Systematic review and meta-analysis of the correlates of cancer-related fatigue

Worldviews Evid Based Nurs. 2011 Dec;8(4):191-201. doi: 10.1111/j.1741-6787.2011.00214.x. Epub 2011 Feb 22.


Background: Fatigue is one of the most common problems experienced by cancer patients. The factors most frequently reported to correlate with cancer-related fatigue are symptom distress (pain, nausea/vomiting, dyspnea, and lack of appetite) and psychological distress (depression and anxiety).

Aims: This study was performed to examine the overall association of symptom and psychological distress with cancer-related fatigue using systematic literature review and meta-analysis. This study also aimed to determine which factors have a higher correlation with fatigue, and therefore should receive nursing priority.

Methods: A meta-analysis of 30 primary studies identified by searching computer databases, which included MEDLINE, PubMed, and CINAHL.

Results: Results showed that all symptoms (pain, dyspnea, nausea/vomiting, and lack of appetite) and psychological distress (depression and anxiety) included had a significant association with cancer-related fatigue with medium-to-large effect sizes, which were estimated using correlation coefficients. The overall correlations of psychological distress with cancer-related fatigue were found to be higher than those of symptom distress. The correlation of nausea/vomiting with cancer-related fatigue was higher than those of pain and dyspnea.

Conclusions and implications: Our findings highlight the importance of psychological distress in dealing with cancer-related fatigue in addition to the need to be attentive to a patient's symptom distress. Of the symptom distress, nausea/vomiting should be prioritized by nurses when managing cancer-related fatigue. This study provides sound empirical evidence that can be used to draft guidelines for the management of cancer-related fatigue.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Fatigue / etiology*
  • Fatigue / nursing*
  • Fatigue / psychology
  • Humans
  • Neoplasms / complications*
  • Neoplasms / nursing*
  • Neoplasms / psychology
  • Oncology Nursing / methods*
  • Stress, Psychological / etiology
  • Stress, Psychological / nursing
  • Stress, Psychological / psychology