CANCER-RELATED FATIGUE

Evidence-based recommendation for surveillance of cancer-related fatigue a (IGHG b)

This page is part of the PanCare follow-up recommendations for surveillance of late effects. Click here, for more information on these recommendations.

Who is at risk for cancer-related fatigue?

All CAYA cancer survivors are at risk for cancer-related fatigue c

What surveillance modality should be used and at what frequency should it be performed?

All CAYA cancer survivors:

  • Medical history focused on survivors’ feelings of tiredness and exhaustion d
    regularly (at every long-term follow-up visit, or at general medical check-ups)

What should be done if there is an indication for cancer-related fatigue from the medical history?

  • Perform further testing with a validated fatigue measure e
  • Screen for physical problems that may cause fatigue f

What should be done if abnormalities are identified?

  • Refer to a specialist in fatigue (or more generic specialist such as a psychologist, physiotherapist, or other relevant specialist)
  • Discuss useful interventions g

a Cancer-related fatigue is defined as “a distressing, persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning”.

b This recommendation reflects the recommendations of the preliminary evidence-based IGHG Fatigue guideline. The guideline will be published in a peer-reviewed journal soon.

c Main risk factors for cancer-related fatigue in CAYA cancer survivors are psychological distress, late effects or health problems, pain, older age at follow-up and radiotherapy.

d Questions to ask: “Do you get tired easily?”, or “Are you too tired or exhausted to enjoy the things you like to do?”

e Ideally, the PROMIS Pediatric Fatigue Measure or the PedsQL Multidimensional Fatigue Scale.

f For example other late effects like cardiac dysfunction, endocrine dysfunction, pulmonary dysfunction, and renal dysfunction (IGHG guidelines under development); and/or other general causes like anaemia, arthritis, neuromuscular complications, pain, fever and/or infection, and nutritional deficiencies (list not conclusive).

g Physical activity, education about cancer-related fatigue, relaxation and mindfulness, cognitive behavioural therapy, adventure-based training.