Fatigue in older cancer patients: etiology, assessment, and treatment

Cancer-related fatigue (CRF) is one of the most common and debilitating symptoms experienced by elderly cancer patients and by cancer survivors. However, this has not translated into an increase in clinical trials for assessment and therapy of CRF in this population. The early recognition and formal assessment of this symptom is important in order to be able to treat it, before it negatively impacts the patient's quality of life. All reversible causes like anemia, depression, anxiety, and hypothyroidism should be ruled out and treated appropriately. CRF can be treated with pharmacologic and nonpharmacologic measures and possibly a combination of both measures. Pharmacologic measures that have been studied in cancer patients with fatigue include hematopoeitics, antidepressants, donepezil, modafinil, methylphenidate, and other agents. Exercise programs continue to be the most popular and widely studied nonpharmacologic intervention for CRF. Psychosocial interventions, energy conservation measures, and improvement of sleep also can lead to less fatigue in cancer patients. However, there continues to be a need for randomized controlled trials (RCTs) evaluating CRF specifically in elderly patients with cancer. This review provides a brief overview of CRF in elderly cancer patients and highlights the areas of required research in this patient population.