 32:40–50, 2004.
Belle, S, Paridaens, R, Evers, G, et al. Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: proposal for use as a screening tool. Support Care Cancer 13(4):246–254, 2005.
Cella, D, Lai, JS, Chang, CH, Peterman, A, Slavin, M. Fatigue in cancer patients compared with fatigue in the general United States population. Cancer 94(2):528–538, 2002.
Hjermstad, MJ, Fayers, PM, Bjordal, K, Kaasa, S. Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: the QLQ=C30 (+3). J Clin Oncol 16(3):1188–1196, 1998.
Portenoy, RK, Itri, LM. Cancer-related fatigue: guidelines for evaluation and management. Oncologist 4(1):1–10, 1999.
Hjollund, NH, Andersen, JH, Bech, P. Assessment of fatigue in chronic disease: a bibliographic study of fatigue measurement scales. Health Qual Life Outcomes 5:12–16, 2007.
Dittner, AJ, Wessely, SC, Brown, RG. The assessment of fatigue: a practical guide for clinicians and researchers. J Psychosom Res 56(2):157–170, 2004.
Jacobsen, PB. Assessment of fatigue in cancer patients. J Natl Cancer Inst Monogr 32:93–97, 2004.
Kirsh, KL, Passik, S, Holtsclaw, E, Donaghy, K, Theobald, D. I get tired for no reason: a single item screening for cancer-related fatigue. J Pain Symptom Manage 22(5):931–937, 2001.
Portenoy, RK, Thaler, HT, Kornblith, AB, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 30A(9):1326–1336, 1994.
Yellen, SB, Cella, DF, Webster, K, Blendowski, C, Kaplan, E. Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage 13(2):63–74, 1997.
Aaronson, NK, Ahmedzai, S, Bergman, B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85(5):365–376, 1993.
Lai, JS, Crane, PK, Cella, D. Factor analysis techniques for assessing sufficient unidimensionality of cancer related fatigue. Qual Life Res 15(7):1179–1190, 2006.
Basch, E, Iasonos, A, McDonough, T, et al. Patient versus clinician symptom reporting using the National Cancer Institute Common Terminology Criteria for Adverse Events: results of a questionnaire-based study. Lancet Oncol 7(11):903–909, 2006.
Krupp, LB, LaRocca, NG, Muir-Nash, J, Steinberg, AD. The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46(10):1121–1123, 1989.
Smets, EMA, Garssen, B, Bonke, B, Haes, JCJM. The Multidimensional Fatigue Inventory (MFI): psychometric qualities of an instrument to assess fatigue. J Psychosom Res 39(3):315–325, 1995.
Serlin, RC, Mendoza, TR, Nakamura, Y, Edwards, KR, Cleeland, CS. When is cancer pain mild, moderate or severe? Grading pain severity by its interference with function. Pain 61(2):277–284, 1995.
Cleeland, CS, Ryan, KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 23(2):129–138, 1994.
Cleeland, CS, Gonin, R, Hatfield, AK, et al. Pain and its treatment in outpatients with metastatic cancer. N Engl J Med 330(9):592–596, 1994.
Visser, MR, Smets, EM, Sprangers, MA, Haes, HJ. How response shift may affect the measurement of change in fatigue. J Pain Symptom Manage 20(1):12–18, 2000.
Schwartz, CE, Bode, R, Repucci, N, Becker, J, Sprangers, MA, Fayers, PM. The clinical significance of adaptation to changing health: a meta-analysis of response shift. Qual Life Res 15(9):1533–1550, 2006.
Cleeland, CS. Symptom burden: multiple symptoms and their impact as patient-reported outcomes. J Natl Cancer Inst Monogr 37:16–21, 2007.
Morrow, GR, Hickok, JT, Roscoe, JA, et al. Differential effects of paroxetine on fatigue and depression: a randomized, double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program. J Clin Oncol 21(24):4635–4641, 2003.
Minton, O, Richardson, A, Sharpe, M, Hotopf, M, Stone, P. A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. J Natl Cancer Inst 100(16):1155–1166, 2008.
Fava, M, Thase, ME, DeBattista, C. A multicenter, placebo-controlled study of modafinil augmentation in partial responders to selective serotonin reuptake inhibitors with persistent fatigue and sleepiness. J Clin Psychiatry 66(1):85–93, 2005.
Morrow, GR, Jean-Peirre, P, Roscoe, JA, et al. A phase III randomized, placebo-controlled, double-blind trial of a eugeroic agent in 642 cancer patients reporting fatigue during chemotherapy: A URCC CCOP Study [abstract]. American Society of Clinical Oncology 44th Annual Meeting, Chicago IL, May 30–June 3, 2008. J Clin Oncol 26(15 Suppl), 2008. Abstract 9512.
Moss, EL, Simpson, JS, Pelletier, G, Forsyth, P. An open-label study of the effects of bupropion SR on fatigue, depression and quality of life of mixed-site cancer patients and their partners. Psychooncology 15(3):259–267, 2006.
Schmitz, KH, Holtzman, J, Courneya, KS, Mâsse, LC, Duval, S, Kane, R. Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev 14(7):1588–1595, 2005.
Mustian, KM, Morrow, GR, Carroll, JK, Figueroa-Moseley, CD, Jean-Pierre, P, Williams, GC. Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. Oncologist 12(Suppl 1):52–67, 2007.
Markes, M, Brockow, T, Resch, KL. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev 4:CD005001, 2006.
Jacobsen, PB, Donovan, KA, Vadaparampil, ST, Small, BJ. Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychol 26(6):660–667, 2007.
Luebbert, K, Dahme, B, Hasenbring, M. The effectiveness of relaxation training in reducing treatment-related symptoms and improving emotional adjustment in acute non-surgical cancer treatment: a meta-analytical review. Psychooncology 10(6):490–502, 2001.
Moher, D, Jones, A, Lepage, L. Use of the CONSORT statement and quality of reports of randomized trials: a comparative before-and-after evaluation. JAMA 285(15):1992–1995, 2001.
Moher, D, Schulz, KF, Altman, D. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomized trials. JAMA 285(15):1987–1991, 2001.
Bentler, SE, Hartz, AJ, Kuhn, EM. Prospective observational study of treatments for unexplained chronic fatigue. J Clin Psychiatry 66(5):625–632, 2005.
Elam, JL, Carpenter, JS, Shu, XO, Boyapati, S, Friedmann-Gilchrist, J. Methodological issues in the investigation of ginseng as an intervention for fatigue. Clin Nurse Spec 20(4):183–189, 2006.
Ginseng may relieve cancer treatment fatigue. Mayo Clin Health Lett 25(12):4, 2007.
Barton, DL, Soori, GS, Bauer, B, et al. A pilot, multi-dose, placebo-controlled evaluation of American ginseng (Panax quinquefolius) to improve cancer-related fatigue: NCCTG trial N03CA. [abstract]. American Society of Clinical Oncology 43rd Annual Meeting, Chicago IL, June 1–5, 2007. J Clin Oncol 25(18 Suppl), 2007. Abstract 9001.
Patrick, DL, Ferketich, SL, Frame, PS, et al. National Institutes of Health State-of-the-Science Conference statement: symptom management in cancer: pain, depression, and fatigue, July 15–17, 2002. J Natl Cancer Inst 95(15):1110–1117, 2003.
Cancel
Confirm
×