Fatigue (PDQ®): Supportive care - Health Professional Information [NCI] - Intervention
Much of the information regarding interventions for fatigue relates either to healthy subjects or to persons in whom muscle fatigue is the primary etiology of the problem or fatigue is secondary to treatment-related anemia.[1,2][Level of evidence: II];[3,4] Without a determination of the causative mechanisms of fatigue in oncology patients, interventions must be directed to symptom management and emotional support. Although some recommendations for the management of fatigue in oncology patients have been made, these are theoretical or anecdotal in nature and in general have not been the focus of scientific evaluation.
Published in 2013, a study conducted in patients with advanced cancer (N = 152) demonstrated that managing symptoms (e.g., pain, nausea, and decreased appetite) can have a significant positive impact on fatigue. In this 12-week study, patients were randomly assigned to receive either monitoring and protocolized treatment of physical symptoms coordinated by a nurse or care as usual (symptom management included in the standard oncologic care). Patients in the intervention group received tailored treatment for any of the identified troublesome symptoms. Fatigue levels, as measured by the Multidimensional Fatigue Inventory, showed significant improvement in the intervention group compared with the group receiving care as usual. The intervention group also showed improvements in the following:
- Specific fatigue dimensions.
- Interference by fatigue with daily life.
- Overall symptom burden.
- Symptoms of depression and anxiety.
Similar studies are needed to investigate whether treatment of specific physical and psychological symptoms can alleviate fatigue and to identify patient populations that might benefit from such management. One message of this study may be that fatigue can be a primary symptom or a secondary symptom (a result of other bothersome problems). Therefore, assessing patients for the appropriate target symptom for intervention is probably the most efficient way to help patients improve health-related quality of life.
Because the etiology and mechanisms regarding fatigue/asthenia in cancer patients are indeterminate, there is considerable variation in practice patterns regarding the management of this symptom. The focus of medical management is often directed at identifying specific and potentially reversible correlated symptoms, as in the following examples:
- Patients with fatigue and pain may have titration of pain medications.
- Patients with fatigue and anemia may receive a transfusion of packed red blood cells, nutritional interventions including iron-rich foods, supplemental iron or vitamins to correct an underlying deficiency, or injections of epoetin alfa.
- Patients with depressed mood and fatigue may be treated with antidepressants or psychostimulants.