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Fatigue in palliative care patients -- an EAPC approach
Lukas Radbruch1, Florian Strasser, Frank Elsner
1Department of Palliative Medicine, RWTH Aachen University, Aachen, Germany. lradbruch@ukaachen.de
Palliative Medicine
|January 25, 2008
Summary
Fatigue is a common, multidimensional symptom in palliative care. Treatment involves addressing causes and symptoms, but may be detrimental in the final life stage.
Area of Science:
- Palliative Care Medicine
- Symptom Management
- Oncology
Background:
- Fatigue is highly prevalent in palliative care patients, affecting up to 99% of those undergoing cancer treatment and significant numbers of non-cancer patients.
- Cultural and linguistic factors influence the assessment and treatment of fatigue across different European countries.
- The pathophysiology of fatigue in palliative care remains incompletely understood, with proposed distinctions between primary and secondary fatigue.
Purpose of the Study:
- To present the European Association for Palliative Care (EAPC) expert group's position on fatigue in palliative care.
- To evaluate current evidence on the diagnosis and treatment of fatigue in this patient population.
- To provide a basis for future discussions, emphasizing cultural considerations.
Main Methods:
- Expert working group review of available evidence on fatigue diagnosis and treatment in palliative care.
- Focus on cultural issues impacting fatigue assessment and management.
- Development of a working definition of fatigue as a subjective lack of energy, weakness, or tiredness.
Main Results:
- Fatigue is recognized as a multidimensional construct with physical and cognitive components.
- Screening should account for linguistic variations, using terms like 'weakness' and 'tiredness'.
- Treatment strategies include causal interventions for secondary fatigue and symptomatic management (pharmacological and non-pharmacological), with strong evidence for aerobic exercise in cancer patients.
Conclusions:
- Fatigue management requires differentiating primary and secondary causes and considering multidimensional aspects.
- Cultural sensitivity is crucial for effective assessment and treatment.
- In the end-of-life phase, fatigue may serve a protective role, making intervention potentially harmful; identifying this point is critical.
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