Cancer-Related Fatigue, Version 2.2015.

Cancer-related fatigue is defined as a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning. It is one of the most common side effects in patients with cancer. Fatigue has been shown to be a consequence of active treatment, but it may also persist into posttreatment periods. Furthermore, difficulties in end-of-life care can be compounded by fatigue. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cancer-Related Fatigue provide guidance on screening for fatigue and recommendations for interventions based on the stage of treatment. Interventions may include education and counseling, general strategies for the management of fatigue, and specific nonpharmacologic and pharmacologic interventions. Fatigue is a frequently underreported complication in patients with cancer and, when reported, is responsible for reduced quality of life. Therefore, routine screening to identify fatigue is an important component in improving the quality of life for patients living with cancer.

[1]  G. Lyman,et al.  Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical oncology clinical practice guideline adaptation. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[2]  C. Morin,et al.  Randomized study on the efficacy of cognitive-behavioral therapy for insomnia secondary to breast cancer, part I: Sleep and psychological effects. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[3]  S. Walker,et al.  An explanatory model of fatigue in women receiving adjuvant breast cancer chemotherapy. , 2001, Nursing research.

[4]  Mellar P. Davis,et al.  Methylphenidate for fatigue in advanced cancer: A prospective open-label pilot study , 2001, The American journal of hospice & palliative care.

[5]  S. Fosså,et al.  Fatigue, anxiety, and depression in long-term survivors of testicular cancer. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[6]  D. Uebelhart,et al.  Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  S. Paul,et al.  Symptom clusters and their effect on the functional status of patients with cancer. , 2001, Oncology nursing forum.

[8]  S. Kvaløy,et al.  High level of fatigue in lymphoma patients treated with high dose therapy. , 2000, Journal of pain and symptom management.

[9]  M. Sateia,et al.  Clinical guideline for the evaluation and management of chronic insomnia in adults. , 2008, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[10]  B. Thomsen,et al.  Psychoeducational intervention for patients with cutaneous malignant melanoma: a replication study. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[11]  B. Ferrell,et al.  Implementing the Fatigue Guidelines at one NCCN member institution: process and outcomes. , 2007, Journal of the National Comprehensive Cancer Network : JNCCN.

[12]  G. Bleijenberg,et al.  Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. , 2002, Annals of oncology : official journal of the European Society for Medical Oncology.

[13]  J. Nanda,et al.  The effectiveness of the comprehensive coping strategy program on clinical outcomes in breast cancer autologous bone marrow transplantation. , 2000, Cancer nursing.

[14]  P. Hinds,et al.  Three instruments to assess fatigue in children with cancer: the child, parent and staff perspectives. , 2003, Journal of pain and symptom management.

[15]  A. Richardson,et al.  Supportive intervention for fatigue in patients undergoing chemotherapy: a randomized controlled trial. , 2006, Journal of pain and symptom management.

[16]  E. Bruera,et al.  Placebo and nocebo effects in randomized double‐blind clinical trials of agents for the therapy for fatigue in patients with advanced cancer , 2010, Cancer.

[17]  M. Irwin,et al.  Yoga for persistent fatigue in breast cancer survivors , 2012, Cancer.

[18]  P. Ganz,et al.  Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[19]  A. Vickers,et al.  Acupuncture for postchemotherapy fatigue: a phase II study. , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[20]  A. Hoffman,et al.  Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment. , 2014, Clinical journal of oncology nursing.

[21]  Declan Walsh,et al.  Symptom clustering in advanced cancer , 2006, Supportive Care in Cancer.

[22]  Jean K. Brown A systematic review of the evidence on symptom management of cancer-related anorexia and cachexia. , 2002, Oncology nursing forum.

[23]  Kathryn A. Lee,et al.  Sleep wake disturbances in people with cancer and their caregivers: state of the science. , 2005, Oncology nursing forum.

[24]  M. Hjermstad,et al.  The effect of a physical exercise program in palliative care: A phase II study. , 2006, Journal of pain and symptom management.

[25]  K. Savik,et al.  Therapeutic Massage and Healing Touch Improve Symptoms in Cancer , 2003, Integrative cancer therapies.

[26]  M. Akbari,et al.  Factors predicting fatigue in breast cancer patients , 2003, Supportive Care in Cancer.

[27]  N. Aaronson,et al.  Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health‐related quality of life in breast cancer patients and survivors—a meta‐analysis , 2011, Psycho-oncology.

[28]  D. Walsh,et al.  The symptoms of advanced cancer: relationship to age, gender, and performance status in 1,000 patients , 2000, Supportive Care in Cancer.

[29]  H. Geinitz,et al.  Fatigue in patients with adjuvant radiation therapy for breast cancer: long-term follow-up , 2004, Journal of Cancer Research and Clinical Oncology.

[30]  F. Blackhall,et al.  Modafinil for the treatment of fatigue in lung cancer: results of a placebo-controlled, double-blind, randomized trial. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[31]  S. Horning,et al.  Impact of cancer-related fatigue on the lives of patients: new findings from the Fatigue Coalition. , 2000, The oncologist.

[32]  S. Iwase,et al.  Efficacy and undesirable effects of corticosteroid therapy experienced by palliative care specialists in Japan: a nationwide survey. , 2011, Journal of palliative medicine.

[33]  B. Given,et al.  Comparison of changes in physical functioning of elderly patients with new diagnoses of cancer. , 2000, Medical care.

[34]  M. Hotopf,et al.  Drug therapy for the management of cancer-related fatigue. , 2010, The Cochrane database of systematic reviews.

[35]  David J. Kerr,et al.  Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Cancer Fatigue Forum. , 2000, Annals of oncology : official journal of the European Society for Medical Oncology.

[36]  P. Hinds,et al.  NCCN Practice Guidelines for Cancer-Related Fatigue. , 2000, Oncology.

[37]  G. Aufdemkampe,et al.  The effect of physical exercise on cancer-related fatigue during cancer treatment: a meta-analysis of randomised controlled trials. , 2010, Clinical oncology (Royal College of Radiologists (Great Britain)).

[38]  B. Given,et al.  Physical Functioning of Elderly Cancer Patients Prior to Diagnosis and Following Initial Treatment , 2001, Nursing older people.

[39]  L. Natarajan,et al.  The association between fatigue and inflammatory marker levels in cancer patients: A quantitative review , 2007, Brain, Behavior, and Immunity.

[40]  P. Craft,et al.  Phase III, randomized, double-blind, placebo-controlled study of modafinil for fatigue in patients treated with docetaxel-based chemotherapy , 2014, Supportive Care in Cancer.

[41]  J. Lynch,et al.  Feasibilty of a sleep intervention during adjuvant breast cancer chemotherapy. , 2002, Oncology nursing forum.

[42]  M. Herring,et al.  Differential effects of exercise on cancer-related fatigue during and following treatment: a meta-analysis. , 2012, American journal of preventive medicine.

[43]  V. Mock,et al.  Assessment and management of cancer-related fatigue in adults , 2003, The Lancet.

[44]  P. Stone,et al.  A prospective survey of the use of dexamethasone on a palliative care unit , 2001, Palliative medicine.

[45]  P. Andrews,et al.  Fatigue associated with cancer and its treatment , 2002, Supportive Care in Cancer.

[46]  P. Ganz,et al.  T-cell homeostasis in breast cancer survivors with persistent fatigue. , 2003, Journal of the National Cancer Institute.

[47]  M. Rosenzweig,et al.  Pilot, randomized, modified, double-blind, placebo-controlled trial of acupuncture for cancer-related fatigue. , 2009, Journal of the Society for Integrative Oncology.

[48]  C. Kirschbaum,et al.  Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[49]  J. Sloan,et al.  Wisconsin Ginseng (Panax quinquefolius) to improve cancer-related fatigue: a randomized, double-blind trial, N07C2. , 2013, Journal of the National Cancer Institute.

[50]  I. D. Fernandez,et al.  Effects of yoga on cancer-related fatigue and global side-effect burden in older cancer survivors. , 2015, Journal of geriatric oncology.

[51]  G. Werneck,et al.  Association of social network and social support with health-related quality of life and fatigue in long-term survivors of Hodgkin lymphoma , 2013, Supportive Care in Cancer.

[52]  A. Berger,et al.  Putting evidence into practice: evidence-based interventions for sleep-wake disturbances. , 2006, Clinical journal of oncology nursing.

[53]  K. Olson A new way of thinking about fatigue: a reconceptualization. , 2007, Oncology nursing forum.

[54]  T. Rich Symptom clusters in cancer patients and their relation to EGFR ligand modulation of the circadian axis. , 2007, The journal of supportive oncology.

[55]  L. Nail,et al.  A Pilot Study Examining Energy Conservation for Cancer Treatment–related Fatigue , 2002, Cancer nursing.

[56]  Patricia A. Ganz,et al.  Fatigue and Proinflammatory Cytokine Activity in Breast Cancer Survivors , 2002, Psychosomatic medicine.

[57]  L. Carlson,et al.  Impact of mindfulness-based stress reduction (MBSR) on sleep, mood, stress and fatigue symptoms in cancer outpatients , 2005, International journal of behavioral medicine.

[58]  G. Bleijenberg,et al.  Fatigue after treatment for malignant and benign bone and soft tissue tumors. , 2003, Journal of pain and symptom management.

[59]  P. Hinds,et al.  Nocturnal awakenings, sleep environment interruptions, and fatigue in hospitalized children with cancer. , 2007, Oncology nursing forum.

[60]  Rebecca Andridge,et al.  Yoga's impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[61]  Tamara Harth,et al.  What do patients living with advanced cancer and their carers want to know? – A needs assessment , 2002, Supportive Care in Cancer.

[62]  Young Ae Kim,et al.  Web-based tailored education program for disease-free cancer survivors with cancer-related fatigue: a randomized controlled trial. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[63]  P. Stone,et al.  Pharmacological treatments for fatigue associated with palliative care. , 2015, The Cochrane database of systematic reviews.

[64]  C. Koopman,et al.  A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer , 2007, Biological Psychology.

[65]  F. De Conno,et al.  Quality-of-life assessment during a palliative care programme. , 1990, Annals of oncology : official journal of the European Society for Medical Oncology.

[66]  V. Conn,et al.  A meta-analysis of exercise interventions among people treated for cancer , 2006, Supportive Care in Cancer.

[67]  P. Jean-Pierre,et al.  Cancer-related fatigue: the scale of the problem. , 2007, The oncologist.

[68]  E. Curtis,et al.  Common Symptoms in Patients with Advanced Cancer , 1991, Journal of palliative care.

[69]  C. Morin,et al.  Insomnia in the context of cancer: a review of a neglected problem. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[70]  V. Mock,et al.  Evidence-based practice for fatigue management in adults with cancer: exercise as an intervention. , 2004, Oncology nursing forum.

[71]  C. Frangakis,et al.  Exercise manages fatigue during breast cancer treatment: A randomized controlled trial , 2005, Psycho-oncology.

[72]  K. Courneya,et al.  Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis , 2006, Canadian Medical Association Journal.

[73]  R. Pötter,et al.  Quality of life changes during conformal radiation therapy for prostate carcinoma , 2000, Cancer.

[74]  T. Hassard,et al.  Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. , 2011, The Lancet. Oncology.

[75]  David Cella,et al.  Symptoms and treatment burden associated with cancer treatment: results from a cross-sectional national survey in the U.S. , 2008, Supportive Care in Cancer.

[76]  A. Berger,et al.  Modifying cancer-related fatigue by optimizing sleep quality. , 2008, Journal of the National Comprehensive Cancer Network : JNCCN.

[77]  G. Bleijenberg,et al.  Psychosocial interventions for reducing fatigue during cancer treatment in adults. , 2009, The Cochrane database of systematic reviews.

[78]  P. Jacobsen,et al.  Fatigue and Functional Dependence in Older Cancer Patients , 2008, American journal of clinical oncology.

[79]  David Cella,et al.  Prevalence and characteristics of moderate to severe fatigue: A multicenter study in cancer patients and survivors , 2014, Cancer.

[80]  J. Staal,et al.  Physical Exercise for Patients Undergoing Hematopoietic Stem Cell Transplantation: Systematic Review and Meta-Analyses of Randomized Controlled Trials , 2012, Physical Therapy.

[81]  D. Osoba,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. , 1993, Journal of the National Cancer Institute.

[82]  Eduardo Bruera,et al.  Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[83]  C. Lengacher,et al.  Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters , 2012, Journal of Behavioral Medicine.

[84]  J. Brug,et al.  Physical and psychosocial benefits of yoga in cancer patients and survivors, a systematic review and meta-analysis of randomized controlled trials , 2012, BMC Cancer.

[85]  F. Petermann,et al.  A patient education program is effective in reducing cancer-related fatigue: a multi-centre randomised two-group waiting-list controlled intervention trial. , 2013, European journal of oncology nursing : the official journal of European Oncology Nursing Society.

[86]  P. Jean-Pierre,et al.  A phase 3 randomized, placebo‐controlled, double‐blind, clinical trial of the effect of modafinil on cancer‐related fatigue among 631 patients receiving chemotherapy , 2010, Cancer.

[87]  K. Courneya,et al.  American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. , 2010, Medicine and science in sports and exercise.

[88]  S. Kaasa,et al.  Late medical complications and fatigue in Hodgkin's disease survivors. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[89]  S. Block,et al.  Psychiatric disorders in advanced cancer , 2007, Cancer.

[90]  J. Farrar,et al.  Acupuncture for nonpalliative radiation therapy-related fatigue: feasibility study. , 2009, Journal of the Society for Integrative Oncology.

[91]  M. Mori,et al.  Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. , 2001, Medicine and science in sports and exercise.

[92]  V. Diehl,et al.  Fatigue in long-term survivors of Hodgkin's lymphoma; a report from the German Hodgkin Lymphoma Study Group (GHSG). , 2003, European journal of cancer.

[93]  John A Thompson,et al.  Interferon-induced fatigue in patients with melanoma: a pilot study of exercise and methylphenidate. , 2002, Oncology nursing forum.

[94]  D. Cella,et al.  A case for including spirituality in quality of life measurement in oncology , 1999, Psycho-oncology.

[95]  E. Bruera,et al.  Palliative management of fatigue at the close of life: "it feels like my body is just worn out". , 2007, JAMA.

[96]  S. Brearley,et al.  What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews , 2013, Supportive Care in Cancer.

[97]  P. Hardy,et al.  The effectiveness of a psycho‐educational group after early‐stage breast cancer treatment: results of a randomized French study , 2009, Psycho-oncology.

[98]  R. Portenoy,et al.  L-carnitine supplementation in patients with advanced cancer and carnitine deficiency: a double-blind, placebo-controlled study. , 2009, Journal of pain and symptom management.

[99]  A. Vickers,et al.  Massage therapy for symptom control: outcome study at a major cancer center. , 2004, Journal of pain and symptom management.

[100]  C. Friedenreich,et al.  The group psychotherapy and home‐based physical exercise (group‐hope) trial in cancer survivors: Physical fitness and quality of life outcomes , 2003, Psycho-oncology.

[101]  L. Hou,et al.  Effect of Methylphenidate in Patients with Cancer-Related Fatigue: A Systematic Review and Meta-Analysis , 2014, PloS one.

[102]  E. Ernst,et al.  Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials , 2013, Supportive Care in Cancer.

[103]  H. Thaler,et al.  The measurement of symptoms in young children with cancer: the validation of the Memorial Symptom Assessment Scale in children aged 7-12. , 2002, Journal of pain and symptom management.

[104]  S. Ancoli-Israel,et al.  The relationship between fatigue and sleep in cancer patients: a review. , 2001, European journal of cancer care.

[105]  M. Perlis,et al.  Cancer-related fatigue and sleep disorders. , 2007, The oncologist.

[106]  P. Fayers,et al.  Efficacy of methylprednisolone on pain, fatigue, and appetite loss in patients with advanced cancer using opioids: a randomized, placebo-controlled, double-blind trial. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[107]  A. Barsevick,et al.  In their own words: using the common sense model to analyze patient descriptions of cancer-related fatigue. , 2001, Oncology nursing forum.

[108]  S. Dirksen,et al.  Randomized trial of a cognitive-behavioral intervention for insomnia in breast cancer survivors. , 2007, Oncology nursing forum.

[109]  M. Hallquist,et al.  Fatigue during breast cancer radiotherapy: an initial randomized study of cognitive-behavioral therapy plus hypnosis. , 2009, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[110]  C. Meade,et al.  Efficacy and costs of two forms of stress management training for cancer patients undergoing chemotherapy. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[111]  W. Breitbart,et al.  Meaning‐centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial , 2010, Psycho-oncology.

[112]  A. Schwartz Daily fatigue patterns and effect of exercise in women with breast cancer. , 2000, Cancer practice.

[113]  A. Molassiotis,et al.  The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: a randomised controlled trial. , 2007, Complementary therapies in medicine.

[114]  S. Iwase,et al.  Physician-reported corticosteroid therapy practices in certified palliative care units in Japan: a nationwide survey. , 2012, Journal of palliative medicine.

[115]  J. Bower,et al.  Cancer-related fatigue: Links with inflammation in cancer patients and survivors , 2007, Brain, Behavior, and Immunity.

[116]  E. Emanuel,et al.  Symptoms and suffering at the end of life in children with cancer. , 2000, The New England journal of medicine.

[117]  K. Courneya,et al.  Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[118]  J. Sloan,et al.  Phase III, randomized, double-blind, placebo-controlled study of long-acting methylphenidate for cancer-related fatigue: North Central Cancer Treatment Group NCCTG-N05C7 trial. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[119]  S. Fraser,et al.  Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. , 2014, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[120]  B. Given,et al.  Family Support in Advanced Cancer , 2001, CA: a cancer journal for clinicians.

[121]  I. Tannock,et al.  A randomised, placebo-controlled, double-blind trial of the effects of d-methylphenidate on fatigue and cognitive dysfunction in women undergoing adjuvant chemotherapy for breast cancer , 2008, Supportive Care in Cancer.

[122]  M. Hotopf,et al.  A systematic review and meta-analysis of the pharmacological treatment of cancer-related fatigue. , 2008, Journal of the National Cancer Institute.

[123]  A. Schiaffino,et al.  Nursing education as an intervention to decrease fatigue perception in oncology patients. , 2006, European journal of oncology nursing : the official journal of European Oncology Nursing Society.

[124]  S. Kaasa,et al.  Fatigue and psychiatric morbidity among Hodgkin's disease survivors. , 2000, Journal of pain and symptom management.

[125]  E. Lower,et al.  Efficacy of dexmethylphenidate for the treatment of fatigue after cancer chemotherapy: a randomized clinical trial. , 2009, Journal of pain and symptom management.

[126]  Charles M. Morin,et al.  Insomnia: A clinical guide to assessment and treatment. [References] , 2003 .

[127]  M. Hotopf,et al.  A randomized controlled trial to evaluate the effectiveness of a brief, behaviorally oriented intervention for cancer‐related fatigue , 2007, Cancer.

[128]  A. Clavarino,et al.  A Randomized Controlled Trial of an Educational Intervention for Managing Fatigue in Women Receiving Adjuvant Chemotherapy for Early Stage Breast Cancer , 2005 .

[129]  R. Gosselink,et al.  Physical activity, physical fitness and the effect of exercise training interventions in lymphoma patients: a systematic review , 2013, Annals of Hematology.

[130]  J. Berkhof,et al.  Stress management training for breast cancer surgery patients , 2013, Psycho-oncology.

[131]  A. Vickers,et al.  Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[132]  C. Snyder,et al.  Exercise interventions on health-related quality of life for people with cancer during active treatment. , 2012, The Cochrane database of systematic reviews.

[133]  M. Hertzog,et al.  Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy , 2009, Supportive Care in Cancer.

[134]  C. Fürst,et al.  Quality of life in terminal care—with special reference to age, gender and marital status , 2006, Supportive Care in Cancer.

[135]  N. Douglas,et al.  Randomized controlled clinical effectiveness trial of cognitive behavior therapy compared with treatment as usual for persistent insomnia in patients with cancer. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[136]  L. Kristjanson,et al.  An Exercise Intervention for Advanced Cancer Patients Experiencing Fatigue: A Pilot Study , 2000, Journal of palliative care.

[137]  H. Thaler,et al.  Symptom prevalence, characteristics and distress in a cancer population , 1994, Quality of Life Research.

[138]  R. Stephens,et al.  Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data. , 2000, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[139]  E. Bruera,et al.  The impact of hypogonadism and autonomic dysfunction on fatigue, emotional function, and sexual desire in male patients with advanced cancer , 2006, Cancer.

[140]  S. Ersser,et al.  Effectiveness of mindfulness-based stress reduction in mood, breast- and endocrine-related quality of life, and well-being in stage 0 to III breast cancer: a randomized, controlled trial. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[141]  Blair T. Johnson,et al.  Efficacy of Exercise Interventions in Modulating Cancer-Related Fatigue among Adult Cancer Survivors: A Meta-Analysis , 2010, Cancer Epidemiology, Biomarkers & Prevention.

[142]  C. Pui,et al.  Validity and reliability of a new instrument to measure cancer-related fatigue in adolescents. , 2007, Journal of pain and symptom management.

[143]  E. Bruera,et al.  Methylphenidate and/or a nursing telephone intervention for fatigue in patients with advanced cancer: a randomized, placebo-controlled, phase II trial. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[144]  S. Beck,et al.  Putting evidence into practice: evidence-based interventions for fatigue during and following cancer and its treatment. , 2007, Clinical journal of oncology nursing.

[145]  M. Herdman,et al.  Systematic review of megestrol acetate in the treatment of anorexia-cachexia syndrome. , 2004, Journal of pain and symptom management.

[146]  L. Nail,et al.  A randomized clinical trial of energy conservation for patients with cancer‐related fatigue , 2004, Cancer.

[147]  D. Cella,et al.  Fatigue and cancer: causes, prevalence and treatment approaches , 2004, British Journal of Cancer.

[148]  C. Cleeland,et al.  The rapid assessment of fatigue severity in cancer patients , 1999, Cancer.

[149]  T. Ahles,et al.  Massage therapy for patients undergoing autologous bone marrow transplantation. , 1999, Journal of pain and symptom management.

[150]  P. Flynn,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. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[151]  L. Vlahos,et al.  The role of physical and psychological symptoms in desire for death: a study of terminally ill cancer patients , 2006, Psycho-oncology.

[152]  Elliott M. McMillan,et al.  Exercise is an effective treatment modality for reducing cancer-related fatigue and improving physical capacity in cancer patients and survivors: a meta-analysis. , 2011, Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme.

[153]  K. Olson,et al.  Fatigue in Individuals With Advanced Cancer in Active Treatment and Palliative Settings , 2007, Cancer nursing.

[154]  D. Cella,et al.  Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[155]  M. Bulsara,et al.  A randomized, double-blind, placebo-controlled trial assessing the impact of dexamphetamine on fatigue in patients with advanced cancer. , 2009, Journal of pain and symptom management.

[156]  P. Jean-Pierre,et al.  Integrative nonpharmacologic behavioral interventions for the management of cancer-related fatigue. , 2007, The oncologist.

[157]  J. Byron-Daniel,et al.  Exercise for the management of cancer-related fatigue in adults. , 2012, The Cochrane database of systematic reviews.

[158]  K. Courneya,et al.  Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. , 2007, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[159]  J. Varni,et al.  The PedsQL™ in pediatric cancer , 2002, Cancer.

[160]  D. McCarthy,et al.  Cancer-Induced Fatigue and Skeletal Muscle Wasting: The Role of Exercise , 2001, Biological research for nursing.

[161]  G. Bleijenberg,et al.  Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: a randomized controlled trial. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[162]  C. Cleeland,et al.  A fatigue clinic in a comprehensive cancer center , 2001, Cancer.

[163]  M. Arroyo-Morales,et al.  The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors: a randomized controlled trial. , 2013, Archives of physical medicine and rehabilitation.

[164]  S. Ancoli-Israel,et al.  Neuroendocrine-immune mechanisms of behavioral comorbidities in patients with cancer. , 2008, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[165]  A. Schuchat DEPARTMENT OF HEALTH & HUMAN SERVICES , 2015 .

[166]  M. Winningham,et al.  Fatigue in cancer : a multidimensional approach , 2000 .

[167]  J. Davidson,et al.  Nonpharmacologic group treatment of insomnia: a preliminary study with cancer survivors , 2001, Psycho-oncology.

[168]  A. Jemal,et al.  Cancer statistics, 2015 , 2015, CA: a cancer journal for clinicians.

[169]  B. Given,et al.  Pain and fatigue management: results of a nursing randomized clinical trial. , 2002, Oncology nursing forum.

[170]  S. Wadler,et al.  Interferon‐mediated fatigue , 2001, Cancer.

[171]  Gwen Uman,et al.  Cancer-related fatigue: role of oncology nurses in translating National Comprehensive Cancer Network assessment guidelines into practice. , 2008, Clinical journal of oncology nursing.

[172]  L. Edgar,et al.  Results of a feasibility study for a psycho‐educational intervention in head and neck cancer , 2004, Psycho-oncology.

[173]  B. Dahme,et al.  The effectiveness of relaxation training in reducing treatment‐related symptoms and improving emotional adjustment in acute non‐surgical cancer treatment: a meta‐analytical review , 2001, Psycho-oncology.

[174]  A. House,et al.  Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. , 2002, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[175]  G. Bleijenberg,et al.  Fatigue after breast cancer and in chronic fatigue syndrome: similarities and differences. , 2002, Journal of psychosomatic research.

[176]  T. Oliver,et al.  A pan-Canadian practice guideline and algorithm: screening, assessment, and supportive care of adults with cancer-related fatigue. , 2013, Current oncology.

[177]  K. Courneya,et al.  Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[178]  P. Hinds,et al.  Creating the basis for a breast health program for female survivors of Hodgkin disease using a participatory research approach. , 2005, Oncology nursing forum.

[179]  C. Loprinzi,et al.  A Critical Review of Complementary Therapies for Cancer-Related Fatigue , 2007, Integrative cancer therapies.

[180]  E. A. Reicherter,et al.  Recommended Exercise Protocol to Decrease Cancer‐related Fatigue and Muscle Wasting in Patients With Multiple Myeloma: An Evidence‐based Systematic Review , 2006 .

[181]  W. Hryniuk,et al.  Effects of Aerobic Exercise Training on Peak Aerobic Capacity, Fatigue, and Psychological Factors During Radiation for Breast Cancer , 2005 .

[182]  P. Jacobsen,et al.  A systematic review of research using the diagnostic criteria for cancer‐related fatigue , 2013, Psycho-oncology.

[183]  P. Hinds,et al.  An evaluation of the impact of a self-care coping intervention on psychological and clinical outcomes in adolescents with newly diagnosed cancer. , 2000, European journal of oncology nursing : the official journal of European Oncology Nursing Society.

[184]  R. Hayward,et al.  Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment , 2007, Cancer.

[185]  E. Shaw,et al.  A phase III, double-blind, placebo-controlled prospective randomized clinical trial of d-threo-methylphenidate HCl in brain tumor patients receiving radiation therapy. , 2007, International journal of radiation oncology, biology, physics.

[186]  J. Griggs,et al.  Effect of paroxetine hydrochloride (Paxil®) on fatigue and depression in breast cancer patients receiving chemotherapy , 2005, Breast Cancer Research and Treatment.

[187]  E. Bruera,et al.  Patient-controlled methylphenidate for the management of fatigue in patients with advanced cancer: a preliminary report. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[188]  N. Hanna,et al.  A phase II study of methylphenidate for the treatment of fatigue , 2006, Supportive Care in Cancer.

[189]  R. Timman,et al.  Systematic monitoring and treatment of physical symptoms to alleviate fatigue in patients with advanced cancer: a randomized controlled trial. , 2013, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[190]  G. Montgomery,et al.  Cancer-related fatigue: a systematic and meta-analytic review of non-pharmacological therapies for cancer patients. , 2008, Psychological bulletin.

[191]  S. Vadaparampil,et al.  Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[192]  Hans Ivers,et al.  Efficacy of cognitive-behavioral therapy for insomnia in women treated for nonmetastatic breast cancer. , 2003, Journal of consulting and clinical psychology.

[193]  P. Jacobsen,et al.  Fatigue in women treated with bone marrow transplantation for breast cancer: A comparison with women with no history of cancer , 2005, Supportive Care in Cancer.

[194]  G. Canaris,et al.  The Colorado thyroid disease prevalence study. , 2000, Archives of internal medicine.

[195]  E. Bruera,et al.  Patient-controlled methylphenidate for cancer fatigue: a double-blind, randomized, placebo-controlled trial. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[196]  S. Dirksen,et al.  Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. , 2008, Journal of advanced nursing.

[197]  P. Stone,et al.  Fatigue in patients with cancer. , 1998, European journal of cancer.

[198]  C. Hadley What doesn't kill you makes you stronger , 2003, EMBO reports.

[199]  E. Shaw,et al.  A randomized, double-blind, placebo-controlled study of oral coenzyme Q10 to relieve self-reported treatment-related fatigue in newly diagnosed patients with breast cancer. , 2012, The journal of supportive oncology.

[200]  S. Amadori,et al.  Cancer‐related fatigue , 2003, Cancer.