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

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Specific attention should be paid to underlying factors that contribute to fatigue and may be correctable, including the following:[17,18]

  • Anemia.
  • Depression.
  • Anxiety.
  • Pain.
  • Dehydration.
  • Nutritional deficiencies (e.g., protein, calories, vitamins).
  • Sedating medications (e.g., opioids, benzodiazepines).
  • Neurotoxic therapies.
  • Infection.
  • Fever.
  • Sleep disturbances.
  • Immobility.

Proposed criteria for cancer-related fatigue (CRF) are listed below. These criteria have been adopted for inclusion in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM).[19]

Defining CRF as a diagnostic syndrome has some potential advantages and disadvantages.[20] One of the possible advantages is that it would enable clinicians to document the presence or absence of fatigue in a reproducible fashion. It may also be useful in establishing appropriate reimbursement for management of this finding. The potential disadvantage of this approach is that it may deter management of fatigue that does not reach the threshold for ICD-10 diagnosis. The alternative to the syndrome-based approach (commonly used for depression) is a symptom-based approach, which is commonly used for phenomena such as pain and nausea. The utility of the following ICD-10 criteria for CRF has not been validated.

ICD-10 Criteria for Cancer-related Fatigue

The following symptoms have been present every day or nearly every day during the same 2-week period in the past month:

  1. Significant fatigue, diminished energy, or increased need to rest, disproportionate to any recent change in activity level, plus five or more of the following:
    1. Complaints of generalized weakness, limb heaviness.
    2. Diminished concentration or attention.
    3. Decreased motivation or interest to engage in usual activities.
    4. Insomnia or hypersomnia.
    5. Experience of sleep as unrefreshing or nonrestorative.
    6. Perceived need to struggle to overcome inactivity.
    7. Marked emotional reactivity (e.g., sadness, frustration, or irritability) to feeling fatigued.
    8. Difficulty completing daily tasks attributed to feeling fatigued.
    9. Perceived problems with short-term memory.
    10. Postexertional fatigue lasting several hours.
  2. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  3. There is evidence from the history, physical examination, or laboratory findings that the symptoms are a consequence of cancer or cancer therapy.
  4. The symptoms are not primarily a consequence of comorbid psychiatric disorders such as major depression, somatization disorder, somatoform disorder, or delirium.
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