Fatigue is a distressing, persistent, and subjective sense of tiredness or exhaustion that is not proportional to the activity and interferes with usual function. Lack of endurance refers to limited physical capability to sustain an exercise or activity for an extended period of time. From 80% to 100% of patients with cancer report experiencing fatigue. It can be isolated or occur within a symptom cluster with pain, depression, dyspnea, anorexia, and sleep disturbance.
For fatigue/lack of endurance, standards of care are based on established evidence-based practice.
• Fatigue is a distressing, persistent, and subjective sense of tiredness or exhaustion that is not proportional to the activity and interferes with usual function.
• Lack of endurance refers to limited physical capability to sustain an exercise or activity for an extended period of time.
• From 80% to 100% of patients with cancer report experiencing fatigue. It can be isolated or occur within a symptom cluster with pain, depression, dyspnea, anorexia, and sleep disturbance.
Assessment Tools and Recommended Intervals
• Screen at regular intervals with a scale from 1 (no fatigue) to 10 (worst fatigue imaginable).
• A detailed assessment should include onset, pattern, duration, change over time, aggravating or relieving factors, and interference with function.
• Based on the presence of other symptoms, onset, and severity of fatigue, consider seeking a complete blood cell count with differential, comprehensive metabolic panel with hepatic and renal function, and endocrinologic evaluation with thyroid-stimulating hormone.
• Encourage a healthy lifestyle with exercise and a healthy diet combined with adequate hydration.
Evidence-Based Interventions and Management
• Suggest increased physical activity (30 minutes of intentional moderate exercise daily, with a goal of three to five hours per week). Yoga and tai chi can also be implemented.
• Manage concurrent symptoms, such as depression or anxiety.
• Stress adequate hydration and electrolyte balance to prevent and treat fatigue.
• Recommend psychosocial interventions, including cognitive behavioral therapy, supportive expressive therapies (e.g., art, music, pet therapy), or guided relaxation therapy, as needed.
• If nonpharmacologic interventions are not effective, consider adding a psychostimulant (methylphenidate).
Agents and Interventions to Avoid
• Modafinil and armodafinil are not likely to be effective.
• Discourage excessive alcohol use, which can lead to somnolence.
• When possible, avoid medications with a side effect of drowsiness, dizziness, or sedation.
Evidence-Based Resources for Providers
• NCCN Clinical Practice Guidelines in Oncology: Cancer-Related Fatigue (v.1.2021) (www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf)
• Oncology Nursing Society Putting Evidence Into Practice: Fatigue (www.ons.org/pep/fatigue)
Evidence-Based Resources for Patients and Family
• Cancer.Net: Fatigue (https://bit.ly/3Chg0o6)
• NCCN Guidelines for Patients: Survivorship Care for Cancer-Related Late and Long-Term Effects (www.nccn.org/patients/guidelines/content/PDF/survivorship-crl-patient.pdf)
• American Cancer Society Guidelines for Fitness and Nutrition in Cancer Survivors (https://bit.ly/3baSrSc)
About the Author(s)
Suzanne M. Mahon, DNS, RN, AOCN®, AGN-BC, FAAN, is a professor in the Department of Internal Medicine in the Division of Hematology/Oncology and in the Trudy Busch Valentine School of Nursing at Saint Louis University in Missouri and Ellen Carr, PhD, RN, AOCN®, is the editor of the Clinical Journal of Oncology Nursing at the Oncology Nursing Society in Pittsburgh, PA. The authors take full responsibility for this content. The article has been reviewed by independent peer reviewers to ensure that it is objective and free from bias. Mahon can be reached at firstname.lastname@example.org, with copy to CJONEditor@ons.org. (Submitted June 2021. Accepted August 26, 2021.)
National Comprehensive Cancer Network. (2021). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Cancer-related fatigue [v.1.2021]. https://www.nccn.org/professionals/physician_gls/pdf/fatigue.pdf
Stout, N.L., Santa Mina, D., Lyons, K.D., Robb, K., & Silver, J.K. (2021). A systematic review of rehabilitation and exercise recommendations in oncology guidelines. CA: A Cancer Journal for Clinicians, 71(2), 149–175. https://doi.org/10.3322/caac.21639