Cancer Related Fatigue (CRF) is a persistent sense of tiredness/diminished energy related to cancer and/or its treatment, which is not relieved by rest, and which causes diminution in functional capacity and quality of life.
Additional proposed ICD-10 features include: diminished concentration; diminished motivation; insomnia or hypersomnia; nonrestorative sleep; short-term memory deficits, and marked emotional reactivity to fatigue that are not primarily consequences of depression.
CRF is often multifactorial, with biochemical, physiological, psychological, and behavioral dimensions that remain poorly defined.
Common causes include
- Direct effect from cancer and/or treatments
- Sedating medications
- Psychiatric co-morbidities (e.g. depression, anxiety)
- Hypoxemia, or severe anemia (Hb ≤8 g/dL) and possibly moderate anemia (Hb ≤11g/dL)
- Systemic infection and/or or significant organ dysfunction (e.g. heart, liver, kidney, lung)
- Electrolyte abnormalities (e.g. ↓Na+, ↓K+, ↓Mg++ , ↑Ca++)
- Nutritional imbalance/impairment
- Sleep disturbance
- Uncontrolled pain
should be directed toward correcting identifiable causes, e.g. elimination of sedating drugs, correction of anemia or electrolyte imbalance.
may help in reduce fatigue, optimize function, and promote adaptation.
1. Education: educate patient/family about CRF in order to normalize the symptom and promote adaptation/adjustment through setting realistic goals.
2. Exercise: aerobic exercise (20-30 minutes of (cumulative) exercise per day, at least 3 days per week) can improve cancer-related fatigue symptoms
3. Drug therapy - the following drugs have been used with variable success:
- Psychostimulants. Methylphenidate: start with 2.5-5 mg and titrate as necessary to 15-30 mg po at 08:00 and noon. Modafanil: suggested initial dosing is 50 mg po qam and titrate as necessary to 200-400 mg po qam.
- Corticosteroids. Prednisone 7.5-10 mg po qday; dexamethasone 1-4 mg po qday; methylprednisolone 32 mg po qday.
- Megestrol acetate: 160 mg by mouth three times a day
- Dietary supplements. Ginseng, L-carinitine
4. Complementary therapies: potential benefit of acupuncture
Adapted from Reinfield GM and Wilson GR. Palliative Care Network of Wisconsin. Fast facts and concepts #173. Cancer related fatigue. Internet. Accessed on January 25, 2016.