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

Fatigue is the most common side effect of cancer treatment with chemotherapy, radiation therapy, or selected biologic response modifiers.[1] 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 survivorship.[2,3] 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 undergoing active cancer treatment. Cancer treatment-related fatigue is reported in 14% to 96% of patients undergoing cancer treatment [4,5,6,7,8,9,10] and in 19% to 82% of patients posttreatment.[1,2]

Several studies have documented significantly worse fatigue in cancer survivors compared with noncancer populations, as described in one review article.[1] For example, a Norwegian cross-sectional study [11] 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.[11]

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Fatigue, like pain, is viewed as a self-perceived state. Patients may describe fatigue as feeling:[12]

  • Tired.
  • Weak.
  • Exhausted.
  • Lazy.
  • Weary.
  • Worn-out.
  • Heavy.
  • Slow.
  • Like they do not have any energy or any get-up-and-go.

Health professionals have included fatigue within concepts such as:

  • Asthenia.
  • Lassitude.
  • Malaise.
  • Prostration.
  • Exercise intolerance.
  • Lack of energy.
  • Weakness.

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.[13] Also, the level of CRF is often disproportionate to the level of activity or energy exerted.[13] 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 cancer fatigue, cancer-related fatigue, and cancer treatment-related fatigue have all been used in the clinical literature, research literature, and educational materials for patients and the public.

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