Fatigue

Fatigue is defined by Radbruch et al. (2008) as a subjective feeling of tiredness, weakness, or lack of energy. Of all the symptoms reported by palliative care patients, fatigue is the most common, yet it is often underreported and undertreated. According to the Mayo Clinic staff, fatigue is a nearly constant state of weariness that develops over time and reduces your energy, motivation, and concentration.

Here are some of the causes and possible treatments.
There are different types of fatigue. Assessment of the type of fatigue can help determine the best treatment. Here are some of the descriptions of the different types:

• Emotional – common with sadness, worries, and depression
  
• Physical – often follows physical activity
  
• Pain – pain on movement depletes energy
  
• Mental fatigue – extensive problem solving
  
• Illness fatigue – some illnesses and their treatments can lead to inherent physical and emotional fatigue
  
• Social fatigue – increased social interaction.
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Causes

• Anemia
  
• Polypharmacy
  
• Autonomic dysfunction
  
• Male hypogonadism
  
• Inflammatory cytokines
  
• Dehydration
  
• Fever (Radbruch, 2008)

Management

• Rx anemia
  
• Symptom management
  
• Meds
  
• Glucocorticoids
  
• Megestrol acetate
  
• Psychostimulants
  
• Testosterone for hypogonadal males (Dev et al., 2014)
  
• Complementary therapies
  
• Exercise
  
• Yoga
  
• Behavioral and psychosocial interventions
  
• Acupuncture
  
• Light therapy (Bruera & Yennurajalingam, 2020; Piper et al., 2010; Saligan et al., 2015)

Reference

Bruera, E. & Yennurajalingam, Y. (2019). Overview of fatigue, weakness, and asthenia in palliative care. UptoDate https://www.uptodate.com/contents/overview-of-fatigue-weakness-and-asthenia-in-palliative-care#H29611093.

Dev, R., Bruera, E. & Del Fabbro, E. (2014). When and when not to use testosterone for palliation in cancer care. Curr Oncol Rep. 16(4), 378.

Mayo Clinic Staff (2021). Fatigue: Definition. https://www.mayoclinic.org/symptoms/fatigue/basics/definition/sym-20050894

Piper, B.F. & Cella, D. (2010). Cancer-related fatigue: definitions and clinical subtypes. J Natl Compr Canc Netw. 8(8),958-66.

Radbruch, L., Strasser, F., Elsner, F., et al. (2008). Fatigue in palliative care patients — an EAPC approach. Palliative Medicine. 22(1), 13-32.

Saligan, L.N., Olson, K., Filler, K., et al. (2015). The biology of cancer-related fatigue: a review of the literature. Support Care Cancer. 23(8),2461-78.

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