Cancer-Related Fatigue (2018–2022)

Full Systematic Review Question

This systematic review addressed the question “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance and participation for adults living with cancer?”

Current Theme Reported

The main theme of this systematic review is to focus on interventions to manage cancer-related fatigue (CRF).

Clinical Scenario

One of the most common side effects for those who have had cancer treatment is CRF that limits one’s ability to complete daily activities, resulting in a poorer quality of life (Stone et al., 2000; Wang et al., 2014). According to the National Comprehensive Cancer Network, CRF is defined as an individual’s feeling of physical, emotional, and/or cognitive tiredness related to cancer or its treatment that is not related to recent activity participation. This perception of fatigue results in emotional distress and interferes with day-to-day functioning (Berger et al., 2015, p. 1020). Because CRF is prevalent among individuals with cancer, occupational therapy practitioners need interventions that will target this common impairment. We provide current evidence about interventions that can be provided by occupational therapy practitioners as part of the treatment plan for adults with breast cancer and colorectal cancer who are experiencing CRF. This systematic review brief focuses on CRF interventions.

Summary of Key Findings

Three systematic reviews were included addressing interventions to reduce CRF after a cancer diagnosis. They were divided into subthemes based on the type of intervention and/or population (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018).

Bottom Line for Occupational Therapy Practice

Occupational therapy practitioners provide interventions with adults with CRF using a variety of interventions to manage fatigue across the cancer rehabilitation continuum. Home programs are a mainstay of rehabilitation in all areas of practice, particularly within outpatient, home health, and community settings. With improved cancer treatments and greater survivorship, more individuals will be living with impairments that impact functional performance, such as CRF.

Current evidence reflects participation in supervised and unsupervised moderate exercise at home or community in conjunction with internet-based self-care management programs focused on CRF, which may reduce the feeling of fatigue among adults diagnosed with a variety of cancers at different stages (Table 1). Specifically, occupational therapy should use (1) supervised or unsupervised moderate exercise with individuals with colorectal cancer after surgery for less than 12 wk and (2) home-based moderately intense walking with individuals with breast cancer. Occupational therapy practitioners could use internet-based self-care management programs to manage CRF by providing personalized advice and codeveloping an action plan to manage fatigue. These recommendations can be developed for adults with all types of cancer and stage through the use of the internet, telephone, electronic library, handbook, discussion, and teaching.