Cancer-Related Fatigue: Guidelines for Screening, Assessment, and Treatment in Patients Aged 18 and Older Who Have Completed Primary Cancer Treatment

This article provides full-process guidance on screening, assessment, and treatment of cancer-related fatigue (CRF) for patients aged 18 and older who have completed primary cancer treatment. CRF is one of the most common and distressing symptoms among cancer patients; it cannot be relieved by rest, severely impacts the recovery process and quality of life, and requires systematic management.

CRF is a distressing, persistent subjective experience of physical/emotional/cognitive fatigue that is disproportionate to activity and interferes with normal function (definition by NCCN). Compared to ordinary fatigue, it is difficult to relieve with rest, lasts longer, and is accompanied by emotional/cognitive issues; approximately 30-60% of survivors still experience moderate to severe symptoms months to years after treatment.

Biological mechanisms include inflammatory responses, neuroendocrine disorders, changes in muscle metabolism, mitochondrial dysfunction, anemia, etc.; psychosocial factors include depression and anxiety, sleep disorders, insufficient social support, negative coping styles, etc.

All patients who have completed primary treatment need to undergo screening. After a positive result from a single-item screening (asking about fatigue duration in the past week), a multi-dimensional scale (such as PFS-R, CFS, BFI, etc.) is used for assessment, covering fatigue characteristics, functional impact, accompanying symptoms, reversible factors, and patient concerns.

Exercise interventions (aerobic/resistance/flexibility training, individualized and progressive); psychological interventions (CBT, mindfulness-based stress reduction, psychoeducation); medication (psychostimulants, antidepressants, etc., with attention to side effects); integrative medicine (acupuncture, massage, light therapy, etc.).

For elderly patients, it is necessary to distinguish between age-related decline and CRF, and consider polypharmacy; for patients with comorbid chronic diseases, multidisciplinary collaboration is required; for different cancer types (such as hormone therapy for breast cancer, androgen deprivation therapy for prostate cancer, etc.), targeted management is needed.

Incorporate into survivor care plans, with regular screening, symptom monitoring, and functional assessment; self-management includes energy conservation, adjusting activity rhythm, keeping a symptom diary, and accessing support resources.

CRF is common but easily overlooked; symptoms can be improved through systematic screening and assessment, and multimodal interventions. In the future, there is a need for in-depth mechanism research, development of prediction models, precision treatment, application of new technologies, and research on long-term outcomes to help survivors improve their quality of life.