Hematology and Oncology Book


  • Fatigue in Cancer


Fatigue in Cancer

Aka: Fatigue in Cancer, Fatigue in Terminally Ill Patients, Cancer Related Fatigue
  1. Epidemiology
    1. Affects 75 to 90% of cancer patients
  2. Symptoms and Signs
    1. See Fatigue
  3. Differential Diagnosis
    1. See Fatigue Causes
  4. Comorbid and reversible conditions
    1. Anxiety Disorder
    2. Major Depression
    3. Medication Causes of Fatigue
    4. Anemia
    5. Cancer Pain
    6. Infection
    7. Sleep disorder
  5. Evaluation
    1. Brief Fatigue Inventory
  6. Management: General Measures
    1. Enlist family support in understanding Fatigue is real
    2. Give patient permission to feel tired
    3. Restructure patient activities to conserve energy
    4. Offer stress management for patient and family
    5. Eliminate unnecessary medications
    6. Maximize hydration and nutrition
  7. Management: Empiric Medications
    1. Dexamethasone (Decadron)
      1. Dose: 2 to 20 mg PO qAM
      2. Effects may wane after 4 to 6 weeks
    2. Methylphenidate (Ritalin)
      1. Initial Dose: 2.5 to 5 mg PO qAM and at Noon
      2. Titrate Dose to 30 mg PO qd
    3. Selective Serotonin Reuptake Inhibitors (SSRI) trial
  8. References
    1. Portenoy (1999) Oncologist 4:1-10 [PubMed]

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