Fatigue, defined as a persistent sense of tiredness which is not relieved by sleep or rest, is an extremely common problem amongst palliative care patients and causes significant distress. [1,10,13-16] A systematic review of symptoms in adult and paediatric patients with advanced cancer indicated that over half experienced fatigue. [10,17] The prevalence of fatigue is likely to be similar or indeed higher in patients with other life-limiting diseases, including HIV-AIDS, heart disease, chronic obstructive pulmonary disease, Parkinson’s disease and renal disease. [15,16,18,19] Careful assessment is needed to ensure appropriate differentiation of fatigue and other conditions such as depression.
Factors which may contribute to fatigue in palliative care patients, some of which can be treated or modified, include:
It is likely that the presence and intensity of fatigue may increase as patients’ disease progresses. The negative impact on quality of life of patients and their caregivers can be substantial.  While fatigue is distressing and common in palliative care patients it is often inadequately assessed. [1-3] Cultural issues are important in understanding the significance of fatigue for a particular person. 
Simple self-report scales should be used to routinely assess fatigue.  In a recent review of available tools used to measure fatigue in cancer patients only four tools met the authors quality standards.  The Brief Fatigue Inventory (BFI), the Functional Assessment of Cancer Therapy (FACT-F), the Multidimensional Fatigue Inventory 20 (MFI-20) and the Piper Fatigue Scale (PFS) were found to have adequate psychometric properties. These tools have not been validated in the palliative care context but may be useful. Fatigue is one of the symptoms screened for by the Symptom Assessment Scale in the PCOC dataset, which is used by many palliative care services in Australia. It is also screened in the Edmonton Symptom Assessment Scale, which has been validated in the palliative care setting.  Validated assessment tools are available for adolescents. Younger children can be asked if they are 'tired or not tired'. [4,5]
Regular assessment, attention to reversible factors, and multidisciplinary approaches to treating fatigue are essential. [2,3,5] Interventions involving physical exercise (walking and multimodal exercise) [2,6] and psychosocial interventions (eg. stress management, counselling, and restorative approaches) show definite promise for cancer related fatigue [7,8] although studies of physical activity involving a defined palliative care population have not been conclusive. [9-11] Whilst guidelines for the management of cancer related fatigue are available  these do not specifically address the needs of palliative care patients, or those with non-malignant conditions. 
Last updated 27 August 2021