Fatigue is one of the most common complaints of people with cancer and is also increased in some cancer survivors.[1,2] Fatigue exists in 14% to 96% of people with cancer, particularly in individuals actively undergoing treatment.[3-7] Fatigue is difficult to describe and patients express it in a variety of ways, using terms such as tired, weak, exhausted, weary, worn-out, heavy, or slow. Likewise, health professionals struggle to describe fatigue, using terms such as asthenia, lassitude, prostration, exercise intolerance, lack of energy, and weakness.

Defining fatigue has challenged clinicians and researchers for many years. Generally, fatigue may be defined as a condition characterized by distress and decreased functional status related to a decrease in energy.[8,9] The specific manifestations may be physical, mental, or emotional. For clinical and research purposes, it is useful to attempt to distinguish significant cancer-related fatigue from other kinds of fatigue to direct specific therapies toward the underlying etiology.

Acute fatigue is normal or expected tiredness characterized by localized intermittent symptoms, rapid onset, and short duration. Whereas rest will completely restore a healthy individual to a normal level of functioning, this restorative capacity is diminished in the presence of neoplastic disease. Chronic fatigue describes a prolonged, debilitating fatigue that is persistent or relapsing, lasting weeks, and is not anticipated to end soon.[2] This illness is sometimes diagnosed in the general medical population.[10] Although a variety of treatment- and disease-related factors may contribute to the development of fatigue, the biochemical, physiologic, psychologic, and behavioral mechanisms of this symptom complex are poorly understood. There is no standard of care for the assessment or treatment of fatigue in patients with cancer.

For many people diagnosed with cancer, fatigue may become a critical issue in their lives. Fatigue may influence one’s sense of well-being, daily performance, activities of daily living, relationships with family and friends, and compliance with treatment.[8,11,12] Financial resources may become limited as people suffering from fatigue are forced into disability programs or out of a job. Treatment outcomes may then become compromised due to difficulties in maintaining health insurance, problems in gaining access to care, or financial barriers to pursuing aggressive treatment.[13]

Consequently, a thorough understanding of fatigue may lead to initiation of effective interventions. Several instruments to measure fatigue have been validated in patients with cancer and are being utilized to characterize the symptom of fatigue and its effect on quality of life.[14-20] Interventions such as the use of epoetin alfa to improve quality of life and functional capacity are being evaluated with promising results.[21,22]

References

1. Fosså SD, Dahl AA, Loge JH: Fatigue, anxiety, and depression in long-term survivors of testicular cancer. J Clin Oncol 21 (7): 1249-54, 2003.  [PUBMED Abstract]
   
   
2. Miaskowski C, Portenoy RK: Update on the assessment and management of cancer-related fatigue. Principles and Practice of Supportive Oncology Updates 1 (2): 1-10, 1998. 
   
   
3. Irvine DM, Vincent L, Bubela N, et al.: A critical appraisal of the research literature investigating fatigue in the individual with cancer. Cancer Nurs 14 (4): 188-99, 1991.  [PUBMED Abstract]
   
   
4. Vogelzang NJ, Breitbart W, Cella D, et al.: Patient, caregiver, and oncologist perceptions of cancer-related fatigue: results of a tripart assessment survey. The Fatigue Coalition. Semin Hematol 34 (3 Suppl 2): 4-12, 1997.  [PUBMED Abstract]
   
   
5. Detmar SB, Aaronson NK, Wever LD, et al.: How are you feeling? Who wants to know? Patients' and oncologists' preferences for discussing health-related quality-of-life issues. J Clin Oncol 18 (18): 3295-301, 2000.  [PUBMED Abstract]
   
   
6. Costantini M, Mencaglia E, Giulio PD, et al.: Cancer patients as 'experts' in defining quality of life domains. A multicentre survey by the Italian Group for the Evaluation of Outcomes in Oncology (IGEO). Qual Life Res 9 (2): 151-9, 2000.  [PUBMED Abstract]
   
   
7. Cella D, Lai JS, Chang CH, et al.: Fatigue in cancer patients compared with fatigue in the general United States population. Cancer 94 (2): 528-38, 2002.  [PUBMED Abstract]
   
   
8. Pickard-Holley S: Fatigue in cancer patients. A descriptive study. Cancer Nurs 14 (1): 13-9, 1991.  [PUBMED Abstract]
   
   
9. Stone P, Richards M, Hardy J: Fatigue in patients with cancer. Eur J Cancer 34 (11): 1670-6, 1998.  [PUBMED Abstract]
   
   
10. Fukuda K, Straus SE, Hickie I, et al.: The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med 121 (12): 953-9, 1994.  [PUBMED Abstract]
    
    
11. Glaus A: Assessment of fatigue in cancer and non-cancer patients and in healthy individuals. Support Care Cancer 1 (6): 305-15, 1993.  [PUBMED Abstract]
    
    
12. Given B, Given CW, McCorkle R, et al.: Pain and fatigue management: results of a nursing randomized clinical trial. Oncol Nurs Forum 29 (6): 949-56, 2002.  [PUBMED Abstract]
    
    
13. Curt GA: The impact of fatigue on patients with cancer: overview of FATIGUE 1 and 2. Oncologist 5 (Suppl 2): 9-12, 2000.  [PUBMED Abstract]
    
    
14. Yellen SB, Cella DF, Webster K, et al.: Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage 13 (2): 63-74, 1997.  [PUBMED Abstract]
    
    
15. Piper BF, Dibble SL, Dodd MJ, et al.: The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum 25 (4): 677-84, 1998.  [PUBMED Abstract]
    
    
16. Schwartz AL: The Schwartz Cancer Fatigue Scale: testing reliability and validity. Oncol Nurs Forum 25 (4): 711-7, 1998.  [PUBMED Abstract]
    
    
17. Hann DM, Jacobsen PB, Azzarello LM, et al.: Measurement of fatigue in cancer patients: development and validation of the Fatigue Symptom Inventory. Qual Life Res 7 (4): 301-10, 1998.  [PUBMED Abstract]
    
    
18. Aaronson LS, Teel CS, Cassmeyer V, et al.: Defining and measuring fatigue. Image J Nurs Sch 31 (1): 45-50, 1999.  [PUBMED Abstract]
    
    
19. Mendoza TR, Wang XS, Cleeland CS, et al.: The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85 (5): 1186-96, 1999.  [PUBMED Abstract]
    
    
20. Okuyama T, Akechi T, Kugaya A, et al.: Development and validation of the cancer fatigue scale: a brief, three-dimensional, self-rating scale for assessment of fatigue in cancer patients. J Pain Symptom Manage 19 (1): 5-14, 2000.  [PUBMED Abstract]
    
    
21. Glaspy J, Bukowski R, Steinberg D, et al.: Impact of therapy with epoetin alfa on clinical outcomes in patients with nonmyeloid malignancies during cancer chemotherapy in community oncology practice. Procrit Study Group. J Clin Oncol 15 (3): 1218-34, 1997.  [PUBMED Abstract]
    
    
22. Demetri GD, Kris M, Wade J, et al.: Quality-of-life benefit in chemotherapy patients treated with epoetin alfa is independent of disease response or tumor type: results from a prospective community oncology study. Procrit Study Group. J Clin Oncol 16 (10): 3412-25, 1998.  [PUBMED Abstract]
    
    

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