Fatigue in patients with cancer.

PURPOSE/OBJECTIVES: To provide a historic perspective on knowledge about fatigue in patients with cancer, review what is known, define gaps, and recommend future approaches. DATA SOURCES: Published research reports, clinical papers, review articles, and practice guidelines. DATA SYNTHESIS: Two tested interventions show consistent positive effects: treatment of chemotherapy-induced anemia and aerobic exercise. Other frequently suggested interventions, such as adequate nutrition, energy conservation, psychostimulants, antidepressants, and increased sleep and rest, either have not been tested or studies underway are not yet complete. Current practice guidelines are based on a combination of research and expert clinical judgment. CONCLUSIONS: The knowledge base on fatigue continues to expand. Information about the mechanisms underlying fatigue is needed to develop innovative approaches to prevent and treat fatigue. IMPLICATIONS FOR NURSING: Current practice guidelines should be used to guide care with the expectation that guidelines will evolve to incorporate the results of studies currently underway. Although specific gaps in knowledge need to be addressed to guide future practice, clinicians need to use existing knowledge in the care they are delivering today. All of the interventions proposed for managing cancer treatment-related fatigue are health policy challenges because they represent additions to usual care rather than replacements of existing components of care.