The biology of cancer-related fatigue: a review of the literature

Abstract

Purpose Understanding the etiology of cancer-related fatigue (CRF) is critical to identify targets to develop therapies to reduce CRF burden. The goal of this systematic review was to expand on the initial work by the National Cancer Institute CRF Working Group to understand the state of the science of the biology of CRF. Specifically, to evaluate studies that examined the relationships between biomarkers and CRF, and to develop an etiologic model of CRF to guide researchers on pathways to explore or therapeutic targets to investigate. Methods This review was completed by the Multinational Association of Supportive Care in Cancer Fatigue Study Group – Biomarker Working Group. The initial search used three terms (biomarkers, fatigue, cancer), which yielded 11,129 articles. After removing duplicates, 7,175 articles remained. Titles were assessed for the keywords, “cancer” and “fatigue” resulting in 3,811 articles. Articles published before 2010 and those with samples <50 were excluded, leaving 75 articles for full-text review. Of the 75 articles, 25 were further excluded for not investigating the associations of biomarkers and CRF. Results Of the 47 articles reviewed, 25 were cross-sectional and 22 were longitudinal studies. Less than half (44%) were published recently (2010-2013). Almost half (46%) enrolled breast cancer participants. A majority of studies assessed fatigue using self-report questionnaires, and only two studies used clinical parameters to measure fatigue. Conclusions The findings from this review suggest that CRF is linked to immune/inflammatory, metabolic, neuroendocrine, and genetic biomarkers. We also identified gaps in knowledge and made recommendations for future research.

Effects of Dexamethasone and Placebo on Symptom Clusters in Advanced Cancer Patients: A Preliminary Report

“…The response in the same direction under treatment www.TheOncologist.com with dexamethasone in the FAD cluster may suggest that clustered symptoms have the same pathophysiology and thus respond to the same treatment. Because cytokine dysregulation is significantly associated with the pathophysiology of cancer-related fatigue, anorexia/cachexia, and depression [20,21,25,31,53,54], the beneficial effects of dexamethasone on the FAD cluster are probably due to the ability of the drug to inhibit these mediators. However, this hypothesis remains to be tested.…”

Equivalência de itens e semântica da versão brasileira do EORTC QLQ-FA13

“…A compreensão da etiologia, da fadiga relacionada ao câncer é importante para identificar pontos de intervenção e desenvolver terapias para reduzi-la 6 . Nesse sentido, instrumentos diagnósticos, seja para a fadiga em geral, seja para dimensões específicas, permite que pesquisadores possam explorar melhor esse construto.…”

The effects of dexamethasone and placebo on symptom clusters in advanced cancer patients: A preliminary report.

“…Because cytokine dysregulation is significantly associated with the pathophysiology of cancer-related fatigue, anorexia/cachexia, and depression [20,21,25,31,53,54], the beneficial effects of dexamethasone on the FAD cluster are probably due to the ability of the drug to inhibit these mediators. However, this hypothesis remains to be tested.…”

“…However, for the symptoms mentioned in the preceding paragraph, evolving evidence points to the central role of proinflammatory cytokines in their causation and worsening [16][17][18][19][20][21][22][23][24]. Yet several studies suggest only a modest association of proinflammatory cytokines with cancer-related pain, fatigue, anorexia, and depression [21,[25][26][27][28][29][30][31]. These cytokines are presumed to be secreted by the tumor and host in response to the disease and its treatments, including radiation therapy and chemotherapy.…”