II. Epidemiology
- Affects 75 to 90% of cancer patients
III. Risk Factors
- Physical comorbidities (e.g. Cancer Pain)
- Mental health comorbidities (e.g. Insomnia, depressed mood)
- Physical inactivity and deconditioning
- Maladaptive emotional response to diagnosis and treatment
IV. Findings
V. Differential Diagnosis
- See Fatigue Causes
VI. Associated Conditions: Comorbid and Reversible Conditions
- Anxiety Disorder
- Major Depression
- Medication Causes of Fatigue
- Anemia
- Cancer Pain
- Infection
- Sleep disorder
VII. Evaluation
VIII. Labs
- See Fatigue Diagnostic Testing
- Consider CBC, comprehensive metabolic panel, TSH, Serum Cortisol at 8 am
IX. Management: General Measures
- Enlist family support in understanding Fatigue is real
- Give patient permission to feel tired
- Restructure patient activities to conserve energy
- Encourage regular Exercise (e.g. Resistance Training, aerobic activity) - paradoxically reduces Fatigue
- Tai chi or qigong (low to moderate intensity)
- Cognitive Behavioral Therapy or Mindfulness activities
- Offer stress management for patient and family
- Eliminate unnecessary medications
- Maximize hydration and nutrition
X. Management: Empiric Medications
-
Dexamethasone (Decadron)
- Dose: 2 to 20 mg PO qAM
- Effects may wane after 4 to 6 weeks
- Integrative therapy
- Consider American Ginseng 1000 mg twice daily during treatment
- Acupuncture after treatment is compleated
- Other agents (not generally recommended in Cancer Related Fatigue)
- Selective Serotonin Reuptake Inhibitors (SSRI) trial
- May consider in comorbid Major Depression
- 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