Fatigue is the most common chronic symptom associated with cancer and other chronic progressive diseases.
It has a major impact on quality of life, function, relationships, and a person’s ability to engage with care requirements.
Fatigue is a persistent and distressing feeling of tiredness, weakness, or lack of energy which
Nurses have an important role in recognising, assessing, and managing symptoms related to fatigue. They can also help patients and families with sensitive and culturally appropriate education and support.
Fatigue is a feeling of constant tiredness or weakness and can be physical, mental or a combination of both. Fatigue is a subjective feeling and people with advanced illness will experience it in their own way. Some people may describe it as feeling, 'heavy', 'slow', 'weak', 'light-headed', or 'dizzy'.
People may describe mental or emotional fatigue as feeling exhausted, listless, depressed, guilty, or frustrated.
Physical and mental fatigue prevents participation in preferred activities and impedes activities of everyday living.
Cognitive fatigue complicates activities such as reading, driving a car, and making decisions.
Many factors can contribute to fatigue. These include:
People experiencing fatigue with advanced illness may see themselves as ‘lazy’ or ‘not positive enough’. They may also feel a loss of self and meaning. Pay attention to the person's experience of fatigue. Listen carefully and acknowledge their distress as this can reduce the distress associated with fatigue.
As the life-limiting illness progresses, fatigue can become unavoidable. Generally there is no real ‘cure’ as such, but ways of improving the person’s experience of this symptom or managing underlying causes where possible.
In assessing fatigue, nurses should aim to understand the symptoms, activity level, and challenges from the person’s perspective. This forms the basis for helping them to manage and structure daily activities to optimise their quality of life.
As for pain and dyspnoea, assessment of the whole person, including physical, psychosocial, and spiritual needs is essential for fatigue.
Ask the person about their experience of fatigue: when it occurs, the severity, whether there are better times during the day for them to get things done, their level of distress, and the impact on their function.
Check for reversible contributing factors as listed above.
While fatigue is distressing and common in palliative care patients, it is often inadequately assessed and managed. Screening is important and fatigue is included in the Symptom Assessment Scale and the Edmonton Symptom Assessment Scale.
Assessment tools specific to fatigue include the Brief Fatigue Inventory (BFI), the Functional Assessment of Cancer Therapy (FACIT-F), the Multidimensional Fatigue Inventory 20 (MFI-20), and the Piper Fatigue Scale (PFS).
Patients often describe fatigue as one of the most difficult symptoms to manage.
Fatigue is often misunderstood and healthcare professionals can help by encouraging open discussion and validating concerns.
Often patients feel guilty about being no longer able to contribute fully to family life and this feeling should be acknowledged.
For many patients, fatigue will be part of their experience of living with their illness.
Awareness and acknowledgement of the symptoms, and consideration of lifestyle and goals can help to manage fatigue and reduce its impact on daily life.
Strategies may include:
Modifying the persons’ activity and rest patterns and helping them to prioritise activities can help. As can taking frequent short breaks rather than a long rest period.
It is important to remember that in the final stages of life, fatigue may provide protection and shielding from suffering for the patient and therefore treatment may be detrimental.
Fatigue is best managed by a multidisciplinary team of health and social care professionals. This may include the person’s GP, nurses, an occupational therapist, physiotherapist, and counsellor or psychologist.
Fatigue can be a side effect of certain medicines. It may help to ask the doctor or pharmacist to review the person’s medicines. Management of fatigue with medicines is controversial.
Certain underlying causes of fatigue can be treated where relevant. These include:
Sleep disturbance may be a cause or contributing factor and you can read more about this in Sleep disturbance.
Music therapists may be able to help in the management of fatigue.
Occupational therapists can help with optimising activities of daily living and ways to manage and conserve energy levels with education, counselling, task redesign and equipment prescription.
Physiotherapists can help with fatigue through pacing and energy conservation, relaxation techniques, and mobility aids.
This information was drawn from the following resources:
Watch Managing Fatigue from the Palliative Care Bridge
Go to Fatigue on the Marie Curie website
Access more Fatigue resources
Page created 4 October 2022