The mainstay of breast cancer care is local therapy consisting of surgery along with systemic adjuvant therapy, which includes chemotherapy, hormonal or a combination therapy. Besides major advances in managing both early and locally advanced breast cancer, patients still have to deal with severe side effects of fatigue during adjuvant therapy resulting in substantial impact on patients' quality of life (Markes, Brockow and Resch, 2006).
Most cancer patients would say that fatigue is a major obstacle to functioning normally (Portenoy & Itri, 1999). Fatigue is a distinctive, dominant symptom in patients with cancer, that impacts life functional ability and occupational status. The fatigue diminishes the patient's ability to do both physical and mental tasks, as it has physical, affective, and cognitive components of the symptom (Dalakas, Mock and Hawkins, 1998). This kind of fatigue is referred as cancer-related fatigue or CRF.
Cancer-related fatigue (CRF) as defined by the National Comprehensive Cancer Network "is an unusual persistent, subjective sense of tiredness related to cancer treatment that interferes with usual functioning" (NCCN, 2005).
Since fatigue is not directly observable in most of its forms, its importance and treatment are often overlooked (Newell, Sanson-Fisher, Girgis, & Bonaventura, 1998; Tanghe, Evers, & Parodaems, 1998). Patients suffering from cancer-related fatigue may have difficulty adhering to and completing treatment regimens. Fatigue has also been identified as the main reason patients withdraw from clinical trials. The quality of life of individuals experiencing cancer-related fatigue may be less than satisfactory. The purpose of this paper is to review literatures on the effect of exercise on fatigue in women with breast cancer and make recommendations for nursing practice and health care providers to improve care of individuals suffering from cancer-related fatigue (Visovsky and Schneider, 2003).
The following electronic databases were searched Cochrane Database Systematic Reviews, Medline, Highbeam and Pubmed. Terms related to breast cancer, exercise, fatigue, cancer-related fatigue and publication type (e.g., random controlled clinical trial) were used in searching. This search strategy was modified as necessary for each database.
Fatigue has been reported by 60% to 100% of patients undergoing treatment for cancer and has been identified as a research priority by the Oncology Nursing Society for a decade (Mock, Pickett, Ropka, Poniatowski and Drake, 2001). Cancer-related fatigue differs from normal tiredness by its sudden appearance, its overwhelming nature, and its refractory response to rest. While oncology nurses are well aware that fatigue is a prevalent complaint in cancer patients, the best way to assess and treat this debilitating symptom is less clear (Clark, 2001).
Fatigue is one of if not the most common complaints of patients with cancer. The etiology for CRF is unknown, but is theorized to be caused from activation of proinflammatory cytokines in response to the tumor such as interleukin-1 beta, interleukin-6 and tumor necrosis factor, have been implicated in the development of cancer-related fatigue resulting in diminished skeletal muscle protein stores. This reduction in muscle protein, also