Cancer-related fatigue has been defined as a distressing, persistent, and subjective sense of tiredness or exhaustion that is not proportional to activity and interferes with usual function. Fatigue is one of the most common problems in patients with cancer. It may be related to the disease itself or cancer treatment and may continue beyond completion of treatment among long-term cancer survivors. Among people with cancer, 80% to 100% report experiencing fatigue. Fatigue may be an isolated problem or occur as one element in a cluster of symptoms, such as pain, depression, dyspnea, anorexia, and sleep disturbance.

Immune-Related Adverse Events With Immunotherapy

Fatigue is a multicomponent symptom that is common among all patients with cancer, so it may not be unexpected in patients receiving immunotherapy treatment. However, with immunotherapies, fatigue may be a presenting symptom of an endocrine disorder secondary to immunotherapy, such as thyroid or pituitary disorder, not just general cancer-related fatigue. Clinicians need to suspect underlying endocrine immune-related adverse events (irAEs) with vague symptoms such as fatigue and take appropriate actions for diagnostic testing and involvement of endocrinologists as needed. Immune-related endocrine disorders can occur relatively late in treatment and take months to resolve or potentially be irreversible. However, some can be easily corrected with prompt interventions (Linardou & Gogas, 2016).

Click here for instructions on navigating the ONS PEP webpages. Have a question about how to apply this PEP topic to your practice? Ask a nurse on ONS staff at clinical@ons.org.

This topic was updated on January 9, 2017.

Linardou, H., & Gogas, H. (2016). Toxicity management of immunotherapy for patients with metastatic melanoma. Annals of Translational Medicine, 4, 272. doi:10.21037/atm2016.07.10

2011–2016 Authors

Sandra Anne Mitchell, PhD, CRNP, AOCN®, Tara A. Albrecht, PhD, ACNP-BC, Mohammad Omar Alkaiyat, RN, CRC, CCRP, Kathleen Browne, RN, BSN, OCN®, Jane C. Clark, PhD, RN, AOCN®, GNP-C, Regina M. DeGennaro, DNP, RN, AOCN®, CNL, Amy J. Hoffman, BSN, MSN, PhD, Karol Huenerberg, FNP-BC, APNP, AOCNP®, Patricia Poirier, PhD, RN, AOCN®, Carolene B. Robinson, RN, MA, AOCN®, CBCN®, Karen Stilwell, RN, MSN, CNS, OCN®, Elizabeth A. Varley, RN, BSN, OCN®, Hsiao-Lan Wang, PhD, RN, CMSRN, HFS, and Breanna M. Weisbrod, RN, OCN® 

ONS Staff: Margaret M. Irwin, PhD, RN, MN, Christine M. Maloney, BA, Kerri A. Moriarty, MLS, and Mark Vrabel, MLS, AHIP, ELS


2009 Authors

Sandra A. Mitchell, PhD, CRNP, AOCN®, and Susan L. Beck, APRN, PhD, AOCN®, FAAN

ONS Staff: Linda H. Eaton, MN, RN, AOCN®


2006 Authors

Sandra A. Mitchell, MScN, CRNP, AOCN®, Susan L. Beck, PhD, APRN, AOCN®, Linda Edwards Hood, MSN, RN, AOCN®, Katen Moore, MSN, APRN, AOCN®, and Ellen R. Tanner, RN, BSN, OCN®

ONS Staff: Linda H. Eaton, MN, RN, AOCN®