Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2013;18(10):1135-43.
doi: 10.1634/theoncologist.2013-0076. Epub 2013 Sep 13.

Aiming for a better understanding and management of cancer-related fatigue

Elisabeth C W Neefjes  1 , Maurice J D L van der Vorst, Susanne Blauwhoff-Buskermolen, Henk M W Verheul
Affiliations
Review

Aiming for a better understanding and management of cancer-related fatigue

Elisabeth C W Neefjes et al. Oncologist. 2013.

Abstract

Cancer-related fatigue (CRF) is a serious symptom of patients with cancer and deteriorates their daily quality of life. Whereas fatigue is a common problem in the general population, with a prevalence of about 30%, up to 99% of patients with cancer have fatigue of more intense severity. CRF is directly related to the biology of cancer, but it can also be caused by anticancer treatment. We reviewed current evidence about the potential pathophysiological mechanisms causing CRF. Clinical methods to determine the presence and severity of CRF and potential treatment options to reduce CRF will be discussed. After reading this review, the reader will have knowledge of the current understanding of CRF and will be able to give evidence-based advice to patients with CRF.

Keywords: Drug therapy; Fatigue; Methylphenidate; Modafinil; Neoplasms; Questionnaires.

PubMed Disclaimer

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1.
Figure 1.
Pathophysiology of cancer-related fatigue. Cancer-related fatigue can be divided into mental and physical fatigue. Mental fatigue is mediated by the suprachiasmatic nucleus that controls the 24-hour circadian rhythm under the influence of the hypothalamic pituitary adrenal axis and by decreased perfusion of basal and frontal ganglia. Physical fatigue might be the result of impaired skeletal muscle activity resulting from central activation failure and changes in mitochondrial and sarcoplasmic reticulum functioning. Abbreviations: HPA, hypothalamic pituitary adrenal; SR, sarcoplasmic reticulum.
Figure 2.
Figure 2.
Summary of National Comprehensive Cancer Network guidelines. The National Comprehensive Cancer Network guidelines on cancer-related fatigue advises asking patients to rate their fatigue on a scale from 0 to 10 [3]. Suggested next steps are provided based on fatigue score and disease stage.
Figure 3.
Figure 3.
Drugs tested for cancer-related fatigue. This figure summarizes the results of the studies listed in supplemental appendix 2 into three categories: drugs showing no benefit over placebo; drugs showing a positive effect in small studies that need to be confirmed in larger, placebo-controlled trials; and one drug that showed some benefit over placebo in such a trial. Abbreviations: CRF, cancer-related fatigue; RCT, randomized clinical trial.
See this image and copyright information in PMC

References

    1. Peuckmann-Post V, Elsner F, Krumm N, et al. Pharmacological treatments for fatigue associated with palliative care. Cochrane Database Syst Rev. 2010;11:CD006788. - PubMed
    1. Jean-Pierre P, Morrow GR, Roscoe JA, et al. A phase 3 randomized, placebo-controlled, double-blind, clinical trial of the effect of modafinil on cancer-related fatigue among 631 patients receiving chemotherapy. Cancer. 2010;116:3513–3520. - PMC - PubMed
    1. National Comprehensive Cancer Network. Clinical Practice Guidelines in Oncology. Cancer Related Fatigue version 1.2013. [Accessed February 21, 2013]. Available at: http://www.nccn.org.
    1. Cella D, Davis K, Breitbart W, et al. Cancer-related fatigue: Prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol. 2001;19:3385–3391. - PubMed
    1. Cella DF, Peterman A, Passik S, et al. Progress toward guidelines for the management of fatigue. Oncology. 1998;62:369–377. - PubMed