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Fatigue in Cancer

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Fatigue in Cancer, Fatigue in Terminally Ill Patients, Cancer Related Fatigue

  • See Also
  1. Fatigue
  2. Fatigue Causes
  • Epidemiology
  1. Affects 75 to 90% of cancer patients
  • Risk Factors
  1. Physical comorbidities (e.g. Cancer Pain)
  2. Mental health comorbidities (e.g. Insomnia, depressed mood)
  3. Physical inactivity and deconditioning
  4. Maladaptive emotional response to diagnosis and treatment
  • Findings
  1. See Fatigue
  2. Overwhelming physical and emotional exhaustion with impaired function or decreased quality of life
  3. Fatigue persists and is not relieved with rest
  • Differential Diagnosis
  1. See Fatigue Causes
  • Associated Conditions
  • Comorbid and Reversible Conditions
  1. Anxiety Disorder
  2. Major Depression
  3. Medication Causes of Fatigue
  4. Anemia
  5. Cancer Pain
  6. Infection
  7. Sleep disorder
  • Evaluation
  1. Brief Fatigue Inventory
  • Labs
  1. See Fatigue Diagnostic Testing
  2. Consider CBC, comprehensive metabolic panel, TSH, Serum Cortisol at 8 am
  • Management
  • General Measures
  1. Enlist family support in understanding Fatigue is real
  2. Give patient permission to feel tired
  3. Restructure patient activities to conserve energy
  4. Encourage regular Exercise (e.g. Resistance Training, aerobic activity) - paradoxically reduces Fatigue
  5. Tai chi or qigong (low to moderate intensity)
  6. Cognitive Behavioral Therapy or Mindfulness activities
  7. Offer stress management for patient and family
  8. Eliminate unnecessary medications
  9. Maximize hydration and nutrition
  • Management
  • Empiric Medications
  1. Dexamethasone (Decadron)
    1. Dose: 2 to 20 mg PO qAM
    2. Effects may wane after 4 to 6 weeks
  2. Integrative therapy
    1. Consider American Ginseng 1000 mg twice daily during treatment
    2. Acupuncture after treatment is compleated
  3. Other agents (not generally recommended in Cancer Related Fatigue)
    1. Selective Serotonin Reuptake Inhibitors (SSRI) trial
      1. May consider in comorbid Major Depression
    2. Methylphenidate (Ritalin)
      1. Initial Dose: 2.5 to 5 mg PO qAM and at Noon
      2. Titrate Dose to 30 mg PO qd
  • References
  1. Eary (2026) Am Fam Physician 114(4): 393-411 [PubMed]
  2. Portenoy (1999) Oncologist 4:1-10 [PubMed]