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Cited by 1,666Cancer survivorship and careCancer-related cognitive impairment studiesChildhood Cancer Survivors' Quality of Life

Cancer-related fatigue—mechanisms, risk factors, and treatments

Open access
Bower, Julienne E.·2014·Nature Reviews Clinical Oncology
DOI 10.1038/nrclinonc.2014.127PMC PMC4664449
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Abstract

Fatigue is one of the most common adverse effects of cancer that might persist for years after treatment completion in otherwise healthy survivors. Cancer-related fatigue causes disruption in all aspects of quality of life and might be a risk factor of reduced survival. The prevalence and course of fatigue in patients with cancer have been well characterized and there is growing understanding of the underlying biological mechanisms. Inflammation seems to have a key role in fatigue before, during, and after cancer-treatment. However, there is a considerable variability in the presentation of cancer-related fatigue, much of which is not explained by disease-related or treatment-related characteristics, suggesting that host factors might be important in the development and persistence of this symptom. Indeed, longitudinal studies have identified genetic, biological, psychosocial, and behavioural risk factors associated with cancer-related fatigue. Although no current gold-standard treatment for fatigue is available, a variety of intervention approaches have shown beneficial effects in randomized controlled trials, including physical activity, psychosocial, mind-body, and pharmacological treatments. This Review describes the mechanisms, risk factors, and possible interventions for cancer-related fatigue, focusing on recent longitudinal studies and randomized trials that have targeted fatigued patients.

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Crossref · 10.1038/nrclinonc.2014.127

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  • Catastrophizing is generally associated with increased symptom intensity and emotional distress, and catastrophic thinking about fatigue strongly predicts continuous elevated fatigue levels.

    “Catastrophizing is generally associated with increased symptom intensity and emotional distress, and catastrophic thinking about fatigue strongly predicts continuous elevated fatigue levels.8,18”

    From Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer-related fatigue (2023) · cites this paper as [8]

    The ‘Coping and appraisal’ section reports that catastrophizing about fatigue was associated with higher fatigue levels in breast cancer patients and was among the strongest predictors of persistent elevations, including up to 42 months after treatment. It does not establish the broader claim that catastrophizing is generally associated with emotional distress or increased intensity of symptoms other than fatigue. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Cancer-related fatigue is one of the most frequent, persistent and disruptive adverse events experienced by breast cancer survivors, with prevalence rates varying from 25% to 99% depending on type of treatment and method of assessment.

    “Along with fear of cancer recurrence, cancer related fatigue has been reported as one of the most frequent, persistent and disruptive adverse events experienced by breast cancer survivors. Prevalence rates vary from 25% to 99% depending on the type of treatment received and method of assessment (Bower, 2014)”

    From A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol (2019) · cites this paper as Bower, 2014

    The Introduction describes fatigue as common, distressing, and sometimes persistent after cancer treatment, including among survivors. But its 25%–99% prevalence range applies to patients during treatment across different patient populations, not specifically to breast cancer survivors; it also names patient population as a factor in the range. (LLM, conf=0.89)

    Experimental — accuracy not yet measured

  • Fatigue in breast cancer survivors is associated with pre-treatment fatigue, pain, dyspnea, depression, physical inactivity, high body mass index, significant disability, health care utilization, and poor HRQoL.

    “Other studies have found an association between fatigue and pre-treatment fatigue (Bower, 2014), pain (Kim et al., 2008), dyspnea, depression, physical inactivity and high body mass index (Bower, 2014), significant disability and health care utilization (Goldstein et al., 2012) and poor HRQoL (Kim et al., 2008).”

    From A guided internet-delivered individually-tailored ACT-influenced cognitive behavioural intervention to improve psychosocial outcomes in breast cancer survivors (iNNOVBC): Study protocol (2019) · cites this paper as Bower, 2014

    The Risk Factors section identifies pre-treatment fatigue as a predictor of later fatigue and reports associations with depression, physical inactivity, and elevated BMI, including findings in breast cancer survivors. The passages located do not establish an association with dyspnea. Pain, disability, health care utilization, and poor HRQoL are attributed to other citations in the citing sentence, not to Bower. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Cancer-related fatigue (CRF) is a multi-factorial condition arising from a complex interplay of clinical, physiological, environmental, and psychosocial factors.

    “CRF is a multi-factorial condition affected by several interrelated protective and perpetuating factors.”

    From Exploring the dynamic interconnectedness of protective and perpetuating factors of cancer-related fatigue (2023) · cites this paper as [8]

  • These averages mask substantial individual differences in survivors' fatigue trajectories that warrant further assessment with responsive measures.

    “However, these averages mask substantial individual differences in survivors’ fatigue trajectories that warrant further assessment with responsive measures [1, 4].”

    From Comparative responsiveness and minimally important difference of fatigue symptom inventory (FSI) scales and the FSI-3 in trials with cancer survivors (2022) · cites this paper as [1]

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Research works printed but not linked: 1

  1. [111]Fagundes CP Lindgren ME Shapiro CL Kiecolt-Glaser JK Child maltreatment and breast cancer survivors: Social support makes a difference for quality of life, fatigue and cancer stress Eur J Cancer 2011 PMC3202655 21752636

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Authors
Bower, J. E.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Bower, Julienne E.
ORCID
Bower, Julienne E.
Venue
Nature Reviews Clinical Oncology
Publisher
Springer Science and Business Media LLC
Published
2014-08-12
Volume
11
Issue
10
Pages
597-609
ISSN
  • 1759-4774 (ISSN-L)
  • 1759-4782
DOI
10.1038/nrclinonc.2014.127
PMC
PMC4664449
OpenAlex
W2091917093
Cited by
1,666
References
187
Citations by year
2026: 207 · 2025: 225 · 2024: 159 · 2023: 195 · 2022: 193 · 2021: 193 · 2020: 147 · 2019: 111 · 2018: 76 · 2017: 61 · 2016: 56 · 2015: 40 · 2014: 2
FWCI
6.02
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Nature Reviews Clinical Oncology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Cancer Institute (R01CA160427)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
Keywords
cancer-related fatigue, inflammation, risk factors, genetic risk factors, psychosocial risk factors, behavioral risk factors, biological mechanisms, fatigue interventions, physical activity, mind-body interventions, pharmacotherapy, cancer survivors, quality of life, survival
MeSH terms
Fatigue, Humans, Inflammation, Longitudinal Studies, Neoplasms, Quality of Life, Risk Factors, Randomized Controlled Trials as Topic, Survivors

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