A Practical Approach to Fatigue Management in Colorectal Cancer

Abstract

Cancer-related fatigue is serious and complex, as well as one of the most common symptoms experienced by patients with colorectal cancer, with the potential to compromise quality of life, activities of daily living, and ultimately survival. There is a lack of consensus about the definition of cancer-related fatigue; however, definitions have been put forward by the European Association for Palliative Care (EAPC) and the National Comprehensive Cancer Network (NCCN). Numerous cancer- and treatment-related factors can contribute to fatigue, including disease progression, comorbidities, medical complications such as anemia, side effects of other medications, and a number of physical and psychologic factors. This underlines the importance of tackling factors that may contribute to fatigue before reducing the dose of treatment. NCCN guidelines and the EAPC have proposed approaches to managing fatigue in cancer patients; however, relatively few therapeutic agents have been demonstrated to reduce fatigue in randomized controlled trials. It is recognized that physical activity produces many beneficial physiologic modifications to markers of physical performance that can help to counteract various causes of fatigue. In appropriately managed and monitored patients with colorectal cancer, emerging evidence indicates that exercise programs may have a favorable influence on cancer-related fatigue, quality of life, and clinical outcomes, and therefore may help patients tolerate chemotherapy. This review assesses fatigue in patients with colorectal cancer and proposes updates to a treatment algorithm that may help clinicians manage this common problem.

Body composition and its association with fatigue in the first 2 years after colorectal cancer diagnosis

“…Fatigue among cancer survivors is thought to have a multifactorial etiology. Fatigue has been associated with treatment (radio-and chemotherapy), stage of disease, presence of (multiple) comorbidities, specific medications with sedating side effects, psychological factors (e.g., depression), decreased physical activity, and malnutrition [2,[5][6][7]. Several studies investigated whether there was an association between obesity and fatigue among cancer patients.…”

Patient perspectives on supportive care in cancer: Results of the Calista 2 study

“…Forty per cent of patients report cancer‐related fatigue (CRF) at diagnosis, and 80%–90% experience treatment‐related fatigue (Aapro, Scotte, Bouillet, Currow, & Vigano, 2017; Berger, Mooney, & CB, 2019; Koornstra, Peters, Donofrio, van den Borne, & de Jong, 2014). The causes of CRF are multiple and complex, and the specific mechanisms have not all been identified (Aapro et al., 2017; Berger et al., 2019). It has been widely reported that CRF directly affects quality of life and survival in cancer (Aapro et al., 2017; Berger et al., 2019).…”

“…The causes of CRF are multiple and complex, and the specific mechanisms have not all been identified (Aapro et al., 2017; Berger et al., 2019). It has been widely reported that CRF directly affects quality of life and survival in cancer (Aapro et al., 2017; Berger et al., 2019). The VICAN 5 (INCa, 2018) study showed that if a patient's needs 6 months after the diagnosis are not successfully managed during the treatment period, they are likely to have a long‐term impact on outcomes (INCa, 2018).…”

“…Pharmacological management of CRF is limited (Aapro et al., 2017). Psychostimulants are the most widely used form of medication though with variable efficacy (Berger et al., 2019).…”

“…A number of studies and dedicated guidelines have highlighted measures for improving under‐recognition and under‐treatment of CRF with a double objective: first, to improve healthcare professionals’ knowledge of assessment techniques and potential interventions. Second, although 90% of cancer patients expect to experience CRF (Hofman et al., 2004), understanding the causes, consequences and importance of early reporting and everyday management is also crucial (Aapro et al., 2017; Berger et al., 2019; Koornstra et al., 2014; Pearson, Morris, & McKinstry, 2015). Patients may also benefit from nurse‐led supportive care (De Raaf et al., 2013; Kotronoulas et al., 2017; Stub, Quandt, Arcury, Sandberg, & Kristoffersen, 2017).…”