Approach to Fatigue Workup

Initial Assessment

The National Comprehensive Cancer Network recommends screening all patients using a numeric rating scale (0-10) or categorization as none, mild, moderate, or severe 3, 4
Patients with scores of 0-3 (mild) require no further assessment; rescreening at regular intervals is sufficient 5, 6
Patients with scores of 4-10 (moderate to severe) warrant a more focused evaluation 7, 1
Patients with scores ≥7 typically experience a marked decrease in physical functioning 2, 8

A thorough review of systems should be conducted to identify affected organ systems 1, 9
An in-depth fatigue assessment should include onset, pattern, duration, and changes over time 2, 8
Associated or alleviating factors should be evaluated 1, 9
Interference with normal functioning and daily activities should be assessed 2, 10
Patient's self-assessment of potential causes should be considered 1, 8

Pain should be assessed and treated effectively as it commonly clusters with fatigue 1, 9
Emotional distress should be screened for depression and anxiety, which frequently co-occur with fatigue 9, 10
Sleep disturbance should be evaluated for sleep quality, quantity, and hygiene 1, 2
Medication side effects should be reviewed as potential contributors to fatigue 1, 2
Alcohol/substance use should be screened for misuse that may contribute to fatigue 9, 10

For cancer survivors, disease recurrence or treatment effects should be considered as potential causes of fatigue 3, 4
Overlooking medication side effects as potential contributors to fatigue should be avoided 1, 2
Fatigue rarely occurs in isolation and often clusters with other symptoms 1, 9