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Fatigue is a subjective feeling of loss of energy, tiredness or exhaustion. In some, it may be described as the most distressing symptom as well as the symptom that has the most negative impact on quality of life. Fatigue can be the result of multiple factors. It is associated with serious illnesses such as heart disease, cancer, and end stage organ failure, as well as electrolyte imbalances, malnutrition, and anemia. Fatigue is also associated with treatments for cancer such as radiation and chemotherapy. Fatigue can be caused by disruptions in sleep as well as anxiety, pain, stress, or depression.

• Assessment Fatigue can be subjectively assessed, like all symptoms, by using the PQRSTU mnemonic (see Symptom Assessment) or other numeric scales such as the ESAS (see Symptom Assessment). Further assessment may include inquiry into the impact fatigue has had on activities of daily living, mood, concentration, and memory.
• Treatment As with many symptoms experienced by persons with serious illness, treatment of the underlying cause should be managed if possible. If fatigue is related to other symptoms, such as pain or depression, rigorous management of those symptoms may help with fatigue. However, fatigue may also be caused by factors that cannot be reversed, such as progression of a serious illness. Nonpharmacologic management may include education about energy conservation, sleep hygiene, journaling, and elimination of nonessential activities, based on etiology and patient-centered goals. Pharmacologic management may include hypnotics, anxiolytics, corticosteroids or psychostimulants based on etiology. Consult an evidence-based guideline for further information in the palliative treatment of fatigue.

Additional Resources

Clinical Practice Guidelines

• Bower, J. E., Bak, K., Berger, A., Breitbart, W., Escalante, C. P., Ganz, P. A., Schnipper, H. H., Lacchetti, C., Ligibel, J. A., Lyman, G. H., Ogaily, M. S., Pirl, W. F., and Jacobsen, P. B. “Screening, Assessment, and Management of Fatigue in Adult Survivors of Cancer: An American Society of Clinical Oncology Clinical Practice Guideline Adaptation.” Journal of Clinical Oncology, 32 no. 17 (2014): 1840-1851.
• Fraser Health
• National Comprehensive Cancer Network (requires free registration)

References

• Kuebler, K. K., Heidrich, D. E., and Esper, P. Palliative and End-of-Life Care: Clinical Practice Guidelines, 2nd ed. (St. Louis, MO: Saunders, 2007).
• Peuckmann-Post, V., Elsner, F., Krumm, N., Trottenberg, P., Radbruch, L., Mücke, M., and Radbruch, L. “.” Cochrane Database Of Systematic Reviews 5 (2015): N.PAG-N.PAG 1p. doi:10.1002/14651858.CD006788.pub3
• Wrede-Seaman, L. Symptom Management Algorithms: A Handbook for Palliative Care, 3rd ed. Yakima, Washington: Intellicard, Inc.