Developing Methods to Fight Cancer-Related Fatigue

The reasons for fatigue in patients go beyond treatment.
Cancer treatments are unlike any other medical procedures. For many, they can cause an overwhelming sense of drowsiness, exhaustion and weakness — despite plenty of rest. Cancer treatment-related fatigue is unlike normal, everyday fatigue, the wear and tear that comes after a long day at the office or a hard workout at the gym. Cancer-related fatigue can feel like being stuck in a car that won’t shift out of first gear. Patients with cancer are likely all too familiar with this. Estimates suggest that nearly 90 percent of patients undergoing radiation therapy and 80 percent treated with chemotherapy experience cancer-related fatigue.

For more than 20 years, the Oncology Nursing Society (ONS) Foundation has worked to provide nurse scientists with funding and support as they conduct research related to fatigue symptoms. Through this area of study, new, evidence-based practices are being incorporated into treatment plans throughout the country.

Pursuing Fatigue Management Research

Cancer-related fatigue symptoms are often pervasive, disruptive and difficult to understand, which is why, in 1995, the ONS Foundation created the Fatigue Initiative through Research and Education® program, awarding grants to oncology nurse scientists seeking ways to treat these symptoms. From 1995–2000, the Foundation awarded more than $1 million to help understand, investigate and ameliorate symptoms associated with cancer-related fatigue.

ONS member Anna Schwartz, Ph.D., FNP, FAAN, was one of the recipients of an early FIRE grant. Her focus was to create a clinically effective scale to assess and monitor fatigue associated with cancer treatment, since previous measurements of fatigue were not designed specifically for people with cancer. She developed the Schwartz Cancer Fatigue Scale, a validated questionnaire that measures fatigue based on physical and perceptual dimensions. In another Foundation-funded study from 2013, ONS member Margaret McCabe, Ph.D., R.N., PNP, studied fatigue in pediatric patients and its association with their hospital environments, accounting for light, sound, temperature, humidity and room entries.

“We documented that reduced sleep impacts fatigue in less well-functioning patients,” McCabe said. “We were able to see that patients who were more ill were more impacted by less sleep — they reported higher levels of fatigue.” McCabe and her colleagues also noticed a relationship between fatigue and factors that can affect sleep quality. “Less fatigue and better sleep quality were associated with less light in the environment,” McCabe said. “We also noticed that elevated sound levels, despite efforts to keep noise at a low level in the hospital, was impacting sleep quality, too.”

For many patients, cancer-related fatigue is thought to stem solely from treatment regimens such as radiation and chemotherapy. However, McCabe was quick to note that the reasons for fatigue in patients go beyond treatment.

“What we’re learning in the science of fatigue is that there are so many variables that have the potential to impact symptoms,” McCabe noted. “We have the environment, everything related to the disease process itself, treatment, and there may be underlying genetic implications for how you experience symptoms, as well.”

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