II. Epidemiology
- Affects 75 to 90% of cancer patients
III. Symptoms and Signs
- See Fatigue
IV. Differential Diagnosis
- See Fatigue Causes
V. Comorbid and reversible conditions
- Anxiety Disorder
- Major Depression
- Medication Causes of Fatigue
- Anemia
- Cancer Pain
- Infection
- Sleep disorder
VI. Evaluation
VII. Management: General Measures
- Enlist family support in understanding Fatigue is real
- Give patient permission to feel tired
- Restructure patient activities to conserve energy
- Offer stress management for patient and family
- Eliminate unnecessary medications
- Maximize hydration and nutrition
VIII. Management: Empiric Medications
-
Dexamethasone (Decadron)
- Dose: 2 to 20 mg PO qAM
- Effects may wane after 4 to 6 weeks
-
Methylphenidate (Ritalin)
- Initial Dose: 2.5 to 5 mg PO qAM and at Noon
- Titrate Dose to 30 mg PO qd
- Selective Serotonin Reuptake Inhibitors (SSRI) trial