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Cancer-related fatigue: Prevalence, screening and clinical assessment

Carmen P Escalante, MD
Section Editor
Paul J Hesketh, MD
Deputy Editor
Sadhna R Vora, MD


Fatigue is a common problem in cancer patients. A majority of patients will experience some level of fatigue during their course of treatment, and approximately one-third will have persistent fatigue for a number of years posttreatment [1,2]. Cancer-related fatigue profoundly affects quality of life (QOL) of both patients and their families, including physical, psychosocial, and economic/occupational aspects [3,4]. Furthermore, fatigue is routinely identified by patients as one of the most distressing symptoms associated with cancer and its treatment, yet fatigue has been consistently underreported and overlooked as a potentially remediable cause of treatment-related morbidity [5]. More recently, screening for and treatment of cancer-related fatigue during therapy and during the period of cancer survivorship has become a major focus of supportive care in oncology and is the subject of guidelines from several expert groups, including the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN) [6-8].

Here we will review the contributory factors and pathogenesis of cancer-related fatigue, and screening for as well as clinical assessment of patients with cancer-related fatigue. Treatment of cancer-related fatigue and issues surrounding fatigue that are specific to palliative care patients are discussed elsewhere. (See "Cancer-related fatigue: Treatment" and "Palliative care: Overview of fatigue, weakness, and asthenia".)


Cancer-related fatigue is defined as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and that significantly interferes with usual functioning [6]. Cancer-related fatigue differs from the fatigue that accompanies everyday life, which is usually temporary and relieved by rest.

The term asthenia has been proposed to describe the condition of chronic pathologic tiredness in patients with cancer [9]. However, the term fatigue has gained widespread acceptance in the medical literature and is preferentially used in the National Cancer Institute (NCI) toxicity grading scale that covers fatigue, asthenia, and malaise (table 1).

Specific diagnostic criteria have been proposed for defining cancer-related fatigue as an independent entity in the International Classification of Diseases, 10th revision (ICD-10) [10,11]. At least 6 of 11 criteria must be met to make the diagnosis of cancer-related fatigue (table 2). In studies of diverse patient populations, approximately 10 to 26 percent of subjects are diagnosed as having cancer-related fatigue using this definition [12-15].

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Literature review current through: Nov 2017. | This topic last updated: Feb 15, 2017.
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