Cancer-Related Fatigue

Cancer-related fatigue (CRF) is among the most commonly reported side effects experienced by cancer patients and survivors. Approximately one-third of women with breast cancer continue to suffer from CRF, even years after the completion of treatment. The causal mechanisms of CRF are not fully understood. However, numerous studies have demonstrated that systemic inflammation is associated with CRF. Hypothalamic-pituitary-adrenal (HPA) dysregulation, endocrine dysfunction, and sleep disturbance have also been proposed as contributing factors to CRF. Due to the high prevalence of CRF, the American Society of Clinical Oncology (ASCO) recommends that oncologists routinely and systematically screen for CRF throughout the cancer trajectory and provide prompt and specific treatments. Patients with CRF should be evaluated for treatable contributing factors (e.g., anemia, hypothyroidism), and, if found, their treatment plan should address those factors. CRF treatments include non-pharmacologic and pharmacologic therapies. Non-pharmacologic therapies such as physical activity, mind-body interventions, and psychosocial therapies have demonstrated promising efficacy and should be considered in the initial management of CRF. In this chapter, we explained the definition, prevalence, and impact of CRF and reviewed possible mechanisms associated with CRF. We also provide an algorithm based on clinical guidelines developed by the National Comprehensive Cancer Network (NCCN), the ASCO, the Pan-Canadian Practice Guideline Committee, and the Oncology Nursing Society to guide oncologists and other health professionals in screening, assessing, and prescribing treatments of CRF in breast cancer survivors.