Post-exertional Malaise in People With Chronic Cancer-Related Fatigue

J Pain Symptom Manage. 2020 Aug;60(2):407-416. doi: 10.1016/j.jpainsymman.2020.02.012. Epub 2020 Feb 24.


Context: Cancer-related fatigue (CRF) is a distressing and persistent sense of tiredness or exhaustion that interferes with usual functioning. Chronic CRF continues for months after curative cancer treatment is complete. Post-exertional malaise (PEM) is a worsening of symptoms after physical or mental activity, with limited investigations in people with chronic CRF.

Objectives: The purpose of this study was to identify and describe self-reported incidences of PEM in people with chronic CRF.

Methods: Participants (n = 18) were eligible if they scored ≤34 on the Functional Assessment of Chronic Illness Therapy-Fatigue scale and had a cancer-related onset of fatigue. Participants completed a brief questionnaire to assess PEM during a six-month time frame (the DePaul Symptom Questionnaire-PEM). In addition, a maximal exercise test was used to investigate self-reported symptom exacerbation (via an open-ended questionnaire) after strenuous physical exertion.

Results: On the DePaul Symptom Questionnaire-PEM, three participants met previously defined scoring criteria, which included experiencing moderate to very severe symptoms at least half of the time, worsening of fatigue after minimal effort, plus a recovery duration of >24 hours. Content analysis of responses to open-ended questionnaires identified five people who experienced a delayed recovery and symptoms of PEM after maximal exercise.

Conclusion: A subset of people with chronic CRF (up to 33% in this sample) may experience PEM. Exercise specialists and health care professionals working with people with chronic CRF must be aware that PEM may be an issue. Symptom exacerbation after exercise should be monitored, and exercise should be tailored and adapted to limit the potential for harm.

Keywords: Exercise oncology; cancer rehabilitation; maximal exercise test.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Exercise
  • Fatigue / epidemiology
  • Fatigue / etiology
  • Fatigue Syndrome, Chronic*
  • Humans
  • Neoplasms* / complications
  • Neoplasms* / therapy
  • Physical Exertion
  • Surveys and Questionnaires