Cancer-Related Fatigue

Cancer-related fatigue (CRF) is a distressing, persistent subjective sense of physical, emotional, and/or cognitive tiredness that affects up to 100% of cancer patients during and following treatment. CRF is strongly associated with degraded quality of life, physical functioning, and vocational potential. A CRF diagnosis is based on history and should be made after ruling out alternative causes of fatigue such as anemia and hypothyroidism. Validated patient-reported outcome tools can help to diagnose CRF and assess its intensity and response to treatment. Co-occurring symptoms and comorbidities are common. Patients with CRF should be assessed for depression, anxiety, and degraded sleep quality. Resistive and aerobic exercises are the most effective treatments for CRF. Psychoeducational interventions emphasizing activity and stress management, mindfulness training, coping skills and problem solving training, and cognitive-behavioral therapy have also been shown capable of significantly reducing CRF. Referral to occupational and physical therapy for training in energy conservation strategies, use of adaptive equipment, and progressive resistive exercise will benefit appropriate patients. Pharmacologic approaches for cancer fatigue center predominantly around the administration of psychostimulants. Overly aggressive aerobic conditioning or strengthening programs may worsen CRF, but treatments are generally safe and well tolerated.