Cancer Related Fatigue: Diagnosis and Rehabilitation

Abstract

Cancer related fatigue (CRF) is a distressing and persistent exhaustion, affecting 30% to 60% of cancer patients during treatment and around 20% to 30 % post-treatment. It is an underdiagnosed and undertreated condition in most cases. Diagnosis is usually made by clinical screening using numeric rating scales and patient reported outcomes, though none are adapted for Low Middle-Income Countries (LMIC) like Pakistan. Evidence-based rehabilitation techniques for CRF include aerobic and resistance exercise, Mind-body therapies, Cognitive behavioural therapy, telerehabilitation, and pharmacological interventions. However, implementation of these strategies in the LMIC is limited due to shortage of trained rehabilitation professionals, absence of LMIC relevant protocols, inadequate referrals, low patient education and lack of clinical guidelines for CRF. This mini review summarizes the current approaches for diagnosis and rehabilitation of CRF. We have identified the challenges and offer some practical strategies for integration of CRF rehabilitation cancer care framework in LMIC including Pakistan.

Keywords: Cancer Related Fatigue; Cancer Rehabilitation; Outcome measures Assessment tools; Exercise intervention; LMIC; Pakistan