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Cancer-related fatigue: Treatment

Carmen P Escalante, MD
Section Editors
Paul J Hesketh, MD
Patricia A Ganz, MD
Deputy Editor
Sadhna R Vora, MD


Fatigue is a common problem in cancer patients, both among those undergoing active cancer treatment and in cancer survivors who have completed treatment. The most important factors contributing to cancer-related fatigue (CRF) are progressive tumor growth, treatment with cytotoxic chemotherapy, biologic response modifiers, molecularly targeted therapy (particularly the small molecular tyrosine kinase inhibitors and therapeutic monoclonal antibodies targeting the vascular endothelial growth factor [VEGF] and epidermal growth factor receptor [EGFR]) or radiation therapy (RT), anemia, pain, emotional distress, sleep disturbance, and poor nutrition. CRF is particularly prevalent with multimodality or dose-intense treatment protocols, and in patients with metastatic disease. (See "Cancer-related fatigue: Prevalence, screening and clinical assessment".)

CRF profoundly affects quality of life (QOL) of both patients and their families, including physical, psychosocial, and economic/occupational aspects [1-7]. Fatigue is routinely identified by patients as one of the most distressing symptoms associated with cancer and its treatment, yet historically it has been consistently underreported and overlooked as a potentially remediable cause of treatment-related morbidity [8]. In contemporary oncologic treatment, however, screening for and treatment of CRF has become a major focus of supportive care. Guidelines from expert groups, including the American Society of Clinical Oncology (ASCO) and National Comprehensive Cancer Network (NCCN), recommend screening for CRF at the initial visit, after completion of primary therapy, as clinically indicated (and at least annually) during the period of cancer survivorship, at the time that advanced disease is diagnosed, and at all chemotherapy visits [9,10]. Patients who have completed primary treatment and are undergoing posttreatment surveillance should continue to be monitored because fatigue may persist beyond the time of active treatment. (See "Cancer-related fatigue: Prevalence, screening and clinical assessment", section on 'Screening' and "Overview of cancer survivorship care for primary care and oncology providers", section on 'Monitoring for late or long-term effects of cancer and its treatment'.)

Here we will review the management of CRF in patients receiving active cancer treatment and in cancer survivors who have completed treatment. The prevalence of fatigue in patients with cancer, screening and assessment for fatigue in this population, and an overview of fatigue in palliative care patients are discussed elsewhere. (See "Cancer-related fatigue: Prevalence, screening and clinical assessment" and "Palliative care: Overview of fatigue, weakness, and asthenia".)


Some basic principles apply to patients with fatigue during active cancer therapy and cancer survivors who have persistent fatigue after the completion of therapy:

All patients undergoing active cancer treatment, as well as cancer survivors and their families, should be offered specific information about fatigue during and following treatment (eg, information about the difference between normal and cancer-related fatigue [CRF], persistence of fatigue beyond treatment, and causes and contributory factors).

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Literature review current through: Nov 2017. | This topic last updated: Aug 23, 2017.
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