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Fatigue (PDQ®)

  • Last Modified: 03/07/2014

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Posttreatment Considerations

This posttreatment section has been especially prepared for those individuals with cancer who have been off all antineoplastic therapy for at least 6 months. The rationale for creating a separate section is twofold. First, the etiology of problems is different for individuals undergoing treatment versus those who are no longer undergoing therapy. Second, intervention strategies and information can be better tailored so that there will be a greater likelihood of meeting the needs of these two distinct populations.

Fatigue is a separate and distinct problem for individuals after treatment is completed. Many theories have been proposed to explain the etiology of fatigue in the patient undergoing treatment and to explain the impact of that treatment on quality of life. Many of these theories, however, do not apply to the posttreatment population. Nonetheless, fatigue continues to be a major issue for individuals who are no longer undergoing therapy and who are considered to be disease free.

There is evidence that fatigue significantly affects the quality of life of cancer survivors. The experience of fatigue in cancer survivors is quite similar to the experience of patients with chronic fatigue syndrome in the general medical setting.[1] Few studies have been done that indicate the impact of fatigue on quality of life, but some examples follow:

  • In cancer survivors who had bone marrow transplants, 50% of 29 survivors reported moderate-to-severe fatigue more than 1 year after transplant. Fatigue was one of the three most negative items studied and had an impact on quality of life more than any other physical problem.[2]

  • In patients who had bone marrow transplants, 56% of 125 patients reported ongoing fatigue 6 to 18 years after transplant.[3]

  • Of 687 posttreatment survivors of various forms of cancer evaluated for quality-of-life issues, fatigue was one of the three most negative items affecting quality of life.[4]

  • Of 90 patients with a diagnosis of Hodgkin lymphoma or non-Hodgkin lymphoma, 30 reported a lack of energy at a median of 32 months after diagnosis.[5]

  • Of 403 individuals with Hodgkin lymphoma, 37% reported their energy levels had not returned to levels that satisfied them even after a median of 9 years posttreatment.[6]

  • In Hodgkin lymphoma survivors, 26% had persistent fatigue 6 months after treatment with 50% associated with psychological distress. Increasing age and no prior psychological symptoms predicted fatigue “caseness.”[7]

  • Of 162 women treated with radiation for breast cancer and 173 women treated with chemotherapy for breast cancer, 75% and 61%, respectively, described decreased stamina 2 to 10 years after the completion of treatment.[8] In a separate cross-sectional survey of women who completed therapy for breast cancer by a mean of 29 months prior to the survey, 38% had severe fatigue compared with only 11% of matched controls.[9]

  • Fatigue has been reported in women survivors of autologous bone marrow transplantation and high-dose chemotherapy treatment for lymphomas 4 to 10 years posttreatment.[10]

  • Almost one-third of breast cancer survivors at 10 years posttreatment reported significant fatigue.[11]

Although many studies document the incidence of fatigue in those who are no longer undergoing cancer treatment, the specific mechanism of fatigue remains unknown. Because fatigue is a multifaceted problem, determining its etiology is difficult.

The information available regarding fatigue in survivors of childhood cancer is from the literature describing the physiologic and cognitive effects following treatment. In one study, cognitive outcomes were evaluated in children 3 to 4 years after diagnosis of brain tumors. Fatigue was a factor in poor school performance.[12]

In another study, survivors of acute lymphoblastic leukemia who were evaluated for cognitive deficits after treatment were noted to have a typical fatigue effect. This was thought to be a factor in the variability of their test scores.[13] Anecdotally, individuals who have received chest and total-body irradiation complain of fatigue, with an increased sleep requirement.

People who are successfully treated for cancer are at risk for a variety of organ-specific complications that are secondary to their treatment.[14] Fatigue in the posttreatment population underscores the importance of follow-up care. The persistence of fatigue following cancer treatment requires a thorough evaluation to rule out contributing physiologic conditions.

References
  1. Servaes P, van der Werf S, Prins J, et al.: Fatigue in disease-free cancer patients compared with fatigue in patients with chronic fatigue syndrome. Support Care Cancer 9 (1): 11-7, 2001.  [PUBMED Abstract]

  2. Whedon M, Stearns D, Mills LE: Quality of life of long-term adult survivors of autologous bone marrow transplantation. Oncol Nurs Forum 22 (10): 1527-35; discussion 1535-7, 1995 Nov-Dec.  [PUBMED Abstract]

  3. Bush NE, Haberman M, Donaldson G, et al.: Quality of life of 125 adults surviving 6-18 years after bone marrow transplantation. Soc Sci Med 40 (4): 479-90, 1995.  [PUBMED Abstract]

  4. Ferrell BR, Grant M, Dean GE, et al.: Bone tired: the experience of fatigue and its impact on quality of life. Oncol Nurs Forum 23 (10): 1539-47, 1996. 

  5. Devlen J, Maguire P, Phillips P, et al.: Psychological problems associated with diagnosis and treatment of lymphomas. II: Prospective study. Br Med J (Clin Res Ed) 295 (6604): 955-7, 1987.  [PUBMED Abstract]

  6. Fobair P, Hoppe RT, Bloom J, et al.: Psychosocial problems among survivors of Hodgkin's disease. J Clin Oncol 4 (5): 805-14, 1986.  [PUBMED Abstract]

  7. Loge JH, Abrahamsen AF, Ekeberg, et al.: Fatigue and psychiatric morbidity among Hodgkin's disease survivors. J Pain Symptom Manage 19 (2): 91-9, 2000.  [PUBMED Abstract]

  8. Berglund G, Bolund C, Fornander T, et al.: Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients. Eur J Cancer 27 (9): 1075-81, 1991.  [PUBMED Abstract]

  9. Servaes P, Verhagen S, Bleijenberg G: Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Ann Oncol 13 (4): 589-98, 2002.  [PUBMED Abstract]

  10. Knobel H, Loge JH, Nordøy T, et al.: High level of fatigue in lymphoma patients treated with high dose therapy. J Pain Symptom Manage 19 (6): 446-56, 2000.  [PUBMED Abstract]

  11. Bower JE, Ganz PA, Desmond KA, et al.: Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer 106 (4): 751-8, 2006.  [PUBMED Abstract]

  12. Radcliffe J, Packer RJ, Atkins TE, et al.: Three- and four-year cognitive outcome in children with noncortical brain tumors treated with whole-brain radiotherapy. Ann Neurol 32 (4): 551-4, 1992.  [PUBMED Abstract]

  13. Brouwers P: Neuropsychological abilities of long-term survivors of childhood leukemia. In: Aaronsen NK, Beckmann J, eds.: The Quality of Life of Cancer Patients. New York: Raven Press, 1987, pp 153-65. 

  14. Baker F, Denniston M, Smith T, et al.: Adult cancer survivors: how are they faring? Cancer 104 (11 Suppl): 2565-76, 2005.  [PUBMED Abstract]