Fatigue affects more patients for more of the time than any other symptom and is regarded by patients as being more important than either pain or nausea/vomiting.1
Up to 90% of cancer patients are affected2,3 receiving chemotherapy and/or radiation therapy, bone marrow transplantation, or treatment with immunotherapies.4,5 Approximately one-third of patients still experience fatigue after completion of therapy3,6 and symptoms may persist for months or years after treatment completion.7 Due to developments in cancer treatment associated with better treatment outcomes more patients with prolonged periods of fatigue are expected.4
Despite the high importance for patients:
Only 14% of patients were treated or received advice about the management of their fatigue.1*
*Cross-sectional, questionnaire-based patient survey
In a study examining patient self-reports on meal disturbances and food, only half of the study cohort were able to prepare a meal after returning home (independent from their fatigue status)10
In colorectal cancer outpatients referred for radiotherapy increased fatigue was significantly associated with poorer nutritional intake and nutritional status deterioration.11
Low protein intake (< 1 g/kg/day) is a powerful contributor to cancer-related fatigue after undergoing chemotherapy.12
Significant improvements in:
were shown in advanced cancer patients undergoing an interdisciplinary rehabilitation programme providing nutritional counselling alongside an exercise programme and dedicated symptom control.13,14
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References:
1) Stone P et al. Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer Fatigue Forum. Ann Oncol. 2000;11(8):971-5.
2) Campos MP et al. Cancer-related fatigue: a practical review. Ann Oncol. 2011;22(6):1273–9.
3) Schvartsman G et al. Could Objective Tests Be Used to Measure Fatigue in Patients With Advanced Cancer? J Pain Symptom Manage. 2017;54(2):237-44. pii: S0885-3924(16)31245-3. doi: 10.1016/j.jpainsymman.2016.12.343.
4) Berger AM et al. Cancer-Related Fatigue, Version 2.2015. J Natl Compr Canc Netw. 2015;13(8):1012-39.
5) Haanen JBAG et al. Management of toxicities from immunotherapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol.2017;28(suppl_4):iv119-iv142.
6) Bower JE et al. Screening, Assessment, and Management of Fatigue in Adult Survivors of Cancer: An American Society of Clinical Oncology Clinical Practice Guideline Adaptation. J Clin Oncol. 2014;32(17):1840-50.
7) Mustian KM et al. Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis. JAMA Oncol. 2017;3(7):961-8. doi: 10.1001/jamaoncol.2016.6914.
8) Hofman M et al. Cancer-Related Fatigue: The Scale of the Problem. Oncologist. 2007;12(suppl 1):4–10.
9) Curt GA et al. Impact of cancer-related fatigue on the lives of patients. Oncologist. 2000;5(5):353-60.
10) Guerdoux‑Ninot E et al. Meal context and food preferences in cancer patients: results from a French self‑report survey. Springerplus. 2016;5(1):810.
11) Ravasco P et al. Dietary Counseling Improves Patient Outcomes: A Prospective, Randomized, Controlled Trial in Colorectal Cancer Patients Undergoing Radiotherapy. J Clin Oncol. 2005;23(7):1431-8.
12) Stobäus N et al. Low Recent Protein Intake Predicts Cancer-Related Fatigue and Increased Mortality in Patients with Advanced Tumor Disease Undergoing Chemotherapy. Nutr Cancer. 2015;67(5):818-24.
13) Gagnon B et al. A prospective evaluation of an interdisciplinary nutrition–rehabilitation program for patients with advanced cancer. Curr Oncol. 2013;20(6):310-8.
14) Chasen MR et al. An interprofessional palliative care oncology rehabilitation program: effects on function and predictors of program completion. Curr Oncol. 2013;20(6):301-9.
