© 2004 European Society for Medical Oncology
Fatigue in cancer patients receiving chemotherapy: an analysis of published studies
In their review article, Iop et al. [1
] carefully evaluated the usually overlooked problem of fatigue in cancer patients receiving chemotherapy, and they should be congratulated on their work. However, we would like to stress the point that cancer-related fatigue also occurs in patients after the time of therapy, and without any connection to the kind of chemotherapy they have received. Fatigue occurring during chemotherapy is predictable, unlike that which develops in patients who are not receiving chemotherapy, which can last years after chemotherapy. Usually this cancer-related fatigue is a non-specific, multidimensional construct characterized by debilitating lassitude unrestored by rest, decreased capacity in maintaining performance, generalized weakness defined as the anticipatory sensation of difficulty in starting a new activity, mental fatigue defined as the presence of impaired mental concentration, loss of memory and emotional lability. Sleep disorders are also frequently reported. Joly et al. [2] reported a statistically significant difference in chronic fatigue in long-term survivors of Hodgkin's disease in comparison with healthy controls. The fatigue levels in these patients remain high even years after treatment. In addition, Andrykowski et al. [3] and Broeckel et al. [4] found higher levels of fatigue, more weakness and less vitality following treatment for breast cancer compared with an age-matched group of woman with no history of cancer. This fatigue syndrome seems to be similar to the one observed in patients (without cancer) who are affected by chronic fatigue syndrome according to the CDC definition [5]. However, the definition of chronic fatigue syndrome is based on exclusion criteria, and cancer is one of the diseases that must be excluded prior to this diagnosis. In conclusion, during a follow-up visit medical oncologists should be aware of the fact that cancer-related fatigue could have developed in their patients and should therefore take care that this syndrome is not ignored.
Division of Medical Oncology A, National Cancer Institute, Aviano, Italy
* Email: oma{at}cro.it
References
1. Iop A, Manfredi AM, Bonura S. Fatigue in cancer patients receiving chemotherapy: an analysis of published studies. Ann Oncol 2004; 15: 712–720.
2. Joly F, Henry-Amar M, Arveux P et al. Late psychosocial sequelae in Hodgkin's disease survivors: a French population-based case-control study. J Clin Oncol 1996; 14: 2444–2453.[Abstract]
3. Andrykowski MA, Curran SL, Lightner R. Off-treatment fatigue in breast cancer survivors: a controlled comparison. J Behav Med 1998; 21: 1–18.[CrossRef][Web of Science][Medline]
4. Broeckel JA, Jacobsen PB, Horton J et al. Characteristics and correlates of fatigue after adjuvant chemotherapy for breast cancer. J Clin Oncol 1998; 16: 1689–1696.[Abstract]
5. Fukuda K, Straus SE, Hickie I et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study International Chronic Fatigue Syndrome Study Group. Ann Intern Med 1994; 121: 953–959.
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