ReviewCancer-related fatigue: A critical appraisal
Introduction
Excessive tiredness is a common complaint of today’s society with some level of fatigue found in nearly all of the population.1 For most individuals fatigue is a protective response to physical and psychological stress2 and is easily remedied by rest. The majority of patients receiving anti-cancer therapy experience fatigue that is dissimilar from that experienced by the general population.3 Cancer-related fatigue (CRF) has a phenomenal impact on a sufferer’s life with devastating social and economical consequences, and can persist for months or even years following completion of treatment.
A lack of consensus surrounds the optimal means of assessing CRF.4 A number of CRF instruments exist that assess fatigue as a uni-dimensional construct, however, CRF can manifest itself in many domains, consequently although these instruments may appear to demonstrate satisfactory psychometric properties, they fall short in assessing the full spectrum of CRF.5 As a multidimensional experience, the most comprehensive approach would be to assess CRF using a multidimensional measure.6
A previous review conducted by Servaes and colleagues,7 concluded that fatigue was a problem for cancer patients, but the association between CRF and tumour and treatment-related variables was difficult to establish.7 It was proposed that this could be attributed to the myriad of fatigue measures used in the reviewed studies as both uni- and multidimensional measurement tools were included. In an attempt to reduce the variability in the findings, this current review only included studies that measured CRF using a multidimensional instrument. Furthermore, the body of evidence has grown substantially in recent years and an update is warranted.
In an attempt to aid clinicians in their understanding of the phenomenon as well as identifying those at most risk of developing CRF, the aims of this review were to provide clarification of the prevalence and pattern of CRF, identify factors associated with its development, and make recommendations for future research.
Section snippets
Patients and methods
Relevant literature was identified through an electronic search of Medline (1966 – September 2005), CINAHL (1982 – September 2005), AMED (1985 – September 2005), PsychINFO (1872 – September 2005), BNI (1985 – September 2005), Cochrane Library and ProQuest, using the keywords “Fatigue”[MeSH] OR “Muscle Fatigue”[MeSH] OR “Mental Fatigue”[MeSH] AND (neoplasm* OR tumor* OR tumour* OR cancer* OR Hodgkin’s OR haematolog* OR radiat* OR radioth* OR chemo* OR hormone therapy OR bone marrow transplant*).
CRF during anti-cancer therapy
Forty-four relevant publications were identified through the search strategy and are summarised in Table 1.10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53 As can be seen from Table 1, some consist of the same study sample and methodology but report on a different analysis.13, 14, 15, 24, 26, 30, 35 Consequently, 40 studies have resulted in 44 separate publications.
From
Discussion
The purpose of this review was to clarify the prevalence of CRF as measured with a multidimensional fatigue self-report questionnaire, and determine the factors associated with its occurrence. It was also proposed that the findings of this review would improve the understanding of the symptom, and guide future research.
The methodological quality of the reviewed studies was generally acceptable; however, the recruitment of an inception cohort was not well executed. Endeavouring to determine the
Conflict of interest statement
None.
Acknowledgements
G. Prue is funded by the Department of Employment and Learning, Northern Ireland. Preliminary reports of this research have been presented to the National Cancer Research Institute at ICC, Birmingham, UK in October 2005.
References (84)
- et al.
Assessment and management of cancer-related fatigue in adults
Lancet
(2003) - et al.
Fatigue in the radiation therapy patient: current management and investigations
Semin Radiat Oncol
(2003) - et al.
Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions
Eur J Cancer
(2002) - et al.
Neuromuscular fatigue in prostate cancer patients undergoing radiation therapy
Arch Phys Med Rehabil
(1997) - et al.
Understanding the level of fatigue in cancer patients undergoing radiotherapy
J Psychosom Res
(1998) - et al.
Fatigue in patients with prostate cancer receiving hormone therapy
Eur J Cancer
(2000) - et al.
Fatigue, serum cytokine levels and blood cell counts during radiotherapy of patients with breast cancer
Int J Radiat Oncol Biol Phys
(2001) - et al.
Fatigue in patients with cancers of the breast or prostate undergoing radical radiotherapy
J Pain Symptom Manage
(2001) - et al.
The impact of haemoglobin levels on fatigue and quality of life in cancer patients
Ann Oncol
(2002) - et al.
Multidimensional independent predictors of cancer-related fatigue
J Pain Symptom Manage
(2003)
The prevalence and correlates of fatigue in older cancer patients
Crit Rev Oncol Hematol
Prevalence and course of fatigue in breast cancer patients receiving adjuvant chemotherapy
Ann Oncol
Course of fatigue in women receiving chemotherapy and/or radiotherapy for early stage breast cancer
J Pain Symptom Manage
Relationship of haemoglobin levels to fatigue and cognitive functioning among cancer patients receiving chemotherapy
J Pain Symptom Manage
Fatigue during breast radiotherapy and its relationship to biological factors
Int J Radiat Oncol Biol Phys
The experience of fatigue, other symptoms and global quality of life during radiotherapy for uterine cancer
Int J Nurs Stud
Course of mental fatigue and motivation in breast cancer patients receiving adjuvant chemotherapy
Ann Oncol
The relationship between fatigue and inflammation during anthracycline-based chemotherapy in breast cancer
Biol Psychol
Cancer-related fatigue: can exercise physiology assist oncologists?
Lancet Oncol
Fatigue in patients with cancer
Eur J Cancer
Fatigue and psychiatric morbidity among Hodgkin’s Disease Survivors
J Pain Symptom Manage
Fatigue in ambulatory patients with advanced lung cancer: prevalence, correlated factors, and screening
J Pain Symptom Manage
Fatigue after treatment for malignant and benign bone and soft tissue tumors
J Pain Symptom Manage
Physical performance, depression, immune status and fatigue in patients with haematological malignancies after treatment
Ann Oncol
Language bias in randomised controlled trials published in English and German
Lancet
The relationship between psychosocial work characteristics and fatigue and psychological distress
Int Arch Occup Environ Heath
Cancer-related fatigue: evaluation and treatment
Rays
Assessment of fatigue in cancer patients
J Natl Cancer Inst Monogr
A multidimensional measure of fatigue for use with cancer patients
Cancer Pract
How to read clinical journals? III. To learn the clinical course and prognosis of disease
Can Med Assoc J
A critical appraisal of the research literature investigating fatigue in the individual with cancer
Cancer Nurs
Fatigue in patients with cancer receiving interferon alpha
Cancer Pract
Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy
Oncol Nurs Forum
Fatigue and radiotherapy: (A) experience in patients undergoing treatment
Br J Cancer
Fatigue, depression and quality of life in cancer patients: how are they related?
Support Care Cancer
The influence of daytime inactivity and nighttime restlessness on cancer-related fatigue
Oncol Nurs Forum
Fatigue, pain and depression in pre-autologous breast cancer patients
Cancer Pract
Fatigue and quality of life in breast cancer patients undergoing autologous stem cell transplantation: a longitudinal comparative study
J Pain Symptom Manage
Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course and correlates
J Pain Symptom Manage
Prospective study of fatigue in localised prostate cancer patients undergoing radiotherapy
Radiat Oncol Investig
Correlates of fatigue during and following adjuvant breast cancer chemotherapy: a pilot study
Oncol Nurs Forum
Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey
Ann Oncol
Cited by (316)
“You feel different in your body”: Experiences of fatigue among children undergoing radiotherapy for cancer treatment
2022, Journal of Pediatric NursingA neuro-metabolic account of why daylong cognitive work alters the control of economic decisions
2022, Current BiologyCitation Excerpt :A choice bias for low-cost (LC) options would thus represent an objective marker of cognitive fatigue, even in the absence of a conscious fatigue sensation that could be reported on a psychometric scale. Indeed, subjective fatigue reports are notoriously unreliable, due to limitation of insight, social desirability bias, and variability in the mapping from sensations to rating scales.19–23 In a previous study,24 we developed a daylong protocol mixing cognitive control tasks meant to induce cognitive fatigue and intertemporal choices to reveal cognitive fatigue.
Exploring the educational needs for severe immune-related adverse events of PD-1/PD-L1 inhibitors in advanced lung cancer: A single-center observational study
2022, Asia-Pacific Journal of Oncology Nursing