Cancer-related fatigue (CRF) has deleterious effects on physical, social, cognitive, and vocational functioning, and causes emotional and spiritual distress for patients and their families; however, it remains under-recognized and undertreated. This article critically reviews and integrates the available empirical evidence supporting the efficacy of pharmacologic and nonpharmacologic treatment approaches to CRF, highlighting new evidence since 2007 and 2009 Putting Evidence Into Practice publications. Interventions that are recommended for practice or likely to be effective in improving fatigue outcomes include exercise; screening for treatable risk factors; management of concurrent symptoms; yoga; structured rehabilitation; Wisconsin ginseng; cognitive-behavioral therapies for insomnia, pain, and depression; mindfulness-based stress reduction; and psychoeducational interventions such as anticipatory guidance, psychosocial support, and energy conservation and activity management. This information can be applied to improve the management of CRF, inform health policy and program development, shape the design of clinical trials of new therapies for CRF, and drive basic and translational research.

Management of treatment side effects, including fatigue, may help patients remain in the workforce during radiation.

Abstract

Undergoing a course of radiation therapy for cancer does not preclude the need to work during treatment. This study examines the impact of sick leave benefits, individual characteristics, and fatigue on employment during radiation therapy. The conceptual model of nursing and health policy (CMNHP) and the Piper integrated fatigue model (IFM) guided this study. Seventy-seven study participants receiving radiation therapy were recruited from one community hospital. The study employed a prospective, longitudinal design. Data were collected at baseline prior to starting radiation therapy, weekly during treatment, and at the 1-month follow-up visit. Only 49% of study participants had paid sick leave benefits available at the start of radiation. Age, pain, gender, side effects, availability of sick leave benefits, and fatigue were associated with work along the trajectory of radiation therapy. Further research addressing the impact of paid leave policies on the relation between work and cancer-related fatigue is warranted.

Management of side effects of treatment, including fatigue, and supporting patients' need to work or not work during treatment may help patients continue to perform activities that are important to them during radiation therapy.