Cancer-related fatigue: epidemiology, pathogenesis, diagnosis, and treatment

Abstract

Background: Many cancer patients suffer from cancer-related fatigue (CRF) both during and after their treatment. CRF can arise at any point in the course of the disease and can be either self-limited or persistent, sometimes for years. It gives rise to a vicious circle of impaired physical performance, avoidance of exertion, inactivity, inadequate physical recovery, helplessness, and depressed mood. Its hallmarks are tiredness, exhaustion, and lack of energy; it can impair performance so severely that the patient is unable to work. It is associated with increased mortality. Cancer patients are hardly ever systematically asked about the symptoms and signs of CRF. The stress and impairments that it produces are often inadequately appreciated, and the opportunities for treatment often neglected.

Method: Selective review of the pertinent literature, including published guidelines from Germany and abroad.

Results: The pathogenesis of CRF is complex, involving an interaction of somatic, emotional, cognitive, and psychosocial factors, with a highly variable pattern of clinical expression. Clinical history-taking plays a key role in diagnostic assessment. Depressive disorders must be considered in the differential diagnosis. Many randomized trials and meta-analyses have documented the efficacy of pharmacological and non-pharmacological treatments for CRF.

Conclusion: Cancer-related fatigue is a serious problem that impairs patients physically, mentally, and socially. Physicians need to know how to recognize and treat it.

Figure 1

Cancer-related fatigue: treatable causes and contributing factors (after Ref. [e81]). (From: Mortimer JE, et al.: Studying cancer-related fatigue: Report of the NCCN Scientific Research Committee. J Natl Compr Canc Netw 2010; 8: 1331–9; Reprinted with permission from JNCCN—Journal of the National Comprehensive Cancer Network)

Figure 2

Basic and detailed diagnostic assessment

Figure 3

Treatment algorithm (modified from Radbruch et al [4]); TRH, thyrotropin-releasing hormone; ESA, erythropoiesis-stimulating agent. (From: Radbruch L, et al.: Fatigue in palliative care patients—an EAPC approach. Palliat Med 2008; 22: 13–32; with the kind permission of SAGE Publications)