CANCER-RELATED FATIGUE: WHAT WE HAVE LEARNED AND WHAT ARE THE CHALLENGES FOR THE FUTURE

Although pain is the most feared symptomatic component of having cancer and being treated for it, cancer-related fatigue is the most severe and impairing symptom that cancer patients and cancer survivors face. If not forewarned by their clinical team, the severity of cancer-related fatigue (CRF) may come as an unexpected consequence both disease and treatment. Although the construct of fatigue is multidimensional, having physical and emotional components and the inability to perform planned activities, most patients are able to rate the severity of their fatigue using brief patient reported outcome (PRO) scales. Increasingly, based on supportive care guidelines from different organizations, it is strongly recommended that screening for severity of fatigue be part of oncology clinical visits, and monitoring symptoms between clinic visits is feasible using web-based symptom tracking on smart phones. Fatigue is a common result of physical illness, and the mechanistic bases of patients having impairing fatigue are often multiple. The relationship between CRF and inflammation is the subject of much current investigation. When patients are able, based on their physical capacity, several studies have shown that exercise can be of benefit for improving fatigue and improving function. Behavioral coaching in scheduling activities may also be of benefit. The role of psychostimulants is still controversial, and more research is needed. Non-traditional interventions such as Ginseng and acupuncture have shown a positive signal in some trials. Especially considering the major burden of CSF to a high percentage of patients and its persistence in survivorship, more research in both the mechanisms and the treatment of CSF is needed.