II. Epidemiology

  1. Affects 75 to 90% of cancer patients

III. Symptoms and Signs

  1. See Fatigue

IV. Differential Diagnosis

V. Comorbid and reversible conditions

VI. Evaluation

VII. 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

VIII. 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

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