Clinical updates in cancer-related fatigue in palliative care settings-a scoping review

Cancer-related fatigue (CRF) is a common symptom affecting patients with the majority of cancers with a significant impact on the overall quality of life. CRF has a complex and multifactorial origin, making it difficult to pinpoint specific causes, as they are interlinked with each other. The given scoping review aims to identify and explore the recent clinical updates related to screening, diagnosis, and management.

Databases including PubMed, Embase, Cochrane, and Medline were used for our search, and the articles from January 2020 to March 2025 were screened. Studies that documented adult cancer patients who experienced CRF in palliative care were included. PRISMA-ScR guidelines were followed to carry out the scoping review. Articles underwent titles and abstracts screening, followed by full text screening by 2 independent reviewers. The extracted data was analysed thematically.

A total of 4,444 articles were identified through database searches. After screening titles, abstracts, and full texts, 53 articles were included in the scoping review. The themes that were identified included screening and assessment, pharmacological, non-pharmacological and complementary therapies for the diagnosis and management of CRF. Exercise, cognitive behavioural, mindfulness-based, psychosocial, and sensory therapies were found to be effective non-pharmacological methods for CRF management. Furthermore, pharmacological agents like corticosteroids and psychostimulants were proven beneficial in patients experiencing CRF when other techniques were insufficient in alleviating symptoms. Complementary therapies including acupressure (AS), acupuncture (AT), Tai Chi or Qigong, yoga, and massage were efficacious adjunctive therapies for CRF reduction in palliative care settings.

In palliative care settings, CRF is a multifaceted symptom that affects the physical, mental and psychological well-being. It is essential to raise awareness, promote training, and support research in diverse palliative care settings to integrate CRF into routine cancer care. Work up algorithm must be integrated for CRF at every oncology visit for early and prompt detection. There should be an amalgamation of the pharmacological, non-pharmacological and complementary interventions into a comprehensive treatment pathway that should be able to cater to the majority of cancer patients experiencing CRF.