Cancer-related fatigue (CRF)

Cancer-Related Fatigue (CRF) is one of the most common and debilitating symptoms reported by those who are undergoing cancer treatment and also those who have finished treatment.

What is cancer-related fatigue (CRF)?

Over 80% of individuals who receive chemotherapy and/or radiotherapy will experience CRF, and of those individuals who have a diagnosis of metastatic disease, the prevalence of CRF exceeds 75%.

The characteristics of CRF are; feelings of tiredness, weakness, lack of energy, and it is distinct from the “normal” drowsiness experienced by healthy individuals i.e. not relieved by rest or sleep.  The fatigue that individuals experience is unlike the fatigue that an everyday person experiences, and can hugely affect their quality of life, ability to work, socialising with family and friends, cognitive ability, daily functioning and emotional wellbeing. CRF can persist for months or even years after treatment has been completed.

Managing CRF; activity pacing

Pacing of activities is essential for individuals with CRF to minimise exacerbations in their fatigue, through stabilising symptoms and energy.  Some people with CRF may take the approach of avoiding activity, leading to further deconditioning, while others adopt the ‘boom and bust cycle’ – when they are feeling ‘good’, they might have a tendency to overexert themselves either physically, cognitively or emotionally, resulting in exacerbation of their fatigue, which may impact on their psychological wellbeing.

Understanding that we have one tank of energy for all physical, cognitive and emotional activities is an important concept to grasp when planning activities throughout the day and week. 

Exercise prescription considerations for CRF

Exercise is safe when delivered appropriately to individuals suffering from CRF. Considerations to be made include:  

  • Scheduling exercise during times of least fatigue
  • Conservative progression in line with tolerance
  • Increased intra and inter-session recovery times
  • Initial low exercise dosage to ensure fatigue is not exacerbated by exercise
  • Series of short exercise bouts/ intervals
  • Monitoring overtraining (including unsupervised activity and activities of daily living)
  • Completion of an activity/ symptom diary may be useful to identify triggers and patterns of fatigue, which may assist with overall fatigue management.

People suffering from CRF would benefit from a holistic individualised exercise intervention with research demonstrating that routine exercise can improve sleep quality, concentration and psychological wellbeing.

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References

Bennett, B et al. (2007). The Experience of Cancer-Related Fatigue and Chronic Fatigue Syndrome: A Qualitative and Comparative Study. Journal of Pain and Symptom Management

Cramp, F et al (2012.). Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews

Hofman, M et al (2007). Cancer‐Related Fatigue: The Scale of the Problem. The Oncologist

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