Mechanisms and models of cancerrelated fatigue

In looking at fatigue from a broad mechanistic perspective two categories can be identified:

1. 'Known': by this we mean fatigue associated with conditions or diseases where a plausible mechanism can readily be identified based upon the known underlying pathophysiology. In this category would be included fatigue associated with exercise, myasthenia gravis, multiple sclerosis, cardiac disease, chronic lung disease, severe anaemia, hypothyroidism, polio, and steroid myopathy.

2. 'Unknown': in this category are conditions or diseases where the origin of the fatigue is obscure (although this is changing rapidly), such as cancer, chemotherapy, radiotherapy, viral, and bacterial infections, postsurgery fatigue, and CFS. It is possible that these types of fatigue have at least some mechanistic features in common.

The emerging body of cancer-related fatigue knowledge can be combined with findings from other related fields (particularly exercise and CFS) to generate several models for the aetiology of cancer-related fatigue. None of the models is complete, but each is presented as a plausible and testable model to suggest (and hopefully stimulate) further research on the aetiology of cancer-related fatigue. For each we state the basic hypothesis, the key evidence upon which it is based, and suggest approaches to testing.

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