Management of Fatigue in Palliative Care
Assessment and Screening
- The National Comprehensive Cancer Network recommends regular screening and evaluation of fatigue using brief assessment tools to monitor changes and guide treatment modifications 1, 3
- Assessment should include evaluation of disease status, medication side effects, treatable contributing factors, and impact on quality of life 3, 4
Non-Pharmacological Interventions
- Physical activity is the non-pharmacological intervention with the strongest evidence for managing fatigue, even in palliative care settings when appropriate 5, 6
- Exercise should be tailored to the patient's functional status and modified based on disease progression 6, 7
- Cognitive Behavioral Therapy and Behavioral Therapy are category 1 recommendations for managing fatigue 6, 7
- Mindfulness-based stress reduction and supportive expressive therapies can help manage stress and improve coping 6, 8
- CBT for sleep is a category 1 recommendation for improving sleep quality and reducing fatigue 6, 7
Pharmacological Interventions
- Treatment should target underlying causes when identified, such as anemia, depression, or hypothyroidism 1, 3
- The National Comprehensive Cancer Network suggests that corticosteroids may be helpful for short-term use in advanced cancer 1
Special Considerations for End-of-Life Care
- Fatigue patterns may vary at end-of-life, and common contributing factors include anemia, medication side effects, polypharmacy, cognitive impairment, and malnutrition 9, 8
- Nutrition should be tailored to the terminal patient's comfort and not forced, as nutritional decline is expected 1, 4
Ongoing Management
- Regular reevaluation of fatigue levels and treatment effectiveness is essential 1, 10
- Treatment approaches should evolve as disease progresses and patient's clinical status changes 1, 3