Understanding and managing interferon-α-related fatigue in patients with melanoma

Fatigue is the most common toxicity associated with adjuvant interferon-α treatment of melanoma, with an incidence ranging from 80 to 90%. It may be dose-limiting and may lead to treatment discontinuation in a large proportion of patients. Fatigue is commonly diagnosed by self-report, does not have a precise definition, and has a high degree of overlap with symptoms of depression. Specific fatigue scales have been developed over the past few years, assessing fatigue either one-dimensionally or multi-dimensionally. However, the characteristics that define an accurate and efficient fatigue scale have not been established. Despite the debilitating effects of fatigue resulting from interferon treatment, a large proportion of patients place a higher value on the relapse-free survival benefits of treatment compared with quality-of-life deterioration. Pharmacologic interventions to treat and manage fatigue are not well established, although psychostimulants are sometimes used. We recommend incorporating structure and routine into day-to-day activities to cope with fatigue. In our experience, participating in moderate physical activities and drinking sufficient fluids are key factors to ensuring efficient fatigue management. A multidisciplinary team is necessary to translate the fatigue management recommendations into practice. Clinical trials using appropriate fatigue assessment tools to investigate interventional therapies are warranted. We recommend the use of the cross-culturally European Organisation for Research and Treatment of Cancer quality-of-life questionnaire Fatigue Module FA13 for clinical trials as well as in day-to-day clinical trials.