Fatigue is the most common side effect of cancer
treatment with chemotherapy, radiation therapy, or selected biologic response modifiers.
Cancer treatment–related fatigue generally improves after therapy is
completed, but some level of fatigue may persist for months or years following treatment. Research
indicates that for at least a subset of patients, fatigue may be a significant issue long into
Fatigue is also seen as a presenting symptom in cancers that produce
problems such as anemia, endocrine changes, and respiratory obstruction and is common in people with
advanced cancer who are not receiving active cancer treatment. Cancer treatment–related fatigue is reported
in 14% to 96% of patients undergoing cancer treatment and in 19% to
82% of patients posttreatment.
Several studies have documented significantly
worse fatigue in cancer survivors compared with noncancer populations, as described in one review
article. For example, a Norwegian cross-sectional study
compared the prevalence of fatigue in long-term survivors of testicular
cancer (n = 1,431) at an average of 11 years posttreatment with the prevalence of fatigue in age-matched
men in the general Norwegian population (n = 1,080). The prevalence of chronic cancer-related fatigue (CRF)
was 17.1% (95% confidence interval [CI], 15.2–19.1%) among testicular cancer survivors, compared with 9.7%
(95% CI, 8.0–11.5%) in the general population. Chronic CRF was also associated with multiple psychosocial
problems, somatic complaints, and poor quality of life.
Fatigue, like pain, is viewed as a
self-perceived state. Patients may describe fatigue as feeling:
Health professionals have included fatigue
within concepts such as:
Lack of energy.
Research on fatigue in people with cancer has
included primarily self-reports of fatigue, with fewer but increasing data exploring biologic or
physiologic correlates. Such correlates have included measures of muscle weakness, maximal oxygen uptake,
cytokines, and cortisol.
Fatigue experienced as a side effect of cancer
treatment is differentiated from fatigue experienced by healthy people in their daily lives.
Healthy fatigue is
frequently described as acute fatigue that is eventually relieved by sleep and rest; cancer
treatment–related fatigue is categorized as chronic fatigue because it is present over a long period of
time, interferes with functioning, and is not completely relieved by sleep and rest.
Also, the level of CRF is often disproportionate to the level of activity
or energy exerted. Although the label chronic fatigue is accurate, using this
label does not mean that people with cancer who experience fatigue have chronic fatigue syndrome. Using the
phrase chronic fatigue can be confusing to both patients and health professionals. Terms such as
and cancer treatment–related fatigue have all been used in the clinical literature, research literature, and educational
materials for patients and the public.
Fatigue has a negative impact on all areas
of function, including the following:
Sense of self.
The pattern of fatigue associated with cancer
treatment varies according to type and schedule of treatment. For example, people treated with cyclic
chemotherapy regimens generally exhibit peak fatigue in the days following treatment, then report lower
levels of fatigue until the next treatment; however, those receiving external-beam radiation therapy report
gradually increasing fatigue over the course of therapy of the largest treatment field.
Few studies of people receiving cancer treatment have addressed the issue
of fatigue as a result of the emotional distress associated with undergoing a diagnostic evaluation for
cancer and the effects of medical and surgical procedures used for that evaluation and for initial
treatment. Because most adults enter the cancer care system following at least one surgical procedure and
because surgery and emotional distress are both associated with fatigue, it is likely that most people
beginning nonsurgical treatment are experiencing fatigue at the beginning of treatment.
Recommendations for fatigue management focus on
identifying factors that may be contributing to fatigue. Because the only definitive causal mechanism
demonstrated through research to date is chemotherapy-induced anemia, most clinical recommendations for
managing fatigue caused by something other than chemotherapy-induced anemia rely on careful development of
clinical hypotheses, as outlined in the National Comprehensive Cancer Network guidelines on
The only level 1 intervention for CRF at this time is
exercise. Much more research is needed to better define fatigue
and its trajectory, understand its physiology, and determine the best ways to prevent and treat
In this summary, unless otherwise stated, evidence
and practice issues as they relate to adults are discussed. The evidence and application to practice
related to children may differ significantly from information related to adults. When specific information
about the care of children is available, it is summarized under its own heading. Tiredness Home Remedy