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Cancer-Related Fatigue

CRF is defined as a ‘distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.’ (NCCN)

Cancer-related fatigue (CRF) is one of the most common side effects experienced by patients with, and survivors of, cancer. It is more severe, more distressing and less likely to be relieved by rest than the tiredness or fatigue of daily life.

Specific to lymphomas, the 2018 Lymphoma Coalition Global Patient Survey on Lymphomas & and CLL found that 72% of patients experienced life-impacting fatigue.  The survey also revealed a greater prevalence of CRF in the later stages of lymphomas – relapse, remission and disease transformation – indicating that fatigue may get worse rather than better over time.

CRF is a symptom of cancer itself, as well as a side-effect of the therapies used to treat it. It can affect all aspects of a patient’s quality of life, including physically, mentally, emotionally or socially.

Cancer-related fatigue can be quite severe and often comes on suddenly. It is not usually a result of a person’s activities or their level of exertion.  Some people describe it as feeling weak, drained or washed out.

The following are signs of CRF:

  • Feeling tired and it does not get better with sleep or rest, it keeps coming back, or it becomes severe
  • Feeling more tired than usual during or after activity
  • Feeling tired and it is not related to an activity
  • Arms and legs feel heavy and hard to move
  • Having no energy and/or feeling weak
  • Spending more time in bed and/or sleeping more and/or having trouble sleeping
  • Having trouble concentrating or becoming confused
  • Experiencing tiredness that disrupts work, social life or daily routine

Treating fatigue as early as possible, either following diagnosis or at the beginning of cancer treatment, can help prevent CRF from becoming a long-term issue.

Patients with mild CRF should receive education and counselling related to CRF. As well, general fatigue management strategies, such as monitoring fatigue and conserving energy, have shown to be helpful.

In addition to education and counselling, patients with moderate to severe fatigue should be assessed to identify and treat any conditions or contributing factors, such as pain, anxiety, sleep disturbances, or other side-effects of cancer treatment.  If there are not any treatable factors, or if treatment is not working, patients should be referred to one or a combination of CRF-specific therapies based on their health status. These may include:

  • Physical activity
  • Nutritional consultation and counselling
  • Psychoeducation
  • Cognitive behavioural therapy (CBT)
  • Mindfulness based cognitive therapy (MBCT) or stress reduction (MBSR)
  • Mind-body interventions (yoga)
  • Bright white light therapy
  • Medications or supplements

After any therapy is introduced, patients must be re-screened and re-evaluated for the presence and severity of fatigue.

Read our report on Cancer-related Fatigue and patient resources below for more information.