The Conceptualization and Measurement of Cancer-Related Fatigue in Different Types of Research (Diagnosis, Mechanisms, and Intervention): Systematic Review.

Background: Cancer-related fatigue (CRF) is a prevalent and debilitating symptom that significantly impacts patients' quality of life. Despite its recognition as a critical issue in oncology, there remains substantial variability in how CRF is conceptualized and measured. Standardized frameworks recommend multidimensional assessments, yet research practices remain inconsistent.

Objectives: This systematic review aims to evaluate how CRF is conceptualized and measured in contemporary oncology research (2021-2024). Specifically, it examines CRF assessment within studies focusing on (1) diagnosis, (2) underlying biological and psychological mechanisms, (3) interventions, which include two subtypes: interventions against fatigue and interventions against cancer, the latter referring to studies evaluating the impact of cancer treatment on fatigue.

Methods: A systematic literature search was conducted across PubMed, EMBASE, and Google Scholar following PRISMA guidelines. Eligible studies included clinical and observational research using quantitative methodologies to assess CRF as a primary or secondary outcome. Studies were screened and selected independently by two reviewers, with a third reviewer resolving discrepancies. A total of 968 studies were included in the review, covering the period from 2021 to 2024. Data extraction focused on fatigue conceptualization, measurement tools, their psychometric properties, and the placement of fatigue as a study variable.

Results: The review identified substantial variability in CRF measurement approaches. Fatigue was most frequently assessed as a secondary outcome, particularly in studies on cancer treatments (89%) and interventions (67%), while fewer studies considered it a primary endpoint. A significant proportion of studies relied on single-item measures or subscales rather than comprehensive validated fatigue questionnaires, particularly in research examining cancer treatment effects (64%) and fatigue diagnosis (60%). Furthermore, many studies failed to report the psychometric properties of fatigue measurement tools. Notably, self-designed instruments often lacked theoretical justification and validation, limiting their reliability. The review also identified significant research gaps, including a limited number of studies on rare cancers, combined treatment approaches, and specific fatigue-related interventions such as psychological support and spiritual care.

Conclusions: This review highlights key gaps in CRF research, particularly in the underrepresentation of certain cancer types, treatment modalities, and intervention strategies. The findings emphasize the need for a more consistent application of multidimensional fatigue assessments, a stronger focus on CRF as a primary research outcome and the prioritizing psychometric rigor and transparency in measurement reporting. Addressing these gaps could lead to a more comprehensive understanding of fatigue in oncology.