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J Natl Cancer Inst. 2013 Oct 2;105(19):1432-40. doi: 10.1093/jnci/djt242. Epub 2013 Sep 18.

Recommendations for high-priority research on cancer-related fatigue in children and adults.

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Affiliations of authors: Thomas Jefferson University, Philadelphia, PA (AMB); University of California-Los Angeles, Los Angeles, CA (MRI); Children's National Medical Center, Washington, DC (PH); Emory University, Atlanta, GA (AM); University of Nebraska Medical Center, Omaha, NE (AB); Moffitt Cancer Center, Tampa, FL (PJ); University of California-San Diego, San Diego, CA (SA-I); University of North Carolina at Chapel Hill, Chapel Hill, NC (RBR); University of Rochester, Rochester, NY (KM); National Cancer Institute, Bethesda, MD (AOM); Northwestern University, Chicago, IL (J-SL, DC); M.D. Anderson Cancer Center, Houston, TX (MF).


Over the past decades, some scientific progress has been made in understanding and treating cancer-related fatigue (CRF). However, three major problems have limited further progress: lack of agreement about measurement, inadequate understanding of the underlying biology, and problems in the conduct of clinical trials for CRF. This commentary reports the recommendations of a National Cancer Institute Clinical Trials Planning Meeting and an ongoing National Cancer Institute working group to address these problems so that high-priority research and clinical trials can be conducted to advance the science of CRF and its treatment. Recommendations to address measurement issues included revising the current case definition to reflect more rigorous criteria, adopting the Patient Reported Outcomes Measurement Information System fatigue scales as standard measures of CRF, and linking legacy measures to the scales. With regard to the biology of CRF, the group identified the need for longitudinal research to examine biobehavioral mechanisms underlying CRF and testing mechanistic hypotheses within the context of intervention research. To address clinical trial issues, recommendations included using only placebo-controlled trial designs. setting eligibility to minimize sample heterogeneity or enable subgroup analysis, establishing a CRF severity threshold for participation in clinical trials, conducting dissemination trials of efficacious interventions (such as exercise), and combining nonpharmacologic and pharmacologic interventions to exploit the potential synergy between these approaches. Accomplishing these goals has the potential to advance the science of CRF and improve the clinical management of this troubling symptom.

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