Fatigue Can Be a Symptom of a Serious Health Condition - Research Article (original) (raw)
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Fatigue and quality of life: lessons from the real world
The impact of fatigue on the quality of life of oncology patients is substantial and under-recognized. Fatigue in these patients may begin with a simple decrease in physical activity, but can progress to include a wide range of negative effects that often culminate in patients feeling out of control, lonely, and isolated. In general, surviving cancer patients experience some limitations after the end of treatment but ultimately attain a reasonably good level of functioning. An examination of subpopulations and further analyses of data suggest, however, four different recovery patterns. Patients may: A) improve in their functioning, reach a plateau at approximately year 2 or 3, and then remain at relatively high levels of functioning; B) improve initially, but dete-riorate again after year 2 or 3, never reaching the normal stage; C) improve, returning to normal; or D) have a very mixed pattern of high levels of fatigue that is, to date, very difficult to interpret. Disturbingly, 60% of the survivors in our population of patients with Hodgkin's disease, who were treated in recent trials of the German Hodgkin Study Group and the European Organization for Research and Treatment of Cancer Lymphoma Group, had medium to high levels of fatigue after 5 cancer-free years. Investigations are essential to determine the current status of long-term survivors in more detail and to link that status to conditions observed during the treatment of acutely ill patients. The Oncologist 2003;8(suppl 1):5-9
American family physician, 2008
Fatigue, a common presenting symptom in primary care, negatively impacts work performance, family life, and social relationships. The differential diagnosis of fatigue includes lifestyle issues, physical conditions, mental disorders, and treatment side effects. Fatigue can be classified as secondary to other medical conditions, physiologic, or chronic. The history and physical examination should focus on identifying common secondary causes (e.g., medications, anemia, pregnancy) and life-threatening problems, such as cancer. Results of laboratory studies affect management in only 5 percent of patients, and if initial results are normal, repeat testing is generally not indicated. Treatment of all types of fatigue should include a structured plan for regular physical activity that consists of stretching and aerobic exercise, such as walking. Caffeine and modafinil may be useful for episodic situations requiring alertness. Short naps are proven performance enhancers. Selective serotonin...
Assessment of fatigue in cancer and non-cancer patients and in healthy individuals
Supportive Care in Cancer, 1993
Fatigue is a very complex phenomenon. It has been described as a major distressing symptom in cancer patients. It is a multidimensional experience that focuses not only on biochemical or pathophysiological causes, but also involves psychological and behavioural aspects. Until today, measurement of fatigue has been a neglected topic in medicine and nursing and a nihilistic attitude still prevails. The lack of valid, reliable tools of measurement is one of the problems inhibiting further research. Only recently has quality-oflife research begun to acknowledge this phenomenon and include fatigue in assessment. In this study, fatigue was measured and explored in cancer patients noncancer patients and in healthy individuals. A clear distinction evolved between "healthy" fatigue in healthy individuals and "unhealthy" fatigue in cancer patients, where the impact of fatigue was far more negative. Characteristic fatigue profiles underlined these findings. The new visual-analogue fatigue scale, to measure fatigue four times dally, proved to be very useful. Further research is needed to develop therapeutic strategies and to support the patients who have to cope with this distressing symptom.
Survivorship: Fatigue, Version 1.2014
Journal of the National Comprehensive Cancer Network, 2014
NCCN defines cancer-related fatigue as "a distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning." 1 Fatigue is a common symptom in patients with cancer and is nearly universal in those receiving cytotoxic chemotherapy, radiation NCCN Survivorship: Fatigue, Version 1.2014
European Journal of Cancer, 2008
Fatigue is a common symptom in patients with cancer and in disease-free survivors. It has a significant impact on the quality of life. Although subjective fatigue is often related to objective changes in physical functioning or impaired performance status, the two phenomena are not synonymous and need to be distinguished. A number of robust and reliable assessment instruments to measure fatigue severity are now available and criteria for cancer-related fatigue syndrome have been proposed. The underlying mechanisms and pathophysiology of cancer-related fatigue are unclear. Management strategies include the use of psycho-educational interventions, exercise programmes and pharmacological treatments. The best evidence for the effectiveness of drug treatments is for the haematopoietic agents in anaemic patients undergoing chemotherapy and for methylphenidate in an ontreatment population.
Fatigue in Other Medical Disorders
Sleep Medicine Clinics, 2013
We review fatigue and sleepiness caused by renal, hematological, and endocrine diseases in this article. RENAL DISORDERS Both acute and chronic kidney disease are associated with symptoms of fatigue, lethargy, and malaise. 1,2 There is no specific treatment for fatigue in renal diseases. Management focuses on treating the underlying etiology of the kidney disease and preventing progression of renal dysfunction, if possible. Supportive measures, including medical therapy and dialysis, may need to be initiated. Because most available data pertain to symptoms in chronic renal failure, most of this section focuses on fatigue in chronic kidney disease (CKD). FATIGUE IN CHRONIC KIDNEY DISEASE Fatigue is the initial and one of the cardinal manifestations of CKD. 1,3 This is irrespective of the etiology of CKD. Unlike healthy individuals, in whom fatigue can be a protective mechanism aimed at obtaining rest and replenishment to overcome physical and mental stress, fatigue in medical disorders can be severely debilitating. 4 In CKD, it has significant impact on quality of life and is associated with substantial morbidity and mortality. 5,6 CKD is divided into 5 stages based on the glomerular filtration rate (GFR). 7 The initial stages (stages 1 and 2) are mostly asymptomatic. Clinical manifestations, including fatigue, generally first become apparent with a drop in GFR below 60 mL/min/ 1.73 m 2 (stage 3 CKD). Symptoms are generally progressive unless appropriate management of CKD is initiated. Even with optimal therapy, many patients continue to experience malaise/fatigue. The pathogenesis of fatigue in CKD is multifactorial. Anemia, disordered calcium and phosphate metabolism, wasting, and depression are all implicated (see Table 1). 8 Anemia in Chronic Kidney Disease Anemia is common in patients with CKD. 9 More than half of patients with advanced-stage CKD have low hemoglobin levels. 10 The authors have no conflicts of interest to disclose.
Cancer-Related Fatigue, Version 2.2015
Journal of the National Comprehensive Cancer Network, 2015
Fatigue is a common symptom in patients with cancer. It is nearly universal in those receiving cytotoxic chemotherapy, radiation therapy, bone marrow transplantation, or treatment with biologic response modifiers. 1-3 According to a survey of 1569 patients with cancer, fatigue is experienced by 80% of individuals who receive chemotherapy and/or radiotherapy. 4,5 In patients with metastatic disease, the prevalence of cancer-related fa-NCCN
European Journal of Cancer Care, 1996
Interest in fatigue research has grown since the finding that fatigue/tiredness is the most frequently reported symptom of cancer and its treatment. But even though several authors have tried to conceptualize fatigue (Piper & Rieger, 1989; Cimprich, 1992; Gibson & Edwards, 1985; Winningham, 1994; Irvine et al. 1994; Grandjean, 1970; et al.), its mechanisms are still poorly understood. The aim of this study was two-fold: i) to explore fatigue in cancer patients, inductively, and ii) to compare fatigue/tiredness experiences of healthy individuals with those of cancer patients to identify cancer-specific fatigue/tiredness and related concepts. A qualitative research strategy was adopted using a grounded-theory approach. The prospective study took place in the Oncology Department of the Kantonsspital St Gallen (Switzerland) with samples of 20 cancer patients and 20 healthy individuals. Unstructured, tape-recorded interviews were conducted to collect data. Transcripts of the interviews were analysed using content analysis and constant comparison. Although different themes emerged between the two groups, both fitted a classification system that categorized expression of fatigue/tiredness as physical, affective or cognitive. Physical signs were more frequent than affective and cognitive signs in both groups. For the cancer patients, fatigue involved decreased physical performance, extreme, unusual tiredness, weakness and an unusual need for rest, which was distinctly different for healthy persons. Affective and cognitive distress were also more prominent in cancer patients. Interestingly, the concept of malaise was not identified by either sample and not understood as an expression of fatigue by this German-speaking population. Linguistic differences in the description of fatigue/tiredness between healthy and ill individuals revealed different perceptions of the phenomenon. A step-like theory, involving nociception, perception and expression of tiredness, was put forward tentatively to explain the production of fatigue/tiredness. The emerging concepts break tiredness/fatigue into expressions of physical, affective and cognitive tiredness/fatigue. The experience is different between healthy individuals and cancer patients. The generalization of data needs precaution but the results of the study identify and clarify ideas that might form an important basis for further, controlled studies.
Cancer-Related Fatigue: The Scale of the Problem
The Oncologist, 2007
Fatigue is one of the most common and debilitating symptoms experienced by patients with cancer. Cancer-related fatigue (CRF) is characterized by feelings of tiredness, weakness, and lack of energy, and is distinct from the “normal” drowsiness experienced by healthy individuals in that it is not relieved by rest or sleep. It occurs both as a consequence of the cancer itself and as a side effect of cancer treatment, although the precise underlying pathophysiology is largely unknown. CRF may be an early symptom of malignant disease and is reported by as many as 40% of patients at diagnosis. Virtually all patients expect fatigue from cancer therapy. Up to 90% of patients treated with radiation and up to 80% of those treated with chemotherapy experience fatigue. CRF continues for months and even years ollowing completion of treatment in approximately one third of the patients with cancer. The impact of CRF on a patient's quality of life (QoL), particularly in relation to physical fu...