Purpose of review: Cancer-related fatigue (CRF) is a prevalent and debilitating symptom among breast cancer survivors with a significant adverse impact on quality of life. This comprehensive review synthesizes the current understanding of CRF's complex pathophysiology, including the interplay of inflammatory, neuroendocrine, and psychosocial mechanisms, and evaluates diverse intervention strategies.
Recent findings: Non-pharmacologic approaches (e.g., structured exercise, cognitive-behavioural therapy, mindfulness) have the strongest evidence for alleviating CRF and are emphasized as first-line treatments in oncology guidelines (e.g., ASCO, NCCN, ESMO). In contrast, pharmacologic options such as psychostimulants or bupropion show only modest benefits, with mixed efficacy and notable side effects, underscoring their limited role. Comparing oncology-focused guidelines with those for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) which are psychiatry-focused highlight key differences in management approaches and the need for a unified, multidisciplinary framework across specialties. Modern multidisciplinary, individualized survivorship care, integrating oncologic, psychosocial, and rehabilitative strategies call for adoption of updated, integrated clinical guidelines to optimally address CRF. By consolidating evidence and expert recommendations, this review aims to inform and enhance the clinical management of CRF and improve survivorship outcomes for breast cancer survivors.
Keywords: Cancer related fatigue; Guidelines; Multidisciplinary; Myalgic encephalomyelitis/Chronic fatigue syndrome (ME/CFS); Psychiatry; Survivorship.
© 2025. The Author(s).