Review
Fatigue in cancer patients during and after treatment: prevalence, correlates and interventions

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Abstract

Research on the relationship between cancer and fatigue has increased considerably in recent years. In this review, we focus on fatigue observed in patients during and after treatment for cancer, using data from empirical studies. The results from these studies indicate that fatigue is mostly studied during active treatment for cancer, and is an important problem during this period. Studies that focused on fatigue in disease-free cancer patients, although less prominent, also indicate fatigue is an important complaint in this time period. It is hard to draw conclusions with regard to the relationships between fatigue and disease- and treatment-related characteristics, because these relationships are seldom properly investigated. Relationships between fatigue and psychological, social, behavioural and physical factors have been established in several studies. However, most studies focused on the depression-fatigue association. Finally, most intervention studies to reduce fatigue appear to be successful, but the follow-up analyses are lacking.

Introduction

Fatigue is a subjective experience that affects everybody. For healthy individuals, it might be a protective, sometimes even pleasant, regulatory response to physical or psychological stress. It seems to maintain a healthy balance between rest and activity. For people with specific diseases, fatigue often becomes a major distressing symptom and for people with cancer, fatigue has been described as a major concern during treatment, in the advanced stages of the disease and after curative treatment. Whereas healthy individuals report fatigue to be a pleasant, acute, normal, regulating phenomenon which helps them to schedule their daily rhythm and which disappears after a good night's sleep, cancer patients speak about chronic, unpleasant, distressing, life and activity-limiting fatigue throughout the day.

In various publications, different definitions to describe fatigue in patients with cancer have been used. From all these different descriptions, we conclude that fatigue is a subjective and multidimensional concept with several modes of expression: physical (e.g. diminished energy, need to rest), cognitive (e.g. diminished concentration or attention) and affective (e.g. decreased motivation or interest).

In this review, we focus on what is currently known about fatigue during and after treatment for cancer, based on empirical studies with reliable instruments. In the first part of our review (fatigue during treatment for cancer), studies are included in which fatigue was investigated in patients in the active phase of their disease. In the second part (fatigue after treatment for cancer), disease-free patients who completed cancer treatment are included. The prevalence of fatigue and correlates of fatigue are discussed. In addition, the literature concerning interventions to reduce fatigue in cancer patients is also examined. In Table 1, Table 2, Table 3, all of the reviewed studies are summarised. Study characteristics and key findings are described and, when possible, the effect size was calculated.

Section snippets

Method

We conducted a literature search in Medline, Current Contents (CC) and Psychlit for the period 1980–July 2001. In the first search, 154 different articles were found with the keywords FATIGUE and (CANCER or HODGKIN'S or TUMOR or TUMOUR or MALIGN* or HAEMATOLOG* or RADIOTHERAPY or RADIATION or CHEMOTHERAPY or HORMONE THERAPY) in the title. In a second search, we combined the words CANCER (or HODGKIN'S or TUMOR or TUMOUR or MALIGN* or HAEMATOLOG*) and (INTERVENTION or EXERCISE or PSYCHOTHERAPY or

Description of the reviewed studies

In Table 1, 26 publications are summarised in which fatigue was investigated in a sample of cancer patients during or immediately after treatment for cancer 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26. These 26 publications were based on 22 studies. As indicated in Table 1, some studies were based on the same sample of patients, answering different research questions. In 10 of these 22 studies, a homogenous group of cancer patients was

Description of the reviewed studies

In Table 2, 16 publications are summarised in which the focus was on ‘off-treatment fatigue’ 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42. These 16 publications were based on 13 studies. In these studies, fatigue complaints have been investigated in disease-free cancer patients, who completed curative treatment for cancer in the (recent) past. In seven of these 13 studies, a sample of breast cancer patients was investigated. In one study, Hodgkin's disease survivors, in one

Description of the reviewed studies

In Table 3, 12 controlled intervention studies are summarised. In five of these studies, fatigue was the main dependent variable 48, 50, 51, 52, 54. In the other seven studies, fatigue was one of the investigated outcome measures 43, 44, 45, 46, 47, 49, 53. All studies took place while patients were undergoing treatment for cancer or, in one study, just after treatment for cancer had finished (surgery, without adjuvant therapy). To the best of our knowledge, no intervention studies have been

Discussion

In the last 10 years, the amount of research on the relationship between cancer and fatigue has increased considerably. To give an indication, from the 181 articles we found using Medline, Current Contents and Psychlit, 20 were published between 1980 and 1990, and 161 were published between 1991 and 2001. From these 161 studies, 32 were published between 1991 and 1995 and 129 were published between 1996 and 2001. The conducted research has focused mainly on fatigue complaints during treatment

Acknowledgements

This research was funded by the Dutch Cancer Society.

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