The complexity of fatigue in cancer and the wide range of different mechanisms means that accurate assessment, with an understanding of the likely cause(s) and associated factors, is critical to considering treatment options. There has been a lack of information on this in the past, often leading doctors and nurses to feel hopeless in the face of fatigue.
But some possible methods of assessing fatigue and monitoring progress are now available. Measuring the severity and consequences of fatigue is complex; fatigue is difficult to measure, because of the different ways in which it is interpreted and understood. Yet this is vital if treatments and their outcomes are to be monitored over time. Treatment options are varied, depending on the likely cause. The evidence base for treatments is only now developing; studies are often lacking and are difficult to conduct.
However, correction of simple causes, such as sleep interruption or anaemia, if identified, is a common first step. There are also general non-pharmacological measures such as adapting activities of daily living and occupational therapy to help match clinical function and symptom status with the expectation of patients and families. There is a wide range of pharmacological and non-pharmacological interventions available. Corticosteroids have been proposed as a treatment, and are often used. It is argued that they may decrease fatigue, either by inhibiting the release of tumour-induced substances or by a central euphoria effect. Amphetamines have been favoured in some settings, in particular in North American countries. Many other pharmacological treatments are emerging for the treatment of fatigue and its related symptoms.
Because of the lack of concentration of research and clinical effort in cancer-related fatigue some aspects the findings are preliminary and in some areas they contradict. Here we have sought to present the best knowledge and to debate opposing evidence, in the hope that it will provide doctors, nurses, and all those involved in caring for patients and families with mechanisms for improving care, as well as identifying important future lines of enquiry through research. The appraisals may begin to break the past, sometimes nihilistic, attitude to the assessment, discussion, and treatment of fatigue and encourage future trials and investigation, so that ultimately the effects of this most common and neglected symptom may be reduced.
But some possible methods of assessing fatigue and monitoring progress are now available. Measuring the severity and consequences of fatigue is complex; fatigue is difficult to measure, because of the different ways in which it is interpreted and understood. Yet this is vital if treatments and their outcomes are to be monitored over time. Treatment options are varied, depending on the likely cause. The evidence base for treatments is only now developing; studies are often lacking and are difficult to conduct.
However, correction of simple causes, such as sleep interruption or anaemia, if identified, is a common first step. There are also general non-pharmacological measures such as adapting activities of daily living and occupational therapy to help match clinical function and symptom status with the expectation of patients and families. There is a wide range of pharmacological and non-pharmacological interventions available. Corticosteroids have been proposed as a treatment, and are often used. It is argued that they may decrease fatigue, either by inhibiting the release of tumour-induced substances or by a central euphoria effect. Amphetamines have been favoured in some settings, in particular in North American countries. Many other pharmacological treatments are emerging for the treatment of fatigue and its related symptoms.
Because of the lack of concentration of research and clinical effort in cancer-related fatigue some aspects the findings are preliminary and in some areas they contradict. Here we have sought to present the best knowledge and to debate opposing evidence, in the hope that it will provide doctors, nurses, and all those involved in caring for patients and families with mechanisms for improving care, as well as identifying important future lines of enquiry through research. The appraisals may begin to break the past, sometimes nihilistic, attitude to the assessment, discussion, and treatment of fatigue and encourage future trials and investigation, so that ultimately the effects of this most common and neglected symptom may be reduced.
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