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Cancer-related fatigue—mechanisms, risk factors, and treatments
Open accessAbstract
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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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
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“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]
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“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]
In the citing paper
“On average, fatigue tends to increase during cancer treatment and remit within 1 year following treatment [1, 33].”
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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Metadata
- 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
- Published
- 2014-08-12
- Volume
- 11
- Issue
- 10
- Pages
- 597-609
- ISSN
- 1759-4774 (ISSN-L)
- 1759-4782
- 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
- green
- www.ncbi.nlm.nih.gov
- 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 › Oncology › 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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