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Commentary: Cancer Related Fatigue

Fatigue2by Doris Howell, RN, PhD 

Read the article in the Current Oncology Journal:

A pan-Canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue

Cancer-related fatigue (CRF) is a universal side effect of most cancer treatments, particularly chemotherapy, radiotherapy, or immune therapies. 1-3 About a third of post-treatment survivors, will also experience persistent or chronic fatigue for years. 4-6 Fatigue is described by patients as one of the most distressing symptoms of cancer as it interferes with daily living, affects cognitive functioning, work performance, and negatively impacts quality of life (QoL).7-10 CRF has also been described as the most under-acknowledged and under-treated cancer symptom.11 It is often cited that there is no effective medical treatment for fatigue since its etiology is not yet fully explained.12 This is often reinforced in health care communication to patients and can lead to under-reporting of CRF as patients assume it is untreatable and must be tolerated.13 Yet, our review of the evidence in the pan-Canadian practice guideline for assessment and management of fatiguetargeted to health care practitioners shows there are effective interventions that can improve the patients’ subjective experience of fatigue.14 Moreover, emerging research suggests that many of these interventions (i.e. exercise) may also play a role in altering the biological mechanisms that are hypothesized to cause CRF and its persistence long after treatment ends.15,16 More recent reviews provide further compelling evidence of the efficacy of interventions, particularly activity or exercise-based interventions, on reducing fatigue.17,18 In spite of this evidence, patients may still not be receiving the best advice to manage fatigue.19

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