gms | German Medical Science

Background: Cancer-related fatigue (CRF) is a very common consequence of cancer and/or cancer therapy, which is associated with considerable impairments for those affected. Despite comprehensive guidelines for clinical practice, international studies indicate that CRF is still under-recognised and under-treated in cancer care.

Methods: One of the goals of the multi-angle LIFT project was to describe the current state of CRF management in Germany in order to identify potentials for improvement. Thus, we assessed the perspectives of patients and healthcare professionals (HCPs) using online and paper-pencil questionnaires. The patient sample consisted of 1,179 individuals on average 5.2 months after cancer diagnosis. The HCP sample consisted of 476 HCPs treating or caring for cancer patients (148 oncologists/physicians, 184 nurses, 144 psycho-oncologists). Survey data were analysed descriptively.

Results: Half of patients were never asked by their physicians whether they felt exhausted, 74% were not informed about CRF during cancer treatment, and 64% felt hindered by communication barriers. Common barriers included not knowing who to talk to about fatigue (39%), time constraints (31%), and fear of being perceived as weak (22%). Among HCPs, the majority felt rather or very well informed about CRF (physicians: 64%; nurses: 62%; psycho-oncologists: 84%) and (rather) competent in counselling (physicians: 67%; nurses: 58%; psycho-oncologists: 88%). However, more than two-thirds were not aware of fatigue-specific guidelines, which in turn was associated with lower self-efficacy to intervene for fatigue. Knowledge gaps regarding evidence for the beneficial effects of exercise resulted in a reluctance to recommend this effective intervention. HCPs suggested that awareness of CRF should be raised early in career and that multidisciplinary training should be offered. Patients and HCPs agreed that interprofessional communication about CRF and interdisciplinary collaboration between HCPs were unsatisfactory (patients: 77%; physicians: 93%; nurses: 64%; psycho-oncologists: 92%). For example, nurses and psycho-oncologists felt sparsely involved in CRF management (nurses: 60%; psycho-oncologists: 41%) and called for greater participation (nurses: 51.6%; psycho-oncologists: 34%).

Discussion: Despite HCPs’ perceived knowledge of CRF as well as their awareness of patients’ information needs and the necessity of addressing CRF, patients apparently did not receive adequate counselling, revealing a clear knowledge-to-practice gap.

Conclusions: Current management of CRF in Germany appears to be insufficient. HCPs should routinely address CRF and adopt a communication style that encourages patients to talk about their symptoms and raise their questions. To improve the care of cancer patients with CRF, awareness and knowledge of both HCPs and patients need to be enhanced. According to HCPs and patients, lack of interprofessional collaboration and unclear responsibilities seem to be some of the barriers to guideline-oriented CRF management. Consequently, roles in CRF management need to be clarified.

The authors declare that they have no competing interests.

The authors declare that a positive ethics committee vote has been obtained.