Cancer-Related Fatigue: The Scale of the Problem

Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, James P Wilmot Cancer Center, Rochester, NY 14642, USA.
The Oncologist (Impact Factor: 4.87). 02/2007; 12 Suppl 1(1):4-10. DOI: 10.1634/theoncologist.12-S1-4
Source: PubMed


Fatigue is one of the most common and debilitating symptoms experienced by patients with cancer. Cancer-related fatigue (CRF) is characterized by feelings of tiredness, weakness, and lack of energy, and is distinct from the "normal" drowsiness experienced by healthy individuals in that it is not relieved by rest or sleep. It occurs both as a consequence of the cancer itself and as a side effect of cancer treatment, although the precise underlying pathophysiology is largely unknown. CRF may be an early symptom of malignant disease and is reported by as many as 40% of patients at diagnosis. Virtually all patients expect fatigue from cancer therapy. Up to 90% of patients treated with radiation and up to 80% of those treated with chemotherapy experience fatigue. CRF continues for months and even years ollowing completion of treatment in approximately one third of the patients with cancer. The impact of CRF on a patient's quality of life (QoL), particularly in relation to physical functioning and the ability to perform activities of daily living, is both profound and pervasive. In addition, CRF is associated with considerable psychological distress and can impose a significant financial burden by limiting a patient's ability to work. These effects can extend to caregivers and family members, who may also have to reduce their working capacity in order to provide additional care for a patient with CRF. This paper examines the prevalence of CRF and explores the impact of this distressing symptom on patients' functioning and QoL. Disclosure of potential conflicts of interest is found at the end of this article.

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Available from: Pascal Jean-Pierre, Oct 06, 2014
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    • "Higher levels of fatigue in patients with cancer compared to the general population are a common finding (Hofman et al., 2007). Proinflammatory cytokines have been associated with cancer-related fatigue (Bower et al., 2011). "
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    ABSTRACT: An increasing body of literature indicates that chemotherapy (ChT) for breast cancer (BC) is associated with adverse effects on the brain. Recent research suggests that cognitive and brain function in patients with BC may already be compromised before the start of chemotherapy. This is the first study combining neuropsychological testing, patient-reported outcomes, and multimodal magnetic resonance imaging (MRI) to examine pretreatment cognition and various aspects of brain function and structure in a large sample.
    Clinical neuroimaging 02/2015; 110. DOI:10.1016/j.nicl.2015.02.005 · 2.53 Impact Factor
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    • "Fatigue is a common and distressing symptom reported by cancer patients before, during, and after cancer treatments. Patients with CRF often describe muscle weakness and reduced effort tolerance which have a negative effect on quality of life and functional status (Hofman et al., 2007). Muscle wasting and depressive symptoms are prevalent in patients with CRF and are associated with higher mortality rates in cancer patients with persistent or incurable disease (Mols et al., 2013). "
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    ABSTRACT: Cancer patients frequently suffer from fatigue, a complex syndrome associated with tiredness and depressed mood. Cancer-related fatigue (CRF) can be present at the time of diagnosis, escalates during treatment, and can persist for years after treatment. CRF negatively influences quality of life, limits functional independence, and is associated with decreased survival in patients with incurable disease. We have previously shown that increased pro-inflammatory cytokine expression in the brain contributes to depressive- and fatigue- like behaviors in a mouse model of CRF. Inflammatory cytokines increase activity of indoleamine 2,3-dioxygenase (IDO) and kynurenine 3-monooxygenase (KMO), which competitively reduce serotonin synthesis. Reduced serotonin availability in the brain and increased production of alternative neuroactive metabolites of tryptophan are thought to contribute to the development of depression and fatigue. The purpose of this study was to determine the effects of fluoxetine, a selective serotonin reuptake inhibitor (SSRI), on brain cytokines and behavioral measures of fatigue and depression in tumor-bearing mice. Here we show that tumor growth increased brain expression of pro-inflammatory cytokines and KMO. Treatment with fluoxetine had no effect on tumor growth, muscle wasting, fatigue behavior, or cytokine expression in the brain. Fluoxetine, however, reduced depressive-like behaviors in tumor bearing mice. In conclusion, our data confirm that increased brain expression of pro-inflammatory cytokines is associated with tumor-induced fatigue and depressive-like behavior. However, it is possible to separate the effects of tumor growth on mood and fatigue-like behaviors using SSRI's such as fluoxetine. Copyright © 2014. Published by Elsevier Inc.
    Physiology & Behavior 12/2014; 140. DOI:10.1016/j.physbeh.2014.12.045 · 2.98 Impact Factor
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    • "One of the most frequently reported side effects across all types and stages of the disease is cancer-related fatigue (Ahlberg et al. 2003, Hofman et al. 2007, Stone & Minton 2008). Fatigue is often explained as an experience of tiredness or exhaustion, and approximately one-third of the patients continue to experience cancer-related fatigue months and years after the completion of treatment (Hofman et al. 2007). "
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    ABSTRACT: Aims and objectivesTo examine the prevalence of cancer-related fatigue in women treated for various types of gynaecological cancers and, for these cancers, to assess fatigue in relation to distress, health-related quality of life, demography and treatment characteristics.Background Advances in treatment of cancer have improved the likelihood of survival. Consequently, there are a growing number of patients who become survivors after cancer and who face side effects even years after treatment. One of the most frequently reported side effects across all types and stages of the disease is cancer-related fatigue.DesignA descriptive cross-sectional study.Methods One hundred and twenty women treated for gynaecological cancers who were participants in an intervention study were included. Fatigue, psychological distress, health-related QoL and demographics were assessed by questionnaires. Disease and treatment characteristics were extracted from medical records.ResultsCancer-related fatigue was reported in 53% of the women treated for gynaecological cancers, with a higher proportion in the group of cervical cancer, followed by ovarian cancer. Younger participants reported fatigue more frequently than older participants. When adjusting for age, the type of cancer a woman experiences was shown to have little impact on her risk of experiencing fatigue. The participants with fatigue reported higher levels of anxiety and depression than participants without fatigue. There was a relationship between fatigue and quality of life as measured by SF-36 domains.Conclusion The findings underscore the importance of screening for fatigue, patient education and symptom management. This should be included in a standard procedure during treatment and follow-up. Both somatic and psychological aspects of fatigue should be emphasised.Relevance to clinical practiceThe findings imply the need for health personnel to have focus on fatigue during the entire cancer trajectory of women after gynaecological cancers, as well as the need for screening, information, guidance and symptom management.
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