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Review
. 2025 Oct 9:15:1617600.
doi: 10.3389/fonc.2025.1617600. eCollection 2025.

Management of cancer treatment-related fatigue in advanced breast cancer patients: an expert committee's opinion

Stéphanie Bécourt  1 , Sophie Abadie-Lacourtoisie  2 , Thierry Calvat  3   4 , Isabelle Coudurier-Curveur  5 , Frédéric Fiteni  6 , Benoîte Mery  7 , Guillaume Meynard  8 , Florian Scotté  9 , Pauline Vaflard  10 , Laurent Zelek  11
Affiliations
Review

Management of cancer treatment-related fatigue in advanced breast cancer patients: an expert committee's opinion

Stéphanie Bécourt et al. Front Oncol. .

Abstract

Cancer-related fatigue (CRF) is a frequent and complex adverse event associated with advanced breast cancer (ABC). CRF intensity and impact on a patient's daily life are often exacerbated by cancer treatments. This specific manifestation, known as cancer treatment related fatigue (CTRF), begins with treatment onset and can persist beyond its course. CTRF is not unavoidable; its effect can be reduced through careful management and differential diagnosis from CRF. This article aims to review current recommendations for assessing and managing fatigue and present an expert opinion on priority actionable actions for evaluating and alleviating fatigue in ABC patients. In addition, to better understand the current standard of care and management options for ABC patients with fatigue, a quantitative survey was conducted from July to September 2023 through online standardized questionnaire containing identical questions between oncologists (N = 43) and ABC patients (N = 132) in France. Results confirm fatigue's complexity and multidimensional nature. Insufficient time and lack of communication during consultations contribute to ineffective diagnosis and management of fatigue, highlighting the need for improvement through better communication.

Keywords: adapted physical activity; advanced breast cancer; cancer treatment-related fatigue; cancer-related fatigue; metastatic breast cancer; patient education; physical activity.

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Conflict of interest statement

SB has received personal fees and non-financial support from Pfizer, Lilly, Novartis, Gilead, Astrazeneca, Daiichi Sankyo. LZ has received personal fees and non-financial support from Gilead, and personal fees from AstraZeneca, Daiichi-Sankyo, Novartis, Lilly and Pfizer. FF has received consulting fees from Astrazeneca, BMS, Clovis pharma, Daiishi-Serono, GSK, Jansen, Lilly, Novartis, Pfizer, Seagen, Gilead, Menarini-Steamline, MSD, Gilead, and support for attending meetings and/or travel from Pfizer, Lilly, Gilead, Astrazeneca. GM has received personal fees from Pfizer, Lilly, Daiichi, Novartis, Eisai, Astrazeneca, and non-financial support from Pfizer, GSK, Gilead. FS has received consulting fees and personal fees from Sanofi, Roche, MSD, Gilead, Norgine, Helsinn, Prostrakan, Leo Pharma, Janssen, Viatris, Pharmanovia, AMGEN, Pierre Fabre Oncologie, Vifor Pharma, Immedica, La Roche Posay, Pfizer, BMS, Daiichi Sankyo, Fresenius Kabi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Patients’ (A) and oncologists’ (B) views differ as to when fatigue becomes problematic, its intensity and type early in the treatment pathway. (A) Patients’ answers to single choice questions left panel: “What was your level of fatigue at each stage of the treatment process?” (132 replies) Right panel: “When is fatigue most difficult to deal with?” (105 replies). (B) Oncologists’ responses to single choice questions: right panel “When is physical and/or psychological fatigue most difficult for your patients with metastatic breast cancer?” (43 responses). Left panel “What is the level of fatigue in your patients with metastatic breast cancer at each stage of the care journey?” (34 responses) Physicians underestimate the intensity of fatigue patients suffer before treatment begins. This includes at the diagnosis of metastatic breast cancer. Oncologists consider psychological fatigue at diagnosis and when treatment starts to be predominant whereas, patients consider there to be a strong physical component. Once treatment is underway their answers converge for both questions.
Figure 2
Figure 2
Impact of fatigue on patients’ daily lives. Responses to, Patients’ question: “Here are several elements related to well-being that may have been impacted by fatigue related to your cancer. Can you rank the 5 items that impact you the most?” (132 responses), Doctors’ question: “Here are several elements related to well-being that can be impacted by cancer-related fatigue. Can you classify the 5 major items which, according to you, are impacted by fatigue in your patients?” (43 responses). The details of elements within each domain are given in Supplementary Table S1 .
Figure 3
Figure 3
Non-pharmacological solutions proposed to patients to ameliorate CRF. In the survey, 55% of patients agreed that they had received advice as to how to relieve their fatigue themselves. The responses to the question: “What does the oncologist recommend to help you relieve the fatigue linked to your metastatic breast cancer on your own?” are shown here (multiple choice question: 132 patients – 72 received at least 1 recommendation).
Figure 4
Figure 4
CRF management algorithm. Adapted from ESMO 2020, AFSOS 2021 and NCCN 2023 (4, 8, 11).
See this image and copyright information in PMC

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