Treatment Of Cancer-related Fatigue Research Articles

The Correlation of Traditional Chinese Medicine Deficiency Syndromes, Cancer Related Fatigue, and Quality of Life in Breast Cancer Patients

BackgroundTo evaluate the correlation between the different traditional chinese medicine (TCM) deficiency syndromes, cancer related fatigue (CRF), and quality of life (QoL) in breast cancer patients. Patients and methodsNinety-five breast cancer patients were categorized into different qi (氣 qì), blood (血 xuè), yin (陰 yin), and yang (陽 yáng) TCM deficiency syndrome groups (DSGs). We used the ICD-10 for diagnosing CRF. The QoL was assessed by the WHO-BREF and Short Form Health Survey (SF12) questionnaires. The major outcome was to compare the QoL scores between the different TCM DSGs. The second outcome was the intergroup analysis between the CRF and different TCM DSGs in breast cancer patients. ResultsThe patients with qi deficiency (氣虛 qì xu) had a higher correlation with CRF (p=0.001) and poorer QoL both in the WHO-BREF and SF12 survey (p<0.001), whereas the patients with yin deficiency (陰虛 yin xu) had poorer QoL in the psychological (p=0.02) and social aspects (p=0.04). The qi deficiency (氣虛 qì xu) syndrome was closely associated with yin deficiency syndrome (陰虛 yin xu). (p=0.03). ConclusionOur study confirmed the concept of Qi-deficiency (氣虛 qì xu) in TCM was associated with CRF as identified in cancer care in western medicine. The breast cancer patients with qi deficiency (氣虛 qì xu) have poorer QoL. Treatment of CRF and improving QoL by supplying qi (氣 qì) may warrant further investigation.

Dexamethasone (DM) for cancer-related fatigue: A double-blinded, randomized, placebo-controlled trial.

9002 Background: Cancer-related-fatigue (CRF) is the most common and distressing symptoms in patients with advanced cancer. Currently, there is no standard treatment for CRF. Although corticosteroids have been used in the treatment of CRF, there are no well-powered placebo-controlled trials that used a validated CRF outcome measure. The primary objective of this prospective, randomized, double-blind, placebo-controlled study is to compare the effect of DM versus placebo on CRF. Methods: Advanced cancer patients with fatigue ≥ 4/10 on the Edmonton Symptom Assessment Scale (ESAS) and at least 2 other CRF-related symptoms (pain, nausea, appetite, depression, anxiety or sleep disturbance ≥ 4/10), normal cognition, no infections and hemoglobin ≥ 9 g/L were eligible for enrollment. Patients were randomized to either receive dexamethasone 4 mg orally twice a day for 15 days (primary end point) or matching placebo. The primary outcome was the day 15 change in Functional Assessment of Chronic Illness-Fatigue (FACIT-F) subscale scores. Differences in the group means (normal distribution) were analyzed using the two-sample t-test. Results: In 83 evaluable patients (43 DM and 40 placebo), median age was 60 years, 61% were white, and 53% were female. There was no difference in the demographics and fatigue (FACIT-F subscale) between DM and placebo groups except for sex (p=0.02). The mean (SD) FACIT-F subscores at baseline and at day 15 for DM were 18 (11) and 27 (11) (p&lt;0.001) and for placebo were 21 (9) and 24 (12) (p=0.06), respectively. Mean improvement in FACIT-F subscale was significantly higher in the DM group compared to placebo (9.6 (11) vs. 3.1 (9.7), p=0.005). We found a significant difference in ESAS physical distress (p=0.02), but no differences in ESAS overall symptom distress (p=0.11) and ESAS psychological distress (P=0.88) between DM and placebo. There were insignificantly higher numbers of grade ≥3 toxicities in patients who received DM than in patients who received placebo (20/42 vs. 18/47, p=0.37). Conclusions: Dexamethasone was more effective than placebo in reducing CRF in patients with advanced cancer. Long-term safety studies are needed.

Cancer‐related fatigue

Cancer-related fatigue (CRF) has been documented as 1 of the most distressing symptoms reported by breast cancer survivors. CRF affects functioning and impacts quality of life. Possible causal factors include physical conditions, affective and cognitive states, proinflammatory cytokines, and metabolic factors. Several common problems are associated with CRF in women with breast cancer, including treatment side effects, obesity, arm/upper quadrant symptoms, sleep disturbances, psychological effects, and comorbid conditions. In this article, the authors review the state of the knowledge regarding these issues and nonpharmacologic and pharmacologic interventions for CRF. Physical activity and psychosocial interventions are recommended for practice. Numerous limitations of past studies need to be considered in the design of future studies. CRF is prevalent in preoperative, postoperative, and ongoing surveillance phases. Throughout the continuum of care for women with breast cancer, clinicians must screen, further assess as indicated, and treat CRF, because it is associated with emotional distress and limits function and willingness to exercise.

Cancer-related fatigue: epidemiology, pathogenesis, diagnosis, and treatment.

Many cancer patients suffer from cancer-related fatigue (CRF) both during and after their treatment. CRF can arise at any point in the course of the disease and can be either self-limited or persistent, sometimes for years. It gives rise to a vicious circle of impaired physical performance, avoidance of exertion, inactivity, inadequate physical recovery, helplessness, and depressed mood. Its hallmarks are tiredness, exhaustion, and lack of energy; it can impair performance so severely that the patient is unable to work. It is associated with increased mortality. Cancer patients are hardly ever systematically asked about the symptoms and signs of CRF. The stress and impairments that it produces are often inadequately appreciated, and the opportunities for treatment often neglected. Selective review of the pertinent literature, including published guidelines from Germany and abroad. The pathogenesis of CRF is complex, involving an interaction of somatic, emotional, cognitive, and psychosocial factors, with a highly variable pattern of clinical expression. Clinical history-taking plays a key role in diagnostic assessment. Depressive disorders must be considered in the differential diagnosis. Many randomized trials and meta-analyses have documented the efficacy of pharmacological and non-pharmacological treatments for CRF. Cancer-related fatigue is a serious problem that impairs patients physically, mentally, and socially. Physicians need to know how to recognize and treat it.

Non-pharmacological interventions for cancer-related fatigue in men treated for prostate cancer: A systematic review.

Non-pharmacological interventions for cancer-related fatigue in men treated for prostate cancer: A systematic review.

Paulinia cupana (Guaraná) for the treatment of cancer related fatigue in patients undergoing radiation therapy or chemotherapy: a meta-analysis of three clinical trials

For cancer patients undergoing radiation therapy (RT) or systemic chemotherapy (CHT), cancer-related fatigue (CRF) is a common problem that can negatively impact their quality of life. Guarana (Paullinia cupana) is a plant native to the Amazon basin that has been used as a stimulant since pre-Columbian times. PURPOSE: To evaluate the effectiveness of guarana extract on fatigue in BC patients undergoing either CHT or RT. A total of 137 cancer patients (85% with Breast Cancer) undergoing either CHT (101) or RT (36) were randomized to receive either a placebo or guarana. In all 3 studies, the guarana was given as an unmanipulated dry extract at a dose of 75 mg PO QD in the first two studies or 50 mg PO BID in the third study. Patients were crossed over to the other experimental arm, and we evaluated fatigue with the Chalder Scale in all three studies. Guarana significantly improved the The Chalder Scale Global Scores (- 0.85; 95% CI:-1.31 to -0.40; p = 0.0002); Physical Fatigue Scores (-0.44; 95% CI: - 0.74 to - 0.13; p = 0.005) and Mental Fatigue Scores (-0.93; 95% CI: - 1.14 to - 0.72; p < 0.00001). Guarana did not produce any CTCAE grades 3 or 4 toxicities in any of the studies. Guarana is an effective, cheap and non-toxic alternative for the treatment of fatigue in cancer patients undergoing treatment.

Uso de modafinilo en astenia por cáncer avanzado

Modafinil is a psychostimulant with a different mechanism of action to other similar drugs. It is approved for the treatment of excessive daytime sleepiness in relation with several causes. It has also been used in neurology illness- related fatigue with positive results. There is an increasing interest in modafinil as a potentially effective drug to improve fatigue. Following the trend to use other psychostimulants (e.g.,methylphenidate) to improve symptomatic problems in Palliative Care, we performed a review with the aim of exploring the use of modafinil to alleviate cancer - related fatigue. We analysed modafinil articles published in the last ten years, with particular attention to the practical aspects of its use (type of patient, dose, secondary effects, etc.), as well as prospective studies and randomised trials on cancer-related fatigue. The pharmacological profile of Modafinil is appropiate for advanced cancer patients. Four prospective studies and three randomised trials have examined its use since 2005. Between 46-90% of the 157 patients treated with 200 mg of modafinil had a significant improvement in fatigue. There were significant improvements in fatigue in two of the three randomised trials. Modafinil had a good tolerance in all of them. These results justify further research into the treatment of cancer-related fatigue, and meanwhile modafinil could be considered as an alternative for cancer - related fatigue.

Thyrotropin-releasing hormone as a treatment for cancer-related fatigue: a randomized controlled study

Fatigue is a common and often disabling symptom for cancer patients. To date, no pharmacological interventions have shown reliable efficacy in treatment of cancer-related fatigue (CF). Thyrotropin-releasing hormone (TRH), a key regulator of homeostasis, exerts arousing and analeptic actions in instances of behavioral depression. In the present pilot, randomized, placebo-controlled, crossover study, we investigated the efficacy and safety of TRH as a treatment for CF. Patients with cancer experiencing significant fatigue without medically reversible causes were enrolled in this study. The primary outcome measure was the visual analog scale for energy (VAS-E) assessed at 3, 7, and 24 h post-study medication administration. Secondary outcome measures included the profile of mood states (POMS) questionnaire, a 6-min walking test, the hospital anxiety and depression scale, the Leeds sleep questionnaire, and assessment of quality of life using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Eight patients completed the study. TRH administration was associated with significant improvement in fatigue level as measured by the VAS-E, the fatigue and vigor subscales of the POMS, and the fatigue subscale of FACIT-F (p < 0.05). It was also associated with a positive impact on quality of life. TRH administration was associated with transient increases in blood pressure and heart rate. TRH administration was efficacious, safe, and tolerable in the treatment of CF with a positive impact on quality of life. These results provide a crucial impetus for pursuing TRH therapeutics to treat CF.

Cancer-related fatigue: prevalence, assessment and treatment strategies

Cancer-related fatigue (CRF) is one of the most common symptoms reported by patients and is defined as the feeling of extraordinary exhaustion associated with a high level of distress, disproportionate to the patients’ activity, and is not relieved by sleep or rest. Prevalence rates range from 59 to nearly 100% depending on the clinical status of the cancer. Except for chemotherapy-induced anemia, the mechanisms responsible for CRF are not yet completely understood. Therefore, CRF may be influenced by multiple possible somatic and psychosocial factors. CRF has been shown as either a short-term side effect of adjuvant cancer therapy or a chronic long-term late effect. Compared with other symptoms, such as pain or nausea, CRF is more distressing and often long lasting, with a strong impact on daily living and quality of life. The concept of fatigue has been widely elaborated and operationalized in different dimensions within the last few decades and specific instruments assessing fatigue in cancer populations have been developed. To support patients and alleviate CRF symptoms various treatment strategies are discussed in this article, including information and counseling, enhancement of activities, exercise and sports therapy, psychosocial interventions as well as pharmacological treatment. In most Western countries, treatment of CRF has been identified as a priority for advancing cancer patient care. This article gives an overview of the concept of CRF, its pathogenesis, assessment and treatment strategies.

An analysis of the role of paulinia cupana (Guaraná) in blood IL-1b and brain IL-6 levels as well as brain IL-6 and TNF-a mRNA expression in mice.

e21002 Background: Paulinia cupana also known as Guaraná is an amazonic plant which has been used for centuries as a tonic by indigenous populations. We have recently demonstrated that the dry crude extract of Guaraná is effective in preventing the treatment of cancer related fatigue (CRF) in breast cancer patients undergoing adjuvant chemotherapy. Of note, CRF patients have been associated with high blood levels of IL-1beta and IL-6. Methods: female Balb/c mice were divided in 8 groups each with 6 to 8 animals each and treated as follows: 1) Normal Saline PO; 2) Excipient PO; 3) Dexamethasone 1mg/kg subcutaneously (SC) (positive control group; 4-6) Guaraná purified Extract (PC18) at 30, 100 and 300 mg/kg PO; 7-8) Gurana dry crude extract at 100 and 300 mg/kg PO. All animals, except those from Group 1 received 100 ml (2.5 µg/mice) of intraperitoneal Escherichia coli Lipopolyssacaride (LPS). Animals were evaluated for social and exploratory interaction (Fishkin and Winslow, 1997) and motor activity (Dunn e Swiergiel, 2005) before (0) and at 2, 4, 8 and 24 hours after the LPS treatment. Levels of IL-1 beta and IL-6 were measured in the blood by ELISA 2 hours after LPS injection (N=5 animals per group) and the mRNA expression of IL-6, IL-12, TNF-alpha and INF-gama in the brain by quantitative real time RT-PCR 2 hours after LPS injection (N=5 animals per group). Results: We observed a statistically significant improvement in social interaction in animals treated with Guaraná extract. We observed no significant change in the IL-6 levels in the blood from animals that received Guarana extract, whereas plasma IL1-beta levels were significantly lower in the animals treated with Guaraná. Interestingly, Guaraná significantly suppressed the increase in brain IL-6 and TNF-alpha mRNA levels induced by LPS. Conclusions: Guaraná extract is effective to improve social behavior in animals treated with LPS which is associated with suppression of blood IL-1beta as well as IL-6 and TNF-alpha mRNA expression in the brain. Therefore, guarana extract may exhibit orally anti-inflammatory effects that might explain its anti-fatigue activity observed clinically in cancer patients.

Evaluation and management of fatigue in oncology: a multidimensional approach.

Fatigue, one of the most common symptoms experienced by cancer patients, is multidimensional and is associated with significant impairment in functioning and overall quality of life. Although the precise pathophysiology of cancer-related fatigue (CRF) is not well understood, a number of metabolic, cytokine, neurophysiologic, and endocrine changes have been described in these patients. A better understanding of these abnormalities is likely to lead to novel therapeutic interventions. Clinically, all patients presenting with significant fatigue should be evaluated for treatable conditions that might contribute to this symptom. Exercise and treatment of anemia are the two most established interventions for CRF. Psychostimulants seem promising based on early studies. Several complementary medicine treatments that showed efficacy in preliminary studies merit further testing.

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

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.

CANCER-RELATED FATIGUE

Cancer-related fatigue (CRF) is the most commonly reported symptom in patients with cancer with a prevalence up to 100%. It has a signifi cant negative impact on quality of life. An effective management of CRF could signifi cantly reduce the disease burden associated with cancer and its treatment. Unfortunately, the underlying pathophysiology is very complex and not uniform.This article reviews the possible therapy of contributing factors, nonpharmacological treatment, such as exercise and psychosocial interventions, and pharmacologic approaches in managing CRF. Numerous drugs, such as psychostimulants (methylphenidate, dexamphetamines, modafi nil and pemoline), antidepressants, corticosteroids, L-carnitine, donepezil and guarana have been studied. Methylphenidate, modafi nil and guarana show the most promising results so far. However, additional randomized, placebo-controlled trials are needed to determine the benefi t of these and other drugs in the treatment of CRF.

암 관련 피로(CRF: Cancer-related Fatigue)에 미치는 운동의 효과

It has been well known that the cancer-related fatigue(CRF) is one of the most common and distressing side-effects of cancer or/and cancer treatment. In this study, the author reviewed the epidemical, experimental or pilot studies on the prevalence of CRF, the etiology of CRF as well as the effects of exercise intervention for cancer patients with CRF. This study also tried to find any updated exercise guideline of exercise prescription for cancer patients and cancer survivors. To date, it seems that increased pro-inflammatory cytokine activity might be the most potential underlying mechanism of CRF. However, to elucidate the correct etiology of CRF, further controlled and well designed researches are required. Through the review about the effects of exercise intervention for CRF, the author also suggest strongly that exercise should be considered as the most effective approach to deal with CRF and other side effects as well as to improve the patient`s physical function and the quality of life. There are also very important task of developing the relevant and effective exercise program for cancer patients through the cooperation among the oncologists, exercise physiologists, fitness specialists.

Drug therapy for the management of cancer-related fatigue.

This is an updated version of the original Cochrane review published in issue 1 2008 (Minton 2008). Cancer-related fatigue (CRF) is common, under-recognised and difficult to treat. There have been studies looking at drug interventions to improve CRF but results have been conflicting depending on the population studied and outcome measures used. No previous reviews of this topic have been exhaustive or have synthesised all available data. To assess the efficacy of drugs for the management of CRF. We searched the Cochrane Central Register of Controlled Trials (from Issue 2 2007) MEDLINE and EMBASE from January 2007 to October 2009 and a selection of cancer journals. We searched references of identified articles and contacted authors to obtain unreported data. Studies were included in the review if they 1) assessed drug therapy for the management of CRF compared to placebo, usual care or a non-pharmacological intervention in 2) randomised controlled trials (RCT) of 3) adult patients with a clinical diagnosis of cancer. Two review authors independently assessed trial quality and extracted data. Meta-analyses were performed on different drug classes using continuous variable data. Fifty studies met the inclusion criteria. Six additional studies were identified since the original review. Only 31 of these studies involving 7104 participants were judged to have used a sufficiently robust measure of fatigue and thus were deemed suitable for detailed analysis. The drugs were still analysed by class (psychostimulants; haemopoietic growth factors; antidepressants and progestational steroids). Methylphenidate showed a small but significant improvement in fatigue over placebo (Z = 2.83; P = 0.005). Since the publication of the original review increased safety concerns have been raised regarding erythropoietin and this cannot now be recommended in practice.There was a very high degree of statistical and clinical heterogeneity in the trials and the reasons for this are discussed. There is increasing evidence that psychostimulant trials provide evidence for improvement in CRF at a clinically meaningful level. There is still a requirement for a large scale RCT of methylphenidate to confirm the preliminary results from this review. There is new safety data which indicates that the haemopoietic growth factors are associated with increased adverse outcomes. These drugs can no longer be recommended in the treatment of CRF. Readers of the first review should re-read the document in full.

Development of an Educational Intervention for Cancer-Related Fatigue

Introduction: Fatigue is one of the most common and disabling symptoms experienced during cancer treatment. Educational interventions are used by health professionals, such as occupational therapists, to manage cancer-related fatigue; however, there is a lack of information about the content, format and effectiveness of educational interventions in managing fatigue. This paper presents the development and structure of CAN-FIT, a theoretically driven cancer-related fatigue educational intervention, and a preliminary study of the intervention's feasibility and acceptability. Preliminary evaluation: The CAN-FIT programme was piloted with two groups with a total of nine radiotherapy patients. Patients completed a confidential evaluation form and were asked qualitative questions to provide feedback about the programme. The results of the preliminary study indicated that the intervention was acceptable to and feasible for participants. The participants reported that they received a high level of new information and skills from the education sessions and would recommend the sessions to others. Small modifications to programme components were made based on participant feedback. Conclusion: The CAN-FIT programme provided a feasible structured educational intervention for the management of cancer-related fatigue, which was acceptable to the participant sample. A randomised controlled trial is required to provide evidence of its effectiveness among the wider radiotherapy population.

Factors associated with response to methylphenidate in advanced cancer patients with cancer-related fatigue.

9005 Background: There is increasing interest in the use of methylphenidate (MP) for the treatment of cancer related fatigue. However there is limited literature on the patient specific factors associated with response to methylphenidate. Methods: In this study we reviewed patients who received MP as a part of two prospective controlled clinical trials on the use MP for cancer related fatigue conducted by our group, we defined clinical response as D FACIT-F score of ≥ 7 from baseline to day 8. Baseline patient characteristics and symptoms (as assessed by Edmonton Symptom Assessment Scale (ESAS) and response (change in fatigue) at the end of day 1 treatment were analyzed to determine their association with response to methylphenidate. Results: A total of 82 advanced cancer patients received MP. The median age was 55, 66% were female, 74% were white, most common cancer type was breast 37%. 63/82 (77%) patients were responders at Day 8 (primary end point). The intensity of baseline fatigue positively correlates with response to MP (p<0.001). Response to methylphenidate was not associated to intensity of baseline depression, anxiety drowsiness. Higher improvement of fatigue after MP treatment for 1 Day was associated with higher improvement of fatigue at Day 8 as assessed by FACIT-F (p = 0.0004) and ESAS (p = 0.0001). In addition 42/63(67%) patients with ESAS change of fatigue ≥ 1 after Day 1 treatment demonstrated a response of ≥ 7 points change in the FACIT-F score at Day 8 (p = 0.03). The positive predictive value, sensitivity and specificity of Day 1 response being a predictor of response to Day 7 response is 0.67, 0.84, and 0.6 respectively. Conclusions: In this study we found clinical response to methylphenidate in advanced cancer patients with fatigue to be 77% and response at Day 8 (primary end point) is associated with response at Day 1, and severity of baseline fatigue score. No significant financial relationships to disclose.

Does apathy impact cancer patient symptom burden?

e19598 Background: Apathy, or lack of motivation, has been little studied in cancer patients. Because interventions for Cancer-Related Fatigue (CRF) often include behavioral change and involve commitment to treatment, patient apathy may be detrimental to outcome success. We conducted an observational study in our CRF Clinic and report on 110 patients evaluated for apathy. Our objectives were to investigate associations between apathy and fatigue-related symptoms and determine if clinically apathetic patients differed from the non-apathetic in symptom burden. Methods: New CRF patients were evaluated for apathy using the Apathy Evaluation Scale, Clinician Version (AES-C) as primary outcome measure. The AES-C provides a continuous apathy score (range 18-72); scores can also be used to categorize patients as apathetic or non-apathetic (AES-C ≥ 38 reflects clinically significant apathy). To explore apathy and fatigue symptom associations, AES-C scores were correlated (Spearman's rho) with five symptoms commonly experienced by CRF patients (fatigue, pain, depression, anxiety, sleep disturbance), and level of symptom burden was compared (Mann-Whitney U) across apathetic vs. non-apathetic patients. Results: Of the 110 new CRF patients evaluated for apathy, median age was 60 years (range 24-92), 69% (n=76) were female, 76% (n=84) white, and 68% (n=75) married. The most frequent cancer diagnoses were breast (35%, n=38) and leukemia/lymphoma/myeloma (18%, n=20). Median apathy score was 26 (range 18-61), with 22% (n=24) identified as clinically apathetic. Apathy was statistically significantly (p<.05) associated with fatigue, depression, and anxiety (rho=.34, .48, .30, respectively). Apathetic patient symptom burden was statistically significantly (p<.05) greater than the non-apathetic for fatigue (BFI 7.2 vs. 5.6), depression (BDI-II 22.4 vs. 12.6), and anxiety (BAI 16.4 vs. 11.0). Conclusions: Patient apathy is associated with fatigue, depression, and anxiety, while patients identified as apathetic experience increased symptomatic burden. Thus, apathy may undermine patient CRF treatment objectives. Future investigations include determining factors involved in the development of patient apathy and identifying methods to reduce or eliminate it. No significant financial relationships to disclose.

Clinician report as source of apathy information on cancer-related fatigue (CRF) patients.

e19540 Background: Interventions for CRF require patient commitment, particularly if incorporating lifestyle change. Apathy, or lack of motivation, may diminish prospects for a successful outcome, yet few studies have addressed apathy in cancer patients. We conducted an observational study in our CRF Clinic and report on 79 patients evaluated for apathy. Our objective was to determine the apathy information source (clinician vs. patient) most associated with fatigue-related symptoms. Methods: New CRF patients were evaluated for apathy using the Apathy Evaluation Scale (AES); its scores (range 18-72) can be used to classify patients as apathetic or not (≥38 = clinically significant apathy). Two AES versions were employed: Clinician (AES-C) and Patient (AES-S). Scores and reliability were compared, then scores correlated (Spearman's rho) with five symptoms commonly experienced by CRF patients (fatigue, pain, depression, anxiety, sleep disturbance). Apathetic patient symptoms were compared (Mann-Whitney U) to non-apathetic per apathy measure, and agreement on apathy classification assessed. Results: 79 new CRF patients were evaluated for apathy by both clinician and patient. Median age was 59 years (range 26-84), 72% (n = 57) were female, 76% (n = 60) white, and 71% (n = 56) married. Leading cancer diagnoses were breast (37%, n = 29) and leukemia/lymphoma/myeloma (16%, n = 13). Median AES-C was 25 (range 18-61), with 19% (n = 15) clinically apathetic. AES-S range was 18-61, but median was 31 and 27% (n = 21) classified apathetic. Alpha reliability was .96 (AES-C) and .89 (AES-S). AES-C was correlated (p<.05) with fatigue (.27), depression (.41), and anxiety (.29); AES-S was correlated with depression (.49), anxiety (.33), and sleep disturbance (.26). Apathetic patients (AES-C) had greater fatigue (p =.021), depression (p =.001), and anxiety (p =.014) than non-apathetic. Apathetic patients (AES-S) had greater depression (p<.001) than non-apathetic. Apathy classification discordance was 18%. Conclusions: Clinician-reported apathy exhibited symptom correlations and greater discrimination of apathetic vs. not symptom burden. This suggests clinician-reported apathy may have important clinical and research use. No significant financial relationships to disclose.

Cancer-Related Fatigue: State of the Science

Abstract Cancer-related fatigue (CRF) is a disabling and distressing symptom that is highly prevalent across the cancer continuum from a patient's diagnosis and treatment through survivorship and end of life. It has a multifactorial etiology and significant individual variability in its clinical expression, determinants, and sequelae. Despite the significance of CRF, it is often underdiagnosed, and management is frequently suboptimal. This review synthesizes the state of the science concerning the features, possible mechanisms, and predictors of CRF; offers recommendations for the evaluation of CRF; and appraises the strength of the evidence for a wide range of pharmacologic and nonpharmacologic interventions to prevent and manage fatigue during and after cancer and its treatment. There is evidence from methodologically rigorous controlled trials that exercise, psycho-educational interventions, and cognitive-behavioral therapy for insomnia are effective in the treatment of CRF, and a wide range of pharmacologic and nonpharmacologic interventions has shown initial promise in single-arm pilot studies with small, heterogeneous samples. Rigorously designed and adequately powered randomized trials are warranted to (1) determine the effectiveness of promising approaches and (2) identify the interventions that are most effective in treating CRF in specific subpopulations (eg, stem cell transplant recipients, older adults, patients with lung or colorectal cancers, survivors, and those at the end of life). Studies to elucidate the biologic expression profiles of CRF, to explicate the mechanisms through which particular interventions impact CRF, and to identify the mediators and moderators of fatigue outcomes will ultimately permit individually tailored approaches for the treatment of CRF.