FATIGUE Flashcards
What is fatigue?
A subjective, unpleasant symptom which incorporates total body feelings ranging from tiredness to exhaustion creating an unrelenting overall condition which interferes with individual’s ability to function to their normal capacity
How common is fatigue in palliative care pt?
84%
Causes of fatigue in general population?
Depression
Anxiety
Sleep disturbance
Stress
Somatisation
Causes of fatigue in other chronic illness?
Psychological distress
Reconditioning i..e the less somebody does, the more fatigued they feel
Muscle weakness e.g. corticosteroid myopathy
Infections
Anaemia
Cachexia
Metabolic and endocrine disturbances
Treatment side effects e.g. radiotherapy
Multiple symptomatology e.g. pain, dyspnoea, cachexia, insomnia
Causes of fatigue specific to cancer pt?
Muscle dysfunction?
Erythrocyte dysfunction?
Neuroendocrine dysfunction?
Autonomic dysfunction?
Cytokine effects?
Circulating asthenins?
The chronic pro-inflammatory state in cancer can alter serotonin metabolism, cause anaemia, and alter the HPA axis activity.
Fatigue scales for assessment?
Single item instruments e.g. “how would you rate your fatigue on a scale of 0-10 over the past week”
Uni-dimensional scales e.g. FACT-F, (others: brief fatigue inventory, FSS, POMS, EORTC QLQc30)
Multi-dimensional (used in research rather than clinical practice) e.g. Chalder fatigue scale, fatigue symptom inventory
Cancer related fatige scales
What is the EORTC QLQc30 questions?
Did you need to rest?
Have you felt weak?
Were you tired?
Diagnostic criteria for cancer-related fatigue?
Cella’s diagnostic criteria
A1: significant fatigue
A2-A11: 5 other associated symptoms
B: Fatigue impact
C: due to cancer or cancer treatment
D: not due to co-morbid psychopathology
Interventions proven to work for cancer-related fatigue?
Sleep hygiene?
Manage other symptoms that may be impacting on fatigue?
Gradual building up of aerobic exercise - proven for breast and prostate cancer
Conserving energy -e.g. don’t do taxing jobs if they feel they have a bit of energy and instead do things they enjoy
Psycho-social brief interventions
Erythropoietin
Methylphenidate
Modafinil only if severe fatigue
Ginseng
Short course of steroids e.g. only for 1 weak so should only be used if they have a specific thing they want to do for example going to a wedding - as over time they cause more harm than good and effects will likely wear off
Interventions proven to work for MS-related fatigue?
Amantadine
Occupational therapy interventions for conserving energy have some evidence of benefit
(Other drugs, diet and exercise were proven not effective)
Interventions proven to work for MND-related fatigue?
No good benefit
Exercise may be of benefit
Interventions proven to work for COPD-related fatigue?
Pulmonary rehabilitation
Self management education programmes - minor benefit
Interventions proven to work for CF-related fatigue?
No evidence is strong enough
Interventions proven to work for HIV-related fatigue?
Insufficient evidence
Physical examination for a pt with fatigue?
Look for signs of anaemia, infection, weight loss and muscle wasting
Other bits guided by history
