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National Cancer Institute

Post Treatment Health: The Current State of Interventions

Presentation 1: Addressing the Problems of Cancer Survivors: Where Are We?

Paul Jacobsen, Ph.D.
Research Program Leader, Health Outcome and Behavior Program
Clinical Program Leader, Psychosocial and Palliative Care Program
H. Lee Moffitt Cancer Center and Research Institute
Tampa, FL

  • Fatigue is an issue for many cancer survivors and can cause physical, emotional, behavioral, and cognitive problems.
  • Physical inactivity and loss of physical fitness are possible causes of fatigue. A study of exercise training in breast cancer patients showed that increasing activity levels and improving cardiovascular fitness decreased fatigue.
  • Some breast cancer survivors suffer more from fatigue than do others. Attempts to account for differences in fatigue showed that BMI could be associated with fatigue (higher BMI usually led to increased levels of fatigue), but that age and type of treatment could not.
  • Depression is associated with fatigue, but it is not clear which causes the other. A study of stress management training for chemotherapy patients showed that instruction in various relaxation and coping techniques could alleviate both depression and fatigue. Patients who “self-administered” treatment (using brochures, audiotapes and videotapes) showed reduced depression and increased energy levels; changes were more dramatic in self-taught patients than in patients receiving professional treatment.
  • Preliminary data indicate that loss of physical fitness and depression contributes to fatigue, but further research is needed to understand the contribution of other factors (e.g., genetics, immune system) to fatigue in cancer survivors.
  • Challenges to understanding fatigue include limitations in understanding the course of fatigue and prevalence of clinically significant fatigue in cancer survivors as well as how fatigue in cancer survivors differs from fatigue in people without cancer.

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