Fatigue is one of the most common and distressing symptoms experienced by people with cancer, occurring in up to 80% of people having treatment. Cancer-related fatigue (CRF) is characterized by a subjective feeling of tiredness, weakness, or lack of energy. It is different from the usual tiredness experienced after exertion, as it is not relieved by rest. It tends to be pervasive and affects both mental processes, like concentration and attention, and physical processes, restricting activities and potentially leading to social isolation. It is associated with all forms of cancer treatments, including surgery, radiotherapy, chemotherapy, and biological therapies. In spite of this, the underlying processes and pathophysiology of CRF are not fully understood. Assessment of fatigue can be based on simple questions about its presence and the severity and effects on function, rating on a scale of 0 to 10, or it can be rated by the patient as mild, moderate, or severe. Those reporting moderate to severe fatigue should receive a more detailed fatigue assessment. Many of the fatigue management strategies are psychosocial or behavioural, so education and counselling are central to the effective management of fatigue. Psychosocial interventions include education, exercise and activity, energy conservation, sleep hygiene, attention-restoring interventions, and psychological treatments. The most commonly used pharmacological approaches include: psychostimulants, antidepressants, corticosteroids, treatments for anaemia, and progestogens.
