Non Pharmacological Interventions to Manage Cancer-Related Fatigue (CRF) - An Overview
Journal of Complementary and Alternative Medical Research,
Fatigue is almost a common problem often reported by the cancer patients that severely affects all aspects of quality of life. Prevalence of cancer related fatigue ranges from 50% to 90% of cancer patients overall. After addressing treatable contributing factors, such as hypothyroidism, anemia, insomnia, pain, emotional distress, medication adverse effects, metabolic disturbances, or organ dysfunction such as heart failure, myopathy, and pulmonary fibrosis, patients may be screened with a short fatigue assessment tool. There is a pressure for pharmacologic therapy to shift away from reliance on opioids and ineffective procedures toward comprehensive cancer related fatigue (CRF) management that includes evidence-based nonpharmacologic options. This review details the magnitude of the current CRF problem including its impact on quality of life as well as the challenges of CRF management for patients and a healthcare workforce engaging prevalent strategies not entirely based in current evidence. Transforming the current system of CRF care to a responsive comprehensive model necessitates those options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability. Patients with cancer related fatigue may benefit from self-administrable nonpharmacological interventions without any side effects. Health care personnel often have insufficient knowledge about fatigue and its treatments or underestimate the impact of fatigue on quality of life. A practical review may be useful to health care professionals in order to identify the cancer related fatigue during the early period of cancer process and treat it effectively to improve the quality of life which contribute to the positive outcomes in cancer clients. Therefore, the main purpose of this review is to analyze the possible nonpharmacological approach to manage cancer related fatigue and recommend future research that will clarify these approaches and facilitate the formulation of new treatment options.
- Cancer-related fatigue
- non pharmacological
How to Cite
Morrow GR, Shelke AR, Roscoe JA, Hickok JT, Mustian K. Management of cancer-related fatigue. Cancer Invest. 2005;23: 229-39. [PUBMED]
Mock V, Abernethy AP, Atkinson A, Barsevick AM, Berger AM, Cella D, et al. Cancer-related fatigue. Clinical practice guidelines in oncology, JNCCN. 2007; 5:1054-78.
Passik SD, Kirsh KL, Donaghy K, Holtsclaw E, Theobald D, Cella D, et al. Patient-related barriers to fatigue communication: Initial validation of the fatigue management barriers questionnaire. J Pain Symptom Manage. 2002; 24:481-93. [PUBMED]
Julie LR, Jennifer KC, Elizabeth PR, Karen MM, Kevin F, Gary RM. Mechanisms of cancer-related fatigue. Oncologist. 2007; 12:22-4.
Mehnert A, Scherwath A, Schirmer L, Schleimer B, Petersen C, Schulz-Kindermann F, et al. The association between neuropsychological impairment, self-perceived cognitive deficits, fatigue and health related quality of life in breast cancer survivors following standard adjuvant versus high-dose chemotherapy. Patient Educ Couns. 2007; 66:108-18.
Brown DJ, McMillan DC, Milroy R. The correlation between fatigue, physical function, the systemic inflammatory response, and psychological distress in patients with advanced lung cancer. Cancer. 2005; 103:377-82.
Antoni MH, Lutgendorf SK, Cole SW, Dhabhar FS, Sephton SE, McDonald PG, et al. The influence of bio-behavioural factors on tumour biology: Pathways and mechanisms. Nat Rev Cancer. 2006; 6:240-8.
Fan HG, Houédé-Tchen N, Yi QL, Chemerynsky I, Downie FP, Sabate K, et al. Fatigue, menopausal symptoms, and cognitive function in women after adjuvant chemotherapy for breast cancer: 1- and 2-year follow-up of a prospective controlled study. J ClinOncol. 2005; 23:8025-32.
Goldstein D, Bennett B, Friedlander M, Davenport T, Hickie I, Lloyd A. Fatigue states after cancer treatment occur both in association with, and independent of, mood disorder: A longitudinal study. BMC Cancer. 2006; 9:240.
Monga U, Kerrigan AJ, Thornby J, Monga TN. Prospective study of fatigue in localized prostate cancer patients undergoing radiotherapy. Radiat OncolInvestig. 1999; 7:178-85.
Hwang SS, Chang VT, Cogswell J, Kasmis BS. Clinical relevance of fatigue levels in cancer patients at a Veterans Administration Medical Center. Cancer. 2002; 94:2481-9.
Schmidt ME, Chang-Claude J, Vrieling A, Heinz J, Flesch-Janys D, Steindorf K. Fatigue and quality of life in breast cancer survivors: temporal courses and long-term pattern. J Cancer Surviv. 2012;6(1):11–9.
Noal S, Levy C, Hardouin A, Rieux C, Heutte N, Ségura C, et al. One-year longitudinal study of fatigue, cognitive functions, and quality of life after adjuvant radiotherapy for breast cancer. Int J RadiatOncolBiol Phys. 2011;81(3):795–803.
Hofman M, Ryan JL, Figueroa-Moseley CD, Jean-Pierre P, Morrow GR. Cancer-related fatigue: the scale of the problem. Oncologist. 2007;1(1):4-10.
Charalambous A, Kouta C.Cancer Related Fatigue and Quality of Life in Patients with Advanced Prostate Cancer Undergoing Chemotherapy. BioMed Research International Journal; 2016.
Lundström S, Fürst CJ. Symptoms in advanced cancer: Relationship to endogenous cortisol levels. Palliat Med. 2003; 17:503-8.
Available:https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fatigue/what-is-cancer-related-fatigue.htmlaccessed on 10th April 2021
Roe H, Lennan E. Role of nurses in the assessment and management of chemotherapy-related side effects in cancer patients. Nursing (Auckl). 2014; 4:103–115.
Luthy C, Cedraschi C, Pugliesi A, et al. Patients’ views about causes and preferences for the management of cancer-related fatigue-a case for non-congruence with the physicians? Support Care Cancer. 2011;19(3):363–37.
Curt GA, Breitbart W, Cella D, et al. Impact of cancer-related fatigue on the lives of patients: New findings from the Fatigue Coalition. Oncologist. 2000;5(5):353–360.
Ekenga CC, Perez M, Margenthaler JA, Jeffe DB. Early-stage breast cancer and employment participation after 2 years of follow-up: a comparison with age-matched controls. Cancer. 2018;124(9):2026–35.
Lis CG, Rodeghier M, Grutsch JF, Gupta D. Distribution and determinants of patient satisfaction in oncology with a focus on health-related quality of life. BMC Health Serv Res. 2009; 9:190.
American Cancer Society. What Is Cancer-related Fatigue? ; 2021.
Accessed 28 March 2021.
Tazi E, Errihani H. Evaluation and management of fatigue in oncology: A multidimensional approach. Indian Journal of Palliative care. 2011;17(2):92-97.
Mustian KM, Griggs JJ, Morrow GR, et al. Exercise and side effects among 749 patients during and after treatment for cancer: A University of Rochester Cancer Center Community Clinical Oncology Program Study. Supportive care in cancer: official journal of the Multinational Association of Supportive Care in Cancer. 2006; 14:732–41.
Mustian KM, Morrow GR, Carroll JK, et al. Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. The oncologist. 2007;12(1):52-67.
Mustian KM, Peppone LJ, Palesh OG, et al. Exercise and Cancer-related Fatigue. US oncology 2009; 5:20–23.
Anxiety and depression association of America; Physical activity reduces stress.
Mock V, Frangakis C, Davidson NE, et al. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psycho-oncology. 2005; 14:464–77.
Available:http://cfcancerinst.com/content/uploads/Be-Active-Stay-Active_NHSExercise- Guide.pdf -Accessed on 10th April 2021.
Bastani F, Khosravi M, Borimnejad L, Arbabi N. The effect of acupressure on cancer-related fatigue among school-aged children with acute lymphoblastic leukemia. Iranian Journal of Nursing and Midwifery Research. 2015;20(5):545-551.
Lan SC, Lin YE, Chen SC, Lin YF, Wang YJ. Effects of acupressure on fatigue and depression in hepatocellular carcinoma patients treated with transcatheter arterial chemoembolization- A quasi-experimental study; Evid Based Complement Alternat Med; 2015.
Accessed 1 July 2019
Zick SM, Alrawi S, Merel G, Burris B, Sen A, Litzinger A, et al. Relaxation acupressure reduces persistent cancer-related fatigue. Evid Based Complement Alternat Med. 2011; 165:1-11.
Zick SM, Sen A, Wyatt GK, Murphy SL, Arnedt JT, Harris RE. Investigation of 2 types of self-administered acupressure for persistent cancer-related fatigue in breast cancer survivors: A randomized clinical trial. JAMA Oncol. 2016; 2(11):1470-1476.
Mehta P, Dhapte V, Kadam S, Dhapte V. Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments. Journal of Traditional and Complementary Medicine. 2017; 7(2):251-263.
Yeh CH, Chien LC, Lin WC,Bovbjerg DH, Van Londen GJ. Pilot randomized controlled trial of auricular point acupressure to manage symptom clusters of pain, fatigue, and disturbed sleep-in breast cancer patients. Cancer Nursing. 2016;39(5):402-410.
Zhang B, Dong JN, Sun P, Feng C, Liu YC. Effect of therapeutic care for treating fatigue in patients with breast cancer receiving chemotherapy. Medicine. (Baltimore) 2017; 96(33):7750.
Yorke J, Lloyd-Williams M, Smith J, Blackhall F, Harle A, Warden J, et al. Management of the respiratory distress symptom cluster in lung cancer: A randomised controlled feasibility trial. Journal of Support Care Cancer. 2015;23(11):3373-3384.
Tang WR, Chen WJ, Yu CT, Chang YC, Chen CM, Wang CH, et al. Effects of acupressure on fatigue of lung cancer patients undergoing chemotherapy: An experimental pilot study. Complement Therapy Med. 2014;22(4):581-591.
Zick MS, Harris RE. Acupressure for cancer related fatigue; 2018.
(Accessed 25th April 2021)
Khanghah AG, Rizi M S,Nabi B N, Adib M, LeiliEK.Effects of Acupressure on Fatigue in Patients with Cancer Who Underwent Chemotherapy.Journal of Acupuncture and meridian studies. 2019;12(4):103-110.
National Cancer Institute: Nutrition in Cancer Care (PDQ®)–Health Professional Version. National Cancer Institute; 2017.
Zietarska M, Krawczyk-Lipiec J, Kraj L, Zaucha R, MalgorzewiczS: Chemotherapy-Related Toxicity, Nutritional Status and Quality of Life in Precachectic Oncologic Patients with, or without, High Protein Nutritional Support. A Prospective, Randomized Study. Nutrients; 2017. DOI:10.3390/nu9101108
Demark-Wahnefried W, Campbell KL, Hayes SC: Weight management and its role in breast cancer rehabilitation. Cancer. 2012; 118:2277–87.
Bossola M: Nutritional interventions in head and neck cancer patients undergoing chemoradiotherapy: A narrative review. Nutrients. 2015;7:265–76.
Kilgour RD, Vigano A, Trutschnigg B, Lucar E, Borod M, et al.Handgrip strength predicts survival and is associated with markers of clinical and functional outcomes in advanced cancer patients. Support Care Cancer. 2013;21:3261–70.
Smith KB, Pukall CF. An evidence-based review of yoga as a complementary intervention for patients with cancer. Psycho-oncology. 2009;18(5):465-475.
Riley D. Hatha yoga and the treatment of illness. AlternTher Health Med. 2004;10(2):20.
Pilkington K, Kirkwood G, Rampes H, Richardson J. Yoga for depression: The research evidence. J Affect Disord. 2005; 89(1-3):13–24.
Carson JW, Carson KM, Porter LS, Keefe FJ, Seewaldt VL. Yoga of awareness program for menopausal symptoms in breast cancer survivors: results from a randomized trial. Support Care Cancer. 2009;17(10):1301–1309.
Goedendorp MM, et al. Psychosocial interventions for reducing fatigue during cancer treatment in adults; 2009.
Adam R, Bond C, Murchie P. Educational interventions for cancer pain. A systematic review of systematic reviews with nested narrative review of randomized controlled trials. Patient Educ Couns. 2015; 98(3):269–282.
Mustian KM, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3(7):961–968.
Newell SA, Sanson-Fisher RW, Savolainen NJ. Systematic review of psychological therapies for cancer patients: overview and recommendations for future research. J Natl Cancer Inst. 2002; 94(8):558–584.
Available:https://kesslerfoundation.org/info/psychosocial-interventions-cancer-related-fatigue Accessed on 25th May 2021
Berger A, Mitchell SA, Jacobson PB, Prill W F. CA: Screening, evaluation, and management of cancer-related fatigue: Ready for implementation to practice? A cancer Journal for clinicians.2015; 65(3):190-211.
Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer Journal. 2015;15(77).
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