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Cancer Health Center

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Fatigue (PDQ®): Supportive care - Health Professional Information [NCI] - Contributing Factors


Treatment with chemotherapy is a predictor of fatigue and can be exacerbated by the coexistence of pain, depression, and/or anxiety.[25][Level of evidence: II][26] A longitudinal, descriptive study reported highest levels of fatigue at the midpoint of a patient's chemotherapy cycles, with fatigue improving after treatment but not quite returning to baseline levels 30 days after the last treatment.[25] In another longitudinal study of women with stage 0 to stage II breast cancer who received chemotherapy with or without radiation therapy (N = 103) versus radiation therapy alone (N = 102) versus a control group (N = 193),[27] increases in fatigue were demonstrated 3 years posttreatment for the group that received chemotherapy with or without radiation therapy, compared with the two other groups. Mean scores for fatigue severity as measured by the Fatigue Symptom Inventory (range, 0-10) increased over the 3 years as follows:

  • From 2.31 to 2.86 in the group that received chemotherapy with or without radiation.
  • Only from 1.96 to 2.06 in the radiation therapy-alone group.
  • Only from 2.20 to 2.22 in the noncancer control group.

There were statistically significant group-by-time effects for the group that received chemotherapy with or without radiation therapy. This increase in fatigue was not explained by hormone therapy and approached clinically meaningful values.[27] It is not currently known what specific patient characteristics are associated with risk for long-term increased fatigue or more severe fatigue and who will experience fatigue resolution.


Evidence suggests that anemia may be a major factor in cancer-related fatigue (CRF) and quality of life in cancer patients.[28,29,30] Anemia can be related to the disease itself or caused by the therapy. Occasionally, anemia is simply a co-occurring medical finding that is related to neither the disease nor the therapy. Anemia is often a significant contributor to symptoms in persons with cancer. For individual patients, it can be difficult to discern the actual impact of anemia because there are often other problems that confound the ability to weigh the specific impact of anemia. The impact of anemia varies depending on factors such as:[31]

  • The rapidity of onset.
  • Patient age.
  • Plasma-volume status.
  • The number and severity of comorbidities.
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