Management of fatigue in the cancer patient

Fatigue is one of the most common symptoms experienced by patients with cancer and other progressive diseases. Although reported to be a major obstacle to maintaining normal daily activities and quality of life, remarkably few studies of this syndrome have been conducted. This trend is slowly changing with the recognition of fatigue as a diagnosis by the International Classification of Diseases 10th Revision-Clinical Modification; the introduction of new instruments for the measurement of fatigue; and the publication of practice guidelines. An adequate evaluation of fatigue must assess its severity, clarify other characteristics, and determine the impact on daily activities. Potential etiologies include the underlying disease, treatment of the disease, concurrent conditions, and psychological disorders. Interventions for fatigue involve therapies targeted at the correction of the potential etiologies and symptomatic therapies that may be pharmacologic or nonpharmacologic. Possible primary therapies include modification of the patient's drug regimen, correction of metabolic abnormalities, nutritional support, and pharmacologic treatments for anemia, insomnia, or depression. Symptomatic interventions include specific drug treatment, modification of activity, exercise, and cognitive therapies.