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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).

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.

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WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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