title: Management of fatigue in patients with cancer -- a practical overview.
abstract: Cancer-related fatigue (CRF) is a serious clinical problem and is one of the most common symptoms experienced by cancer patients. CRF has deleterious effects on many aspects of patient quality of life including their physical, psychological and social well-being. It can also limit their ability to function, socialise and participate in previously enjoyable activities. The aetiology of CRF is complex and multidimensional, involving many potentially contributing elements. These include tumour-related factors and comorbid medical/psychological conditions and also side effects associated with anti-cancer therapies or other medications. Barriers to the effective management of CRF exist both on the side of physicians and patients, and as a result CRF often remains unrecognised and undiscussed in clinical practice. A change of approach is required, where fatigue is treated as central to patient management during and after systemic anti-cancer treatment. In this review we summarise factors involved in the aetiology of CRF and the barriers to its effective management, as well as factors involved in the screening, diagnosis and treatment of cancer patients experiencing fatigue. Pharmacological and non-pharmacological approaches to its management are also reviewed. We suggest an algorithm for the process of managing CRF, guided by our experiences in The Netherlands, which we hope may provide a useful tool to healthcare professionals dealing with cancer patients in their daily practice. Although CRF is a serious and complex clinical problem, if it is worked through in a structured and comprehensive way, effective management has the potential to much improve patient quality of life.
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: rutger.koornstra@radboudumc.nl.
authors.forename: Rutger H T
authors.initials: RH
authors.lastname: Koornstra
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Marlies.Peters@radboudumc.nl.
authors.forename: Marlies
authors.initials: M
authors.lastname: Peters
authors.affiliation: University of Groningen, Groningen, The Netherlands. Electronic address: s.m.donofrio@rug.nl.
authors.forename: Stacey
authors.initials: S
authors.lastname: Donofrio
authors.affiliation: Catharina Hospital, Eindhoven, The Netherlands. Electronic address: ben.vd.borne@catharinaziekenhuis.nl.
authors.forename: Ben
authors.initials: B
authors.lastname: van den Borne
authors.affiliation: Amgen BV, Breda, The Netherlands. Electronic address: f.a.dejong73@gmail.com.
authors.forename: Floris A
authors.initials: FA
authors.lastname: de Jong
mesh_terms: D000740:Anemia / Q000150:complications* / Q000188:drug therapy / Q000209:etiology; D005221:Fatigue / Q000209:etiology / Q000628:therapy*; D006397:Hematinics / Q000627:therapeutic use; D006801:Humans; D033183:Interdisciplinary Communication; D009369:Neoplasms / Q000150:complications*; D010348:Patient Care Team; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000150:complications / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy
chemical_list: D006397:Hematinics
keywords: Anaemia; Cancer-related fatigue; Diagnosis; Multidisciplinary management; Screening