Advertisement

Cancer-related fatigue

Published:April 01, 2008DOI:https://doi.org/10.1016/j.ejca.2008.02.037

      Abstract

      Fatigue is a common symptom in patients with cancer and in disease-free survivors. It has a significant impact on the quality of life. Although subjective fatigue is often related to objective changes in physical functioning or impaired performance status, the two phenomena are not synonymous and need to be distinguished. A number of robust and reliable assessment instruments to measure fatigue severity are now available and criteria for cancer-related fatigue syndrome have been proposed. The underlying mechanisms and pathophysiology of cancer-related fatigue are unclear. Management strategies include the use of psycho-educational interventions, exercise programmes and pharmacological treatments. The best evidence for the effectiveness of drug treatments is for the haematopoietic agents in anaemic patients undergoing chemotherapy and for methylphenidate in an on-treatment population.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ream E.
        • Richardson A.
        Fatigue: a concept analysis.
        Int J Nurs Stud. 1996; 33: 519-529
        • Cella D.
        • Lai J.S.
        • Chang C.H.
        • Peterman A.
        • Slavin M.
        Fatigue in cancer patients compared with fatigue in the general United States population.
        Cancer. 2002; 94: 528-538
        • Berger A.M.
        • Walker S.N.
        An explanatory model of fatigue in women receiving adjuvant breast cancer chemotherapy.
        Nurs Res. 2001; 50: 42-52
        • Stone P.
        • Hardy J.
        • Broadley K.
        • Tookman A.J.
        • Kurowska A.
        • A’Hern R.
        Fatigue in advanced cancer: a prospective controlled cross-sectional study.
        Br J Cancer. 1999; 79: 1479-1486
        • Cimprich B.
        Attentional fatigue following breast cancer surgery.
        Res Nurs Health. 1992; 15: 199-207
        • Roscoe J.A.
        • Morrow G.R.
        • Hickok J.T.
        • et al.
        Temporal interrelationships among fatigue, circadian rhythm and depression in breast cancer patients undergoing chemotherapy treatment.
        Support Care Cancer. 2002; 10: 329-336
        • Geinitz H.
        • Zimmermann F.B.
        • Stoll P.
        • et al.
        Fatigue, serum cytokine levels, and blood cell counts during radiotherapy of patients with breast cancer.
        Int J Radiat Oncol Biol Phys. 2001; 51: 691-698
        • Servaes P.
        • Gielissen M.
        • Verhagen S.
        • Bleijenberg G.
        The course of severe fatigue in disease-free breast cancer patients: a longitudinal study.
        Psycho-oncology. 2007; 16: 787-795
        • Radbruch L.
        • Strasser F.
        • Elsner F.
        • et al.
        Fatigue in palliative care patients – an EAPC approach.
        Palliat Med. 2008; 22: 13-32
        • Aaronson N.K.
        • Ahmedzai S.
        • Bergman B.
        • et al.
        The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.
        J Natl Cancer Inst. 1993; 85: 365-376
        • Kirsh K.L.
        • Passik S.
        • Holtsclaw E.
        • Donaghy K.
        • Theobald D.
        I get tired for no reason: a single item screening for cancer-related fatigue.
        J Pain Symptom Manage. 2001; 22: 931-937
        • Glaus A.
        Assessment of fatigue in cancer and non-cancer patients and in healthy individuals.
        Support Care Cancer. 1993; 1: 305-315
        • Chang V.T.
        • Hwang S.S.
        • Feuerman M.
        • Chang V.T.
        • Hwang S.S.
        • Feuerman M.
        Validation of the Edmonton Symptom Assessment Scale.
        Cancer. 2000; 88: 2164-2171
      1. NCCN. Clinical practice guidelines in oncology. Cancer related fatigue. <http://www.nccn.org> [accessed 8th January 2008].

        • Chalder T.
        • Berelowitz G.
        • Pawlikowska T.
        • et al.
        Development of a Fatigue Scale.
        J Psychosom Res. 1993; 37: 147-153
        • Smets E.M.
        • Garssen B.
        • Bonke B.
        • De Haes J.C.
        The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue.
        J Psychosom Res. 1995; 39: 315-325
        • Cella D.
        The Functional Assessment of Cancer Therapy-Anemia (FACT-An) Scale: a new tool for the assessment of outcomes in cancer anemia and fatigue.
        Semin Hematol. 1997; 34: 13-19
        • Glaus A.
        Fatigue in patients with cancer. Analysis and assessment. Recent results.
        Cancer Res. 1998; 145: 1-172
        • Hann D.M.
        • Jacobsen P.B.
        • Azzarello L.M.
        • et al.
        Measurement of fatigue in cancer patients: development and validation of the Fatigue Symptom Inventory.
        Qual Life Res. 1998; 7: 301-310
        • Piper B.F.
        • Dibble S.L.
        • Dodd M.J.
        • Weiss M.C.
        • Slaughter R.E.
        • Paul S.M.
        The revised Piper Fatigue Scale: psychometric evaluation in women with breast cancer.
        Oncol Nurs Forum. 1998; 25: 677-684
        • Schwartz A.L.
        The Schwartz Cancer Fatigue Scale: testing reliability and validity.
        Oncol Nurs Forum. 1998; 25: 711-717
        • Stein K.D.
        • Martin S.C.
        • Hann D.M.
        • Jacobsen P.B.
        A multidimensional measure of fatigue for use with cancer patients.
        Cancer Pract. 1998; 6: 143-152
        • Mendoza T.R.
        • Wang X.S.
        • Cleeland C.S.
        • et al.
        The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory.
        Cancer. 1999; 85: 1186-1196
        • Hann D.M.
        • Denniston M.M.
        • Baker F.
        Measurement of fatigue in cancer patients: further validation of the Fatigue Symptom Inventory.
        Qual Life Res. 2000; 9: 847-854
        • Holley S.K.
        Evaluating patient distress from cancer-related fatigue: an instrument development study.
        Oncol Nurs Forum. 2000; 27: 1425-1431
        • Okuyama T.
        • Akechi T.
        • Kugaya A.
        • et al.
        Development and validation of the cancer fatigue scale: a brief, three-dimensional, self-rating scale for assessment of fatigue in cancer patients.
        J Pain Symptom Manage. 2000; 19: 5-14
      2. FACIT. Functional assessment of chronic illness therapy web-site. www.facit.org [accessed 8th January 2008].

        • Bennett B.
        • Goldstein D.
        • Lloyd A.
        • Davenport T.
        • Hickie I.
        Fatigue and psychological distress – exploring the relationship in women treated for breast cancer.
        Eur J Cancer. 2004; 40: 1689-1695
        • Tchen N.
        • Juffs H.G.
        • Downie F.P.
        • et al.
        Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer.
        J Clin Oncol. 2003; 21: 4175-4183
        • Cella D.
        • Zagari M.J.
        • Vandoros C.
        • Gagnon D.D.
        • Hurtz H.J.
        • Nortier J.W.
        Epoetin alfa treatment results in clinically significant improvements in quality of life in anemic cancer patients when referenced to the general population.
        J Clin Oncol. 2003; 21: 366-373
        • Crawford J.
        • Cella D.
        • Cleeland C.S.
        • et al.
        Relationship between changes in hemoglobin level and quality of life during chemotherapy in anemic cancer patients receiving epoetin alfa therapy.
        Cancer. 2002; 95: 888-895
        • Stone P.
        • Richardson A.
        • Ream E.
        • Smith A.G.
        • Kerr D.J.
        • Kearney N.
        Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer fatigue forum.
        Ann Oncol. 2000; 11: 971-975
        • Murphy H.
        • Alexander S.
        • Stone P.
        • Murphy H.
        • Alexander S.
        • Stone P.
        Investigation of diagnostic criteria for cancer-related fatigue syndrome in patients with advanced cancer: a feasibility study.
        Palliat Med. 2006; 20: 413-418
        • Hwang S.
        • Chang V.
        • Kasimis B.
        A comparison of three fatigue measures in veterans with cancer.
        Cancer Invest. 2003; 21: 363-373
        • Cella D.
        • Eton D.T.
        • Lai J.S.
        • Peterman A.H.
        • Merkel D.E.
        Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales.
        J Pain Symptom Manage. 2002; 24: 547-561
        • Brucker P.S.
        • Yost K.
        • Cashy J.
        • Webster K.
        • Cella D.
        General population and cancer patient norms for the functional assessment of cancer therapy-general (FACT-G).
        Eval Health Prof. 2005; 28: 192-211
        • Glaus A.
        • Crow R.
        • Hammond S.
        A qualitative study to explore the concept of fatigue/tiredness in cancer patients and in healthy individuals.
        Support Care Cancer. 1996; 4: 82-96
        • Loge J.H.
        • Abrahamsen A.F.
        • Ekeberg O.
        • Kaasa S.
        Hodgkin’s disease survivors more fatigued than the general population.
        J Clin Oncol. 1999; 17: 253-261
        • Fernades R.
        • Stone P.
        • Andrews P.
        • Morgan R.
        • Sharma S.
        Comparison between fatigue, sleep disturbance, and circadian rhythm in cancer inpatients and healthy volunteers: evaluation of diagnostic criteria for cancer-related fatigue.
        J Pain Symptom Manage. 2006; 32: 245-254
        • Andrykowski M.A.
        • Curran S.L.
        • Lightner R.
        Off-treatment fatigue in breast cancer survivors: a controlled comparison.
        J Behav Med. 1998; 21: 1-18
        • Stone P.
        • Hardy J.
        • Huddart R.
        • A’Hern R.
        • Richards M.
        Fatigue in patients with prostate cancer receiving hormone therapy.
        Eur J Cancer. 2000; 36: 1134-1141
        • Stone P.
        • Richards M.
        • A’Hern R.
        • Hardy J.
        Fatigue in patients with cancers of the breast or prostate undergoing radical radiotherapy.
        J Pain Symptom Manage. 2001; 22: 1007-1015
        • Morriss R.
        • Wearden A.
        • Mullis R.
        Exploring the validity of the Chalder fatigue scale in chronic fatigue syndrome.
        J Psychosom Res. 1998; 45: 411-417
        • Lawrie S.
        • Manders D.
        • Geddes J.
        • Pelosi A.
        A population-based incidence study of chronic fatigue.
        Psychol Med. 1997; 27: 343-353
        • Loge J.H.
        • Ekeberg O.
        • Kaasa S.
        Fatigue in the general Norwegian population: normative data and associations.
        J Psychosom Res. 1998; 45: 53-65
        • Pawlikowska T.
        • Chalder T.
        • Hirsch S.
        • Wallace P.
        • Wright D.
        • Wessely S.
        A population based study of fatigue and psychological distress.
        Br Med J. 1994; 308: 743-746
        • David A.
        • Pelosi A.
        • McDonald A.
        • et al.
        Tired, weak, or in need of rest: fatigue among general practice attenders.
        Br Med J. 1990; 301: 1199-1202
        • Cella D.
        • Peterman A.
        • Passik S.
        • Jacobsen P.
        • Breitbart W.
        Progress toward guidelines for the management of fatigue.
        Oncology (Huntington). 1998; 12: 369-377
        • Andrykowski M.A.
        • Schmidt J.E.
        • Salsman J.M.
        • Beacham A.O.
        • Jacobsen P.B.
        Use of a case definition approach to identify cancer-related fatigue in women undergoing adjuvant therapy for breast cancer.
        J Clin Oncol. 2005; 23: 6613-6622
        • Cella D.
        • Davis K.
        • Breitbart W.
        • Curt G.
        The Fatigue C. Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors.
        J Clin Oncol. 2001; 19: 3385-3391
        • Sadler I.J.
        • Jacobsen P.B.
        • Booth-Jones M.
        • Belanger H.
        • Weitzner M.A.
        • Fields K.K.
        Preliminary evaluation of a clinical syndrome approach to assessing cancer-related fatigue.
        J Pain Symptom Manage. 2002; 23: 406-416
        • Young K.E.
        • White C.A.
        The prevalence and moderators of fatigue in people who have been successfully treated for cancer.
        J Psychosom Res. 2006; 60: 29-38
        • Van Belle S.
        • Paridaens R.
        • Evers G.
        • et al.
        Comparison of proposed diagnostic criteria with FACT-F and VAS for cancer-related fatigue: proposal for use as a screening tool.
        Support Care Cancer. 2005; 13: 246-254
        • Chochinov H.M.
        • Wilson K.G.
        • Enns M.
        • Lander S.
        Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold judgments.
        Am J Psychiatr. 1994; 151: 537-840
        • Stone P.
        • Ream E.
        • Richardson A.
        • et al.
        Cancer-related fatigue – a difference of opinion? Results of a multi-centre survey of healthcare professionals, patients and caregivers.
        Eur J Cancer Care. 2003; 12: 20-27
        • Prue G.
        • Rankin J.
        • Allen J.
        • et al.
        Cancer-related fatigue: a critical appraisal.
        Eur J Cancer. 2006; 42: 846-863
      3. Minton O, Stone P. How common is fatigue in disease-free breast cancer survivors? A systematic review of the literature. Br Cancer Res Treat 2007. doi:10.1007/s10549-007-9831-1.

        • Stone P.
        • Richards M.
        • A’Hern R.
        • Hardy J.
        A study to investigate the prevalence, severity and correlates of fatigue among patients with cancer in comparison with a control group of volunteers without cancer.
        Ann Oncol. 2000; 11: 561-567
        • Byar K.L.
        • Berger A.M.
        • Bakken S.L.
        • Cetak M.A.
        Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life.
        Oncol Nurs Forum. 2006; 33 ([Online]): E18-E26
        • Loge J.H.
        • Abrahamsen A.F.
        • Ekeberg O.
        • Kaasa S.
        Fatigue and psychiatric morbidity among Hodgkin’s disease survivors.
        J Pain Symptom Manage. 2000; 19: 91-99
        • Smets E.
        • Visser M.
        • Willems-Groot A.
        • Garssen B.
        • Schuster-Uitterhoeve A.
        • Haes J.D.
        Fatigue and radiotherapy: (B) experience in patients 9 months following treatment.
        Br J Cancer. 1998; 78: 907-912
        • Visser M.R.
        • Smets E.M.
        Fatigue, depression and quality of life in cancer patients: how are they related?.
        Support Care Cancer. 1998; 6: 101-108
        • Slaughter J.R.
        • Slaughter K.A.
        • Nichols D.
        • Holmes S.E.
        • Martens M.P.
        Prevalence, clinical manifestations, etiology, and treatment of depression in Parkinson’s disease.
        J Neuropsychiatr Clin Neurosci. 2001; 13: 187-196
        • Roscoe J.A.
        • Morrow G.R.
        • Hickok J.T.
        • et al.
        Effect of paroxetine hydrochloride (Paxil®) on fatigue and depression in breast cancer patients receiving chemotherapy.
        Br Cancer Res Treat. 2005; V89: 243-249
        • Morrow G.
        • Hickok J.
        • Roscoe J.
        • et al.
        Differential effects of paroxetine on fatigue and depression: a randomized, double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program.
        J Clin Oncol. 2003; 21: 4635-4641
        • Savard J.
        • Morin C.M.
        Insomnia in the context of cancer: a review of a neglected problem.
        J Clin Oncol. 2001; 19: 895-908
        • Savard J.
        • Simard S.
        • Blanchet J.
        • Ivers H.
        • Morin C.M.
        Prevalence, clinical characteristics, and risk factors for insomnia in the context of breast cancer.
        Sleep. 2001; 24: 583-590
        • Savard J.
        • Simard S.
        • Ivers H.
        • Morin C.M.
        Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: sleep and psychological effects.
        J Clin Oncol. 2005; 23: 6083-6096
        • Wessely S.
        • Hotopf M.
        • Sharpe M.
        Physical mechanisms of fatigue; fatigue and inactivity.
        in: Wessely S. Hotopf M. Sharpe M. Chronic fatigue and its syndromes. OUP, Oxford1998: 55-58
        • Winningham M.L.
        • Nail L.M.
        • Burke M.B.
        • et al.
        Fatigue and the cancer experience: the state of the knowledge.
        Oncol Nurs Forum. 1994; 21: 23-36
        • Yellen S.B.
        • Cella D.F.
        • Webster K.
        • Blendowski C.
        • Kaplan E.
        Measuring fatigue and other anemia-related symptoms with the Functional Assessment of Cancer Therapy (FACT) measurement system.
        J Pain Symptom Manage. 1997; 13: 63-74
        • Lind M.
        • Vernon C.
        • Cruickshank D.
        • et al.
        The level of haemoglobin in anaemic cancer patients correlates positively with quality of life.
        Br J Cancer. 2002; 86: 1243-1249
        • Glaspy J.
        Anemia and fatigue in cancer patients.
        Cancer. 2001; 92: 1719-1724
        • Stone P.
        • Abdul-Wahab A.
        • Gibson J.
        • Wright R.
        • Andrews P.
        Fatigue in cancer patients is not related to changes in oxyhaemoglobin dissociation.
        Support Care Cancer. 2005; 13: 854-858
        • Bower J.E.
        • Ganz P.A.
        • Aziz N.
        • Fahey J.L.
        Fatigue and proinflammatory cytokine activity in breast cancer survivors.
        Psychosom Med. 2002; 64: 604-611
        • Collado-Hidalgo A.
        • Bower J.E.
        • Ganz P.A.
        • Cole S.W.
        • Irwin M.R.
        Inflammatory biomarkers for persistent fatigue in breast cancer survivors.
        Clin Cancer Res. 2006; 12: 2759-2766
        • Mills P.J.
        • Parker B.
        • Dimsdale J.E.
        • Sadler G.R.
        • Ancoli-Israel S.
        The relationship between fatigue and quality of life and inflammation during anthracycline-based chemotherapy in breast cancer.
        Biol Psychol. 2005; 69: 85-96
        • Wratten C.
        • Kilmurray J.
        • Nash S.
        • et al.
        Fatigue during breast radiotherapy and its relationship to biological factors.
        Int J Radiat Oncol Biol Phys. 2004; 59: 160-167
        • Schubert C.
        • Hong S.
        • Natarajan L.
        • Mills P.J.
        • Dimsdale J.E.
        The association between fatigue and inflammatory marker levels in cancer patients: a quantitative review.
        Brain Behav Immun. 2007; 21: 413-427
        • Cleare A.J.
        The neuroendocrinology of chronic fatigue syndrome.
        Endocr Rev. 2003; 24: 236-252
        • Andrews P.L.R.
        • Morrow G.
        • Hickok J.T.
        • Stone P.
        Mechanisms and models of fatigue associated with cancer and its treatment: evidence of pre-clinical and clinical studies.
        in: Armes J. Krishnasamy M. Higginson I. Fatigue in cancer. OUP, Oxford2004: 51-87
        • Bower J.E.
        • Ganz P.A.
        • Aziz N.
        Altered cortisol response to psychologic stress in breast cancer survivors with persistent fatigue.
        Psychosom Med. 2005; 67: 277-280
        • Bower J.E.
        • Ganz P.A.
        • Dickerson S.S.
        • Petersen L.
        • Aziz N.
        • Fahey J.L.
        Diurnal cortisol rhythm and fatigue in breast cancer survivors.
        Psychoneuroendocrinology. 2005; 30: 92-100
        • van der Pompe G.
        • Antoni M.H.
        • Heijnen C.J.
        Elevated basal cortisol levels and attenuated acth and cortisol responses to a behavioral challenge in women with metastatic breast cancer.
        Psychoneuroendocrinology. 1996; 21: 361-374
        • Spiegel D.
        • Giese-Davis J.
        • Taylor C.B.
        • Kraemer H.
        Stress sensitivity in metastatic breast cancer: analysis of hypothalamic–pituitary–adrenal axis function.
        Psychoneuroendocrinology. 2006; 31: 1231-1244
        • Rich T.
        • Innominato P.F.
        • Boerner J.
        • et al.
        Elevated serum cytokines correlated with altered behavior, serum cortisol rhythm, and dampened 24-hour rest-activity patterns in patients with metastatic colorectal cancer.
        Clin Cancer Res. 2005; 11: 1757-1764
      4. Markes M, Brockow T, Resch KL. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane database of systematic reviews: reviews. Chichester (UK): John Wiley & Sons Ltd.; 2006 (issue 4). [pub2 2006(4)].

        • Knols R.
        • Aaronson N.K.
        • Uebelhart D.
        • Fransen J.
        • Aufdemkampe G.
        Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials.
        J Clin Oncol. 2005; 23: 3830-3842
        • Stricker C.
        • Drake D.
        • Hoyer K.-A.
        • Mock V.
        Evidence-based practice for fatigue management in adults with cancer: exercise as an intervention.
        Oncol Nurs Forum. 2004; 31: 963-976
      5. Cramp F, Prue G, Gracey J. Exercise for treatment of cancer related fatigue. Cochrane database of systematic reviews: protocols. Chichester (UK): John Wiley & Sons Ltd.; 2006 (issue 3). .

        • Dimeo F.
        • Stieglitz R.
        • Novelli-Fischer U.
        • Keul J.
        Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy.
        Cancer. 1999; 85: 2273-2277
        • Dimeo F.
        • Rumberger B.
        • Keul J.
        Aerobic exercise as therapy for cancer fatigue.
        Med Sci Sports Exerc. 1998; 30: 475-478
        • Schwartz A.L.
        • Mori M.
        • Gao R.
        • Nail L.M.
        • King M.E.
        Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy.
        Med Sci Sports Exerc. 2001; 33: 718-723
        • Campbell A.
        • Mutrie N.
        • White F.
        • McGuire F.
        • Kearney N.
        A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment.
        Eur J Oncol Nurs. 2005; 9: 56-63
        • Schneider C.M.
        • Hsieh C.C.
        • Sprod L.K.
        • et al.
        Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment.
        Cancer. 2007; 110: 918-925
        • Oldervoll L.M.
        • Loge J.H.
        • Paltiel H.
        • et al.
        The effect of a physical exercise program in palliative care: a phase II study.
        J Pain Symptom Manage. 2006; 31: 421-430
        • Segal R.J.
        • Reid R.D.
        • Courneya K.S.
        • et al.
        Resistance exercise in men receiving androgen deprivation therapy for prostate cancer.
        J Clin Oncol. 2003; 21: 1653-1659
        • Conn V.S.
        • Hafdahl A.R.
        • Porock D.C.
        • et al.
        A meta-analysis of exercise interventions among people treated for cancer.
        Support Care Cancer. 2006; 14: 699-712
        • Jacobsen P.B.
        • Donovan K.A.
        • Vadaparampil S.T.
        • Small B.J.
        Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue.
        Health Psychol. 2007; 26: 660-667
        • Ream E.
        • Richardson A.
        • Alexander-Dann C.
        Supportive intervention for fatigue in patients undergoing chemotherapy: a randomized controlled trial.
        J Pain Symptom Manage. 2006; 31: 148-161
        • Armes J.
        • Chalder T.
        • Addington-Hall J.
        • Richardson A.
        • Hotopf M.
        A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer-related fatigue.
        Cancer. 2007; 110: 1385-1395
        • Gielissen M.F.M.
        • Verhagen S.
        • Witjes F.
        • Bleijenberg G.
        Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial.
        J Clin Oncol. 2006; 24: 4882-4887
        • Gielissen M.F.
        • Verhagen C.A.
        • Bleijenberg G.
        Cognitive behaviour therapy for fatigued cancer survivors: long-term follow-up.
        Br J Cancer. 2007; 97: 612-618
        • Mannix K.A.
        • Blackburn I.M.
        • Garland A.
        • et al.
        Effectiveness of brief training in cognitive behaviour therapy techniques for palliative care practitioners.
        Palliat Med. 2006; 20: 579-584
      6. Minton O, Stone P, Richardson A, Sharpe M, Hotopf M. Drug therapy for the management of cancer related fatigue. Cochrane Database of Syst Rev; 2008. Art No.: CD006704. .

        • Bruera E.
        • Valero V.
        • Driver L.
        • et al.
        Patient-controlled methylphenidate for cancer fatigue: a double-blind, randomized, placebo-controlled trial.
        J Clin Oncol. 2006; 24: 2073-2078
        • Fleishman S.
        • Lower E.
        • Zeldis J.
        • Faleck H.
        • Manning D.
        A phase 2 randomized, placebo-controlled trial of the safety and efficacy of dexmethylphenidate (d-MPH) as a treatment for fatigue and “chemobrain in adult cancer patients.
        Br Cancer Res Treat. 2005; 94: S214
      7. Bohlius J, Wilson J, Seidenfeld J, et al. Erythropoietin or darbepoetin for patients with cancer. Cochrane database of systematic reviews. Art. No.: CD003407(3); 2006.

        • Jones M.
        • Schenkel B.
        • Just J.
        • Fallowfield L.
        Epoetin alfa improves quality of life in patients with cancer.
        Cancer. 2004; 101: 1720-1732