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Fatigue (PDQ®): Supportive care - Health Professional Information [NCI] - Assessment

Assessment of fatigue is multidimensional in nature,[1] and a number of tools originally developed for fatigue research have also been used in clinical practice. Most of these tools include symptom dimensions other than fatigue intensity, such as the impact or consequences of fatigue, timing of fatigue, related symptoms, and self-care actions.[2,3,4,5,6,7,8,9,10] Research has also contributed a validated 10-item measure for children.[11]

However, much of the time in clinical practice, because of perceived provider/patient burden, screening most often relies on a single-item fatigue intensity rating.[12,13,14,15] According to National Comprehensive Cancer Network (NCCN) guidelines, ratings of fatigue of 4 or higher on a scale of 0 to 10 (where 10 is very severe fatigue) should be further evaluated for known contributing factors such as pain, emotional distress, anemia, sleep, nutrition, and level of activity, and these comorbidities should be treated.[16] One study of ambulatory outpatients with solid tumors (N = 148) evaluated the usefulness of single-item screening for symptoms such as fatigue and pain.[12] Investigators found that the single-item assessment can assist as a first screening step to identify patients requiring comprehensive assessment of symptoms. Patients identified by using single-item screening tools should undergo comprehensive assessments to detect clinically relevant symptomatology.[12,13]

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Multiple-item Tools

Ambiguous literature and a previous lack of specific tools to measure fatigue have created difficulties in establishing assessment and management guidelines. Comprehensive assessment of the fatigued patient starts with obtaining a careful history to characterize the individual's fatigue pattern and to identify all factors that contribute to its development. The following should be included in the initial assessment:

  • Self-report of fatigue pattern, including onset, duration, intensity, and aggravating and alleviating factors.
  • Type and degree of disease- and of treatment-related symptoms and/or side effects.
  • Treatment history.
  • Current medications.
  • Sleep and/or rest patterns, relaxation habits, customs, and rituals.
  • Nutrition intake and any appetite or weight changes.
  • Effects of fatigue on activities of daily living and lifestyle.
  • Psychiatric evaluation, including evaluation for depression.
  • Complete physical examination, including gait, posture, and range of motion.
  • Compliance with treatment.
  • Job performance.
  • Financial resources.
  • Other contributing factors (e.g., anemia, dyspnea, muscle wasting).
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