Abstract
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) and Cancer-Related Fatigue (CRF) are syndromes with considerable overlap with respect to symptoms. There have been many studies that have compared the two conditions, and some of this research suggests that the etiologies of the conditions are linked in some cases. In this narrative review, CFS/ME and cancer are introduced, along with their known and putative mechanistic connections to multiple stressors including ionizing radiation. Next, we summarize findings from the literature that suggest the involvement of HPA-axis dysfunction, the serotonergic system, cytokines and inflammation, metabolic insufficiency and mitochondrial dysfunction, and genetic changes in CRF and CFS/ME. We further suspect that the manifestation of fatigue in both diseases and its causes could indicate that CRF and CFS/ME lie on a continuum of potential biological effects which occur in response to stress. The response to this stress likely varies depending on predisposing factors such as genetic background. Finally, future research ideas are suggested with a focus on determining if common biomarkers exist in CFS/ME patients and those afflicted with CRF. Both CFS/ME and CRF are relatively heterogenous syndromes, however, it is our hope that this review assists in future research attempting to elucidate the commonalities between CRF and CFS/ME.
Highlights
HPA-Axis DysfunctionDysfunction of the hypothalamus-pituitary-adrenal (HPA) axis has been suggested as a contributing factor in the underlying etiology of both Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) and Cancer-Related Fatigue (CRF)
Introduction to Chronic FatigueSyndrome/Myalgic Encephalomyelitis (CFS/ME)Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a variably severe disease that presents clinically as a multi-symptom, recurring illness [1]
A survey of approximately 800 general physicians in the United Kingdom revealed that 48% did not feel confident diagnosing the disease and 41% did not feel confident in the available treatments [28]. Another survey of physicians in the United States from 2010 found that the majority (80%) could correctly identify chronic fatigue syndrome (CFS)/ME symptoms, while 40% had given a diagnosis of CFS/ME at some point in their medical practice; this indicates that attitudes towards the illness in healthcare may be changing, with increased awareness and greatly reduced negative attitudes compared to previous years [29]
Summary
Dysfunction of the hypothalamus-pituitary-adrenal (HPA) axis has been suggested as a contributing factor in the underlying etiology of both CFS/ME and CRF. Numerous studies on a myriad of biological parameters that could potentially induce fatigue—including hemoglobin, albumin, and thyroid hormone levels—have been mostly fruitless in explaining the fatigue syndrome in cancer patients [144]. This could reflect a heterogenous etiology in CRF, as we suspect the same for CFS/ME. As with CFS/ME, further research is needed to establish a causal relationship between CRF and HPA axis dysfunction
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