Abstract and Introduction
Abstract
Cancer-related fatigue is one of the most common symptoms experienced by patients receiving chemotherapy and/or radiation therapy. It is subjective in nature; therefore, assessing the extent of its interference with the patient's quality of life and functional status is important. Assessment should also include contributing factors as well as underlying etiologies. Clinicians need to reassess and more than likely readjust the patient's fatigue management along the cancer continuum. Educating the patient to effectively manage other symptoms such as pain in addition to proper nutrition and hydration, exercise, and energy conservation will help empower patients to manage their fatigue.
Introduction
The 2012 National Comprehensive Cancer Network defines cancer-related fatigue (CRF) as "a distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning." Fatigue is one of the most common symptoms that cancer patients experience when receiving treatment with chemotherapy and/or radiation. Percentages of patients who experience CRF vary across studies from 25% to 100% depending on the type of treatment and the type and stage of cancer. Curt and colleagues telephone surveyed 379 patients who had received chemotherapy and found that 76% experienced fatigue at least a few days during the last course of chemotherapy and 30% experienced fatigue every day. Cancer-related fatigue has been experienced by patients from time of diagnosis to clinical remission and, for breast cancer survivors in particular, 5 to 10 years after diagnosis.4,7–11 As treatment for cancer advances, there are more survivors with CRF years after treatment has ended.
Fatigue also affects patients with other diseases. Solano and colleagues conducted a systematic search of medical databases and textbooks and, from 64 original studies, identified 11 common symptoms among patients with terminal cancer, acquired immunodeficiency syndrome, heart disease, chronic obstructive pulmonary disease, or renal disease. Pain, breathlessness, and fatigue were experienced by more than 50% of the patients across all 5 diseases, suggesting the possibility of a common pathway that patients with terminal diseases face. Thus, palliative care is appropriate for noncancer patients as well.