Studying Cancer-Related Fatigue: Report of the NCCN Scientific Research Committee

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NCCN convened a committee of experts to make recommendations for future studies of cancer-related fatigue (CRF). The committee reviewed the current data on the incidence, clinical measurement, and treatment of CRF. The assessment of fatigue is largely derived from self-report questionnaires that address the symptom of fatigue, and do not correlate the presence of fatigue with change in physical activity. The committee developed a self-report questionnaire, NCCN Fatigue and Contributing Factors Inventory, which incorporates assessments of fatigue, pain, difficulty sleeping, distress, physical activity, and concurrent medications. A clinical research study using this measure in conjunction with the NCCN Breast Cancer Outcomes Database Project is planned. The committee noted a strong interaction among fatigue, pain, difficulty sleeping, and distress and recommended that future clinical research address these interactions.

Correspondence: Joanne E. Mortimer, MD, City of Hope Comprehensive Cancer Center, 1500 East Duarte Road, Wing 1, Room 103, Duarte, CA 91010. E-mail: JMortimer@coh.org
  • 1.

    BarsevickAMCleelandCSManningDC. ASCPRO recommendations for the assessment of fatigue as an outcome in clinical trials. J Pain Symptom Manage2010;39:10861099.

    • Search Google Scholar
    • Export Citation
  • 2.

    BergerAAbernethyAAtkinsonA. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue. Version 1.2010. Available at: www.NCCN.org. Last accessed November 10 2010.

    • Search Google Scholar
    • Export Citation
  • 3.

    CellaDDavisKBreitbartWCurtG. Cancer-related fatigue: prevalence of proposed diagnostic criteria in a united states sample of cancer survivors. J Clin Oncol2001;19:33853391.

    • Search Google Scholar
    • Export Citation
  • 4.

    SadlerIJJacobsenPBBooth-JonesM. Preliminary evaluation of a clinical syndrome approach to assessing cancer-related fatigue. J Pain Symptom Manage2002;23:406416.

    • Search Google Scholar
    • Export Citation
  • 5.

    LoscalzoMJClarkKL. Problem-related distress in cancer patients drives requests for help: a prospective study. Oncology (Williston Park)2007;21:11331138.

    • Search Google Scholar
    • Export Citation
  • 6.

    SoWKMarshGLingWM. The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study. Oncol Nurs Forum2009;36:E205214.

    • Search Google Scholar
    • Export Citation
  • 7.

    Gaston-JohanssonFFall-DicksonJMBakosABKennedyMJ. Fatigue, pain, and depression in pre-autotransplant breast cancer patients. Cancer Pract1999;7:240247.

    • Search Google Scholar
    • Export Citation
  • 8.

    DittnerAJWesselySCBrownRG. The assessment of fatigue: a practical guide for clinicians and researchers. J Psychosom Res2004;56:157170.

    • Search Google Scholar
    • Export Citation
  • 9.

    WuHMcSweeneyM. Measurement of fatigue in people with cancer. Oncol Nurs Forum2001;28:13711384.

  • 10.

    HjollundNHAndersenJHBechP. Assessment of fatigue in chronic disease: a bibliographic study of fatigue measurement scales. Health Qual Life Outcomes2007;5:12.

    • Search Google Scholar
    • Export Citation
  • 11.

    JacobsenPB. Assessment of fatigue in cancer patients. J Natl Cancer Inst Monogr2004;32:9397.

  • 12.

    Jean-PierrePFigueroa-MoseleyCDKohliS. Assessment of cancer-related fatigue: implications for clinical diagnosis and treatment. Oncologist2007;12:1121.

    • Search Google Scholar
    • Export Citation
  • 13.

    MintonOStoneP. A systematic review of the scales used for the measurement of cancer-related fatigue (CRF). Ann Oncol2009;20:1725.

  • 14.

    BroderickJESchwartzJEVikingstadG. The accuracy of pain and fatigue items across different reporting periods. Pain2008;139:146157.

  • 15.

    YancikR. Cancer burden in the aged: an epidemiologic and demographic overview. Cancer1997;80:12731283.

  • 16.

    FriedLPTangenCMWalstonJ. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci2001;56:M146156.

  • 17.

    KangasMBovbjergDHMontgomeryGH. Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. Psychol Bull2008;134:700741.

    • Search Google Scholar
    • Export Citation
  • 18.

    CrampFDanielJ. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev2008:CD006145.

  • 19.

    GoedendorpMGielissenMVerhagenCBleijenbergG. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev2009:CD006953.

    • Search Google Scholar
    • Export Citation
  • 20.

    JacobsenPDonovanKVadaparampilSSmallB. Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. Health Psychol2007;26:660667.

    • Search Google Scholar
    • Export Citation
  • 21.

    American Society of Clinical Oncology. Coping with cancer-related fatigue. Available at: http://www.cancer.net/patient/All+About+Cancer/Cancer.Net+Feature+Articles/Side+Effects/Coping+With+Cancer-Related+Fatigue. Accessed November 10 2010.

    • Search Google Scholar
    • Export Citation
  • 22.

    RavascoPMonteiro-GrilloIVidalPMCamiloME. Dietary counseling improves patient outcomes: a prospective, randomized, controlled trial in colorectal cancer patients undergoing radiotherapy. J Clin Oncol2005;23:14311438.

    • Search Google Scholar
    • Export Citation
  • 23.

    DavidsonJMacLeanABrundageMSchulzeK. Sleep disturbance in cancer patients. Soc Sci Med2002;54:13091321.

  • 24.

    EscalanteCManzulloE. Cancer-related fatigue: the approach and treatment. J Gen Intern Med2009;24:412416.

  • 25.

    EpsteinDDirksenS. Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors. Oncol Nurs Forum2007;34:E5159.

    • Search Google Scholar
    • Export Citation
  • 26.

    EspieCAFlemingLCassidyJ. Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. J Clin Oncol2008;26:46514658.

    • Search Google Scholar
    • Export Citation
  • 27.

    SarhillNWalshDNelsonK. Methylphenidate for fatigue in advanced cancer: a prospective open-label pilot study. Am J Hosp Palliat Care2001;18:187192.

    • Search Google Scholar
    • Export Citation
  • 28.

    BrueraEValeroVDriverL. Patient-controlled methylphenidate for cancer fatigue: a double-blind, randomized, placebo-controlled trial. J Clin Oncol2006;24:20732078.

    • Search Google Scholar
    • Export Citation
  • 29.

    LowerEFleishmanSCooperA. A phase III, randomized placebo-controlled trial of the safety and efficacy of d-MPH as new treatment of fatigue and ``chemobrain'' in adult cancer patients [abstract]. J Clin Oncol2005;23(Suppl 1):Abstract 8000.

    • Search Google Scholar
    • Export Citation
  • 30.

    MintonORichardsonASharpeM. A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. J Natl Cancer Inst2008;100:11551166.

    • Search Google Scholar
    • Export Citation
  • 31.

    MoraskaARSoodADakhilSR. Phase III, randomized, double-blind, placebo-controlled study of long-acting methylphenidate for cancer-related fatigue: North Central Cancer Treatment Group NCCTG-N05C7 Trial. J Clin Oncol2010;28:36733679.

    • Search Google Scholar
    • Export Citation
  • 32.

    Provigil [package insert]. Frazer, PA: Cepahlon; 2009.

  • 33.

    MorrowGGilliesLHickokJ. The positive effect of the psychostimulant modafinil on fatigue from cancer that persists after treatment is completed [abstract]. J Clin Oncol2005;23(Suppl 1):Abstract 8012.

    • Search Google Scholar
    • Export Citation
  • 34.

    MorrowGJean-PierrePRoscoeJ. A phase III randomized, placebo-controlled, double-blind trial of a eugeroic agent in 642 cancer patients reporting fatigue during chemotherapy: a URCC CCOP study [abstract]. J Clin Oncol2008;26(Suppl 1):Abstract 9512.

    • Search Google Scholar
    • Export Citation
  • 35.

    SpathisADhillanRBoodenD. Modafinil for the treatment of fatigue in lung cancer: a pilot study. Palliat Med2009;23:325331.

  • 36.

    BlackhallLPetroniGShuJ. A pilot study evaluating the safety and efficacy of modafinil for cancer-related fatigue. J Palliat Med2009;12:433439.

    • Search Google Scholar
    • Export Citation
  • 37.

    MoertelCSchuttAReitemeierRHahnR. Corticosteroid therapy of preterminal gastrointestinal cancer. Cancer1974;33:16071609.

  • 38.

    Della CunaGRPellegriniAPiazziM. Effect of methylprednisolone sodium succinate on quality of life in preterminal cancer patients: a placebo-controlled, multicenter study. The Methylprednisolone Preterminal Cancer Study Group. Eur J Cancer Clin Oncol1989;25:18171821.

    • Search Google Scholar
    • Export Citation
  • 39.

    JunejaVKeeganPGootenbergJ. Continuing reassessment of the risks of erythropoiesis-stimulating agents in patients with cancer. Clin Cancer Res2008;14:32423247.

    • Search Google Scholar
    • Export Citation
  • 40.

    MendozaTRWangXSCleelandCS. The rapid assessment of fatigue severity in cancer patients. Cancer1999;85:11861196.

  • 41.

    WelsteinLDementWRedingtonDGuilleminaultC. Insomnia in the San Francisco Bay Area: a telephone survey. In: GuilleminaultCLugaresiE eds. Sleep/Wake Disorders: Natural History Epidemiology and Long-Term Evolution. New York, NY: Raven Press; 1983:7385.

    • Search Google Scholar
    • Export Citation
  • 42.

    SwarmRAbernethyAAnghelescuDL. NCCN Clinical Practice Guidelines in Oncology: Adult Cancer Pain. Version 1.2010. Available at: http://www.nccn.org/professionals/physician_gls/PDF/pain.pdf. Accessed November 10 2010.

    • Search Google Scholar
    • Export Citation
  • 43.

    HollandJCAndersenBBreitbartWS. NCCN Clinical Practice Guidelines in Oncology: Distress Management. Version 1.2011. Available at: http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf. Accessed November 10 2010.

    • Search Google Scholar
    • Export Citation
  • 44.

    California Teachers Study. Available at: http://www.calteachersstudy.org/surveys.html. Accessed November 10 2010.

  • 45.

    RyanJLCarrollJKRyanEP. Mechanisms of cancer-related fatigue. Oncologist2007;12:2234.

  • 46.

    StasiRAbrianiLBeccagliaP. Cancer-related fatigue: evolving concepts in evaluation and treatment. Cancer2003;98:17861801.

  • 47.

    YellenSBCellaDFWebsterK. Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system. J Pain Symptom Manage1997;13:6374.

    • Search Google Scholar
    • Export Citation
  • 48.

    McNairDLorrM. EITS Manual for the Profile of Mood States. San Diego, CA: Education and Testing Service; 1971.

  • 49.

    PiperBDibbleSDoddM. The Revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum1998;25:677684.

    • Search Google Scholar
    • Export Citation
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