Cancer Related Fatigue Fact Sheet

What it is and how you can help your patients

Do you have problems getting patients to comply with treatment plans due to exhaustion? Are you seeing outcomes decline and extra hospital stays become necessary because patients are listless, have decreased attention or are unable to keep up with the activities of daily living? They could be suffering from Cancer Related Fatigue (CRF).
What Is Cancer Related Fatigue?

Cancer related fatigue is defined by the National Comprehensive Cancer Network 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. It’s one of the most common side effects of treatment, affecting 60-90 percent of individuals during treatment. Recent evidence shows up to one third of all cancer survivors have “clinically relevant levels of CRF” as much as six months post-treatment. What’s more, persistent CRF correlates to higher levels of disability.

Causes of Cancer-Related Fatigue

Various cancer treatments can cause CRF, including surgery, chemotherapy, and radiation. CRF may also be fueled by the cancer itself. Additionally, many patients may present with other medical comorbidities that can cause pre-existing fatigue, exacerbating the problem.


Signs & Symptoms of Cancer Related Fatigue
The first step to helping people with cancer overcome CRF is knowing the symptoms. The following diagnostic criteria* can help identify CRF. proposed by Significant fatigue, decreased energy, or need to rest that’s disproportionate to recent activity levels
  • Generalized weakness, heaviness in limbs
  • Decreased concentration, attention, and/or memory
  • Lack of motivation for normal activities and social interaction
  • Changes in sleep patterns (difficulty with or excessive sleep)
  • Difficulty overcoming inactivity • Irritability and listlessness
  • Difficulty with starting or completing activities of daily living
  • Need to sleep throughout the day
  • Limited ability to eat due to fatigue 
* Source: The Fatigue Coalition as well as those identified by the FACT
Treatment for Cancer Related Fatigue

Exercise is typically the first-line treatment for CRF. Exercise is the strongest literature-supported, nonpharmacological intervention for treatment of CRF, particularly multimodal exercise consisting of moderate to high intensity aerobic activity and resistance training. Treatment options include:

  • Aerobic and resistance exercise
  • Postural and body mechanics education to improve movement efficiency
  • Energy conservation and activity modification education
  • Stretching exercises
  • Breath retraining
  • Mindfulness/relaxation techniques
  • Sleep hygiene


Download the Signs & Symptoms of Cancer Related Fatigue

Help your team easily identify the signs and symptoms of cancer related fatigue with this handy list.



ReVital is a Leader in Cancer Rehabilitation

ReVital cancer rehabilitation therapists have been specially trained to prescribe safe and effective exercise programs for people with cancer and survivors of all cancer types. They have extensive knowledge on the effects of cancer treatment and other medical comorbidities that could impact exercise tolerance. They also understand proper metrics for exercise prescription, allowing survivors to realize the full physiological benefits.

The ReVital team is happy to schedule a team training session on best practices for screening patients with cancer related fatigue. We’re flexible and will make it as easy as possible to learn more about screening and referral set up.

References
  1. National Comprehensive Cancer Network Guidelines Version 2.2018. Cancer Related Fatigue. NCCN.org. Accessed 14 May 2018
  2. Stone P, Richardson A, Ream E, Smith EG et al. Cancer-related fatigue: Inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Annals of Oncology. 2000; 11 (8): 971-975 https://doi.org/10.1023/A:1008318932641
  3. Cella D: The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: A new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 34:13-19, 1997 (suppl 2) 13.
  4. Vogelzang N, Breitbart W, Cella D, et al: Patient, caregiver, and oncologist perceptions of cancer-related fatigue: Results of a tri-part assessment survey. Semin Hematol 34:4-12, 1997 (suppl 2)
  5. Cella D, Tulsky D, Gray G, et al: The functional assessment of cancer therapy scale: Development and validation of the general
  6. Irvine D, Vincent L, Graydon J, et al: The prevalence and correlates of fatigue in patients receiving treatment with chemotherapy and radiation therapy: A comparison with the fatigue experienced by healthy individuals. Cancer Nurs 17:367-378, 1994
  7. Blesch K, Paice J, Wickman R, et al: Correlates of fatigue in people with breast or lung cancer. Oncol Nurs Forum 18:81-87, 1991
  8. Jones JM, Olson K, Catton P, Catton CN, et al. Cancer-related fatigue and associated disability in post-treatment cancer survivors. Journal of Cancer Survivorship. 2016; 10 (1): 51-61.
  9. Cella D, Peterman A, Passik S, et al: Progress toward guidelines for the management of fatigue. Oncology. 1998; 12:369-377.
  10. Functional Assessment of Chronic Illness Therapy. FACIT-Fatigue. www.facit.org/FACITORG/Questionnaires. Accessed 15 May 2018.
  11. Menses-Eschavez JF, Gonzalez-Jimenez E and Ramirez-Velez R. Effects of supervised multimodal exercise interventions on cancer-related fatigue: Systematic review and meta-analysis of randomized controlled trials. Biomed Research International. 2015; http://dx.doi.org/10.1155/2015/328636
  12. Van Waart H, Stuiver M, van Harten WH, Gelejin E, et al. Effect of low-intensity physical activity and moderate to high intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue and chemotherapy completion rates: Results of the PACES randomized controlled trial