Elsevier

The Lancet

Volume 362, Issue 9384, 23 August 2003, Pages 640-650
The Lancet

Review
Assessment and management of cancer-related fatigue in adults

https://doi.org/10.1016/S0140-6736(03)14186-4Get rights and content

Summary

Fatigue is one of the most prevalent and distressing symptoms of cancer, and is a common side-effect of many of the treatments available for the management of malignant disease. We critically assess the evidence for cancer-related fatigue and its treatment in adults. Little is known about the cause and mechanisms of fatigue, and research into methods of alleviating the condition has focused on treatment for anaemia and behavioural Interventions, such as exercise, both of which are effective in reducing fatigue. Although research into the condition has increased considerably in the past decade, important gaps in knowledge remain.

Section snippets

Definition

Cancer-related fatigue, defined by the National Comprehensive Cancer Network (NCCN) as “a persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning”,10, 11 can be described in terms of perceived energy, mental capacity, and psychological status.12, 13 It arises over a continuum, ranging from tiredness to exhaustion. But, by contrast with the tiredness sometimes felt by a healthy individual, cancer-related fatigue is perceived as being

Cause

The specific mechanisms involved in the development of cancer-related fatigue are not completely known, but both physiological and psychosocial factors play a part.

Conclusion

Although fatigue is the most prevalent symptom reported by cancer patients, the assessment and management of this distressing side-effect of cancer and cancer treatment has been limited. This paucity of work is related to many factors, including a lack of understanding of the mechanisms responsible for cancer-related disease, a lack of awareness by cancer-care providers of the importance of the problem, and a lack of evidence-based interventions to manage the condition.74

Treatment of anaemia

Search strategy and selection criteria

We did a search of work published between January, 1997, and October, 2002, using the following databases: Medline, Cancerlit, Cinahl, and the Cochrane Library. We also consulted some classic work published before 1997. Abstracts from the past 5 years of meetings of the American Society of Clinical Oncology (ASCO) and the European Cancer Conference (ECCO) were reviewed. Only studies published in English and done in adults have been included. The key words used in searches were: assessment,

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