Cancer-related fatigue. Recent developments in diagnosis and treatment

Cancer-related fatigue (CRF) is a distressing subjective feeling of physical, emotional, and cognitive exhaustion related to cancer and cancer treatment that is not proportional to recent activity and interferes with daily functioning. CRF can be present in all phases of the disease. CRF is influenced by various factors, but a pathogenetic model of CRF is still missing. All cancer patients should be screened to allow for early intervention. The diagnostic work-up follows an algorithm with the phases screening, extended diagnostic procedures, and evaluation following treatment. Somatic and psychiatric comorbidities have to be assessed as treatable contributing factors. A review of current medication is essential to recognize sedation as a drug reaction and possible change in medication. Treatment of CRF should start as early as possible and is primarily symptom oriented. Physical activity and psychosocial interventions have the strongest evidence for treatment. In addition, pharmacologic interventions, mainly herbal medicines and psychostimulants have been reported to improve symptoms. Because of various causes of CRF, the best results can be expected by using a multimodal treatment approach.