Why is managing fatigue important?
Fatigue can affect your quality of life, keeping you not only from recreational activities you enjoy but also from working or providing care for children, elders, pets, or others in your life. Fatigue can keep you from taking care of your own basic needs, such as preparing meals, overseeing your well-being, and paying bills. It can also interfere with your ability to socialize with the people you need for support, isolating you when you most need help and companionship.
In extreme cases, fatigue may cause a person with cancer to stop treatment. Managing fatigue may allow you to complete treatment to achieve its full benefits.
Connections to body terrain
Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of lower immune function among women with breast cancer with higher fatigue or depression and lower social support
- Lower natural killer cell (NK) activity, which relates to worse prognosis, among women with breast cancer with higher fatigue or depression and lower social support in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study1Levy SR, Herberman ML et al. Correlation of stress factors with sustained depression of natural killer cell activity and predicted prognosis in patients with breast cancer. Journal of Clinical Oncology. 1987 Mar;5(3):348-53.
Connections to symptoms and side effects
Modest evidencesignificant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of a link between pain and fatigue among people with cancer
The relationship between pain and fatigue is bidirectional—each can trigger and impact the other.2Theobald DE. Cancer pain, fatigue, distress, and insomnia in cancer patients. Clinical Cornerstone. 2004;6 Suppl 1D:S15-21.
- Higher levels of fatigue among people with breast or prostate cancer with increased pain in an observational analysis of a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects3Charalambous A, Giannakopoulou M, Bozas E, Paikousis L. Parallel and serial mediation analysis between pain, anxiety, depression, fatigue and nausea, vomiting and retching within a randomised controlled trial in patients with breast and prostate cancer. BMJ Open. 2019 Jan 24;9(1):e026809.
- Higher risk of fatigue among people with newly diagnosed metastatic solid tumors and with pain compared to people without pain in a secondary analysis of a mid-sized observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study4de la O Murillo A, Torres AC et al. Association of pain with the presence of additional supportive care (SC) needs in patients with advanced cancer. Journal of Clinical Oncology. 2022 Jun 1;40(16_suppl):e24071-e24071.
- Higher fatigue scores among older people with cancer living at home with high pain scores compared to people with lower pain scores in a mid-sized observational study5Solvik E, Ytrehus S, Utne I, Grov EK. Pain, fatigue, anxiety and depression in older home‐dwelling people with cancer. Nursing Open. 2019 Nov 5;7(1):430-438.
- Increasing risk of fatigue among people with metastatic breast cancer with increasing pain intensity or frequency in a small observational study6Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer. 1994 Nov 1;74(9):2570-8.