9th January 2024

Fatigue

Fatigue is a sustained, subjective feeling of weakness, tiredness, or low energy. It is reported in up to 80% of patients with cancer, and this increases following treatments like radiotherapy. It is also prevalent in people with non-malignant diseases, including COPD, CCF and multiple sclerosis.

In malignancy, inflammatory cytokines can contribute to fatigue, but secondary causes are common and should be excluded.

Causes of Fatigue

• Organ dysfunction – Renal/ cardiac/ hepatic failure
• Hypothyroidism
• Adrenal insufficiency
• Anaemia
• Infection
• Nutrition – Poor diet/ malabsorption
• Sleep pattern
• Physical exertion or deconditioning
• Depression/ anxiety

Management

Non-Pharmacological:

• Diary – Identifying any triggers for symptoms
• Conserving energy – Prioritising tasks, pace activities, schedule tasks for the time with most energy, occupational therapy input
• Physical activity – Exercise can reduce fatigue, and physiotherapy input may be beneficial
• Stress and anxiety management
• Complementary therapy

Pharmacological:

• Dexamethasone 2-4mg OD may improve appetite, nausea, and subjective feelings of weakness but is more appropriate in those with anorexia/cachexia