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I’m so tired: biological and genetic mechanisms of cancer-related fatigue

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Abstract

Objective

The goal of this paper is to discuss cancer-related fatigue (CRF) and address issues related to the investigation into potential biological and genetic causal mechanisms. The objectives are to: (1) describe CRF as a component of quality of life (QOL); (2) address measurement issues that have slowed progress toward an understanding of mechanisms underlying this symptom; (3) review biological pathways and genetic approaches that have promise for the exploration of causal mechanisms of CRF; and (4) offer directions for future research.

Methods

Review, synthesis, and interpretation of the literature.

Results

Until recently, CRF and QOL have been understood primarily as subjective patient-reported experiences. With increased understanding of human genetics, theories and research are being expanded to incorporate biological and genetic understandings of these subjective experiences. Proposed biological and genetic mechanisms of CRF that have been examined include cytokine dysregulation, hypothalamic–pituitary–adrenal (HPA) axis dysfunction, five hydroxy tryptophan (5-HT) neurotransmitter dysregulation, circadian rhythm disruption, alterations in adenosine triphosphate (ATP) and muscle metabolism, and vagal afferent activation. Approaches to the study of genetic mechanisms have also been addressed including candidate genes, genome-wide scanning, and gene expression. Based on the review and synthesis of the literature, directions for future research are proposed.

Conclusions

Understanding the biological and genetic basis of CRF has the potential to contribute to a more complete understanding of the genetic determinants of QOL.

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Acknowledgments

GENEQOL Consortium participants per March 2009: Amy P. Abertnethy, Duke Cancer Care Research Program, Duke University Medical Center, Durham, NC, US; Frank Baas, Laboratory of Neurogenetics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Andrea M. Barsevick, Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, US; Meike Bartels, Department of Biological Psychology, VU University, Amsterdam, the Netherlands; Dorret I. Boomsma, Department of Biological Psychology, VU University, Amsterdam, the Netherlands; Cynthia Chauhan, Cancer Advocay, Wichita, KS, US; Charles S. Cleeland, Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX, US; Amylou C. Dueck, Section of Biostatistics, Mayo Clinic, Scottsdale, AZ, US; Marlene H. Frost, Women’s Cancer Program, Mayo Clinic, Rochester, MN, US; Per Hall, Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Michele Y. Halyard, Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, US; Pål Klepstad, Department of Intensive Care Medicine, St Olavs University Hospital, Norwegian University of Technology and Science, Trondheim, Norway; Nicholas G. Martin, Queensland Institute of Medical Research, Brisbane, Australia; Christine Miaskowski, School of Nursing, University of California, San Francisco, CA, US; Miriam Mosing, Queensland Institute of Medical Research, Brisbane, Australia; Benjamin Movsas, Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, US; Cornelis J. F. Van Noorden, Department of Cell Biology and Histology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Donald L. Patrick, Department of Health Services, University of Washington, Seattle, WA, US; Nancy L. Pedersen, Department of Medical Epidemiology and Biostatistics, Karolinska; Institute, Stockholm, Sweden; Mary E. Ropka, Cancer Prevention and Control Program, Fox Chase Cancer Center, Cheltenham, PA, US; Quiling Shi, Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, Houston, TX, US; Gen Shinozaki, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, US; Jasvinder A. Singh, Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis, MN and Mayo Clinic College of Medicine, Rochester, MN, US; Jeff A. Sloan, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, US; Mirjam A. G. Sprangers, Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Ruut Veenhoven, Faculty of Social Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands; Ping Yang, Department of Genetic Epidemiology, Mayo Clinic, Rochester, MN, US; Aeilko H. Zwinderman, Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

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Authors and Affiliations

  1. Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, USA

    Andrea Barsevick

  2. Womens’ Cancer Program, Mayo Clinic, Rochester, MN, USA

    Marlene Frost

  3. Department of Clinical Epidemiology and Biostatistics, University of Amsterdam, Amsterdam, The Netherlands

    Aeilko Zwinderman

  4. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Per Hall

  5. Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA

    Michele Halyard

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Correspondence to Andrea Barsevick.

Appendix: Glossary [63, 64]

Appendix: Glossary [63, 64]

  • Case Definition: Criteria or standards used to identify an instance of a disease, syndrome, or condition;

  • DNA (deoxyribonucleic acid): The two-stranded molecule that encodes genetic information;

  • Gene: The basic unit of inheritance. A sequence of DNA bases that codes for a particular product;

  • Genome: All the DNA sequences of an organism;

  • Genotype: The genetic constitution of an organism that is not manifested as outward characteristics;

  • Phenotype: Physical characteristics of an organism or the presence of a disease that may or may not be genetic;

  • Polymorphism: A locus with two or more alleles (alternative forms of a gene at a locus);

  • Functional polymorphism: DNA sequence variations that alter the expression and/or functioning of the gene product;

  • Single nucleotide polymorphism (SNP): Sequences in the genome that differ by a single nucleotide between one portion of the population and another.

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Barsevick, A., Frost, M., Zwinderman, A. et al. I’m so tired: biological and genetic mechanisms of cancer-related fatigue. Qual Life Res 19, 1419–1427 (2010). https://doi.org/10.1007/s11136-010-9757-7

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