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Fatigue in CancerAka: Fatigue in Terminally Ill Patients, Cancer Related Fatigue

Epidemiology
1. Affects 75 to 90% of cancer patients
Symptoms and Signs
1. See Fatigue
Differential Diagnosis
1. See Fatigue Causes
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
Evaluation
1. Brief Fatigue Inventory
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
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
References
1. Portenoy (1999) Oncologist 4:1

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 5/10/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.