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:
- Significant fatigue, diminished energy, or increased need to rest, disproportionate to any recent change in activity level, plus five or more of the following:
- Complaints of generalized weakness, limb heaviness.
- Diminished concentration or attention.
- Decreased motivation or interest to engage in usual activities.
- Insomnia or hypersomnia.
- Experience of sleep as unrefreshing or nonrestorative.
- Perceived need to struggle to overcome inactivity.
- Marked emotional reactivity (e.g., sadness, frustration, or irritability) to feeling fatigued.
- Difficulty completing daily tasks attributed to feeling fatigued.
- Perceived problems with short-term memory.
- Postexertional fatigue lasting several hours.
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- There is evidence from the history, physical examination, or laboratory findings that the symptoms are a consequence of cancer or cancer therapy.
- The symptoms are not primarily a consequence of comorbid psychiatric disorders such as major depression, somatization disorder, somatoform disorder, or delirium.
As with other self-reported symptoms such as pain, it may be necessary to encourage the patient and other family members to report symptoms of fatigue to the medical staff. Information regarding the potential for fatigue due to the underlying disease or treatments, possible options for management, and the importance of reporting these symptoms should be given to all patients at the initiation of treatment. Patients may not mention the fatigue they experience unless they are prompted by a health professional.
Several barriers hamper appropriate management of CRF. Some of these barriers were identified in phase 1 of an ongoing three-phase project related to the implementation of evidence-based (NCCN) guidelines for fatigue management. The most commonly identified barriers were the following:[21,22]
- Patient's belief that the physician would introduce the subject of fatigue if it was important (patient barrier).
- Lack of fatigue documentation (professional barrier).
- Lack of supportive care referrals (system barrier).
Although there is no universally accepted standard for the measurement of fatigue, there are a variety of instruments that have been developed to assess fatigue.[2,3,4,5,6][Level of evidence: II];[7,8,9,10] Fatigue is also commonly assessed in multidimensional quality-of-life instruments. Selected instruments for assessing fatigue are listed below.
- Brief Fatigue Inventory.
- The Functional Assessment of Cancer Therapy-Anemia.
- The Functional Assessment of Cancer Therapy-Fatigue.
- Piper Fatigue Self-Report Scale.
- The Schwartz Cancer Fatigue Scale.
- Fatigue Symptom Inventory.
- The Profile of Mood States Fatigue/Inertia Subscale.
- Lee's Visual Analogue Scale for Fatigue.
- Cancer Fatigue Scale.
Evaluation of Anemia
The proper evaluation of anemia in cancer patients includes a careful history and physical examination, an evaluation of the complete blood count and red blood cell indices, and examination of the peripheral blood smear. In combination, the information from these investigations is often diagnostic.