Fatigue in patients with pre-existing conditions

Fatigue is a common symptom of many chronic conditions. When a patient presents with new or worsening fatigue, consider whether it is related to an existing condition, treatments for the condition(s) or something else. For example, fatigue in a patient with rheumatoid arthritis may be due to the onset of a new condition such as hypothyroidism. The principles of the diagnostic approach remain the same, but it is important to keep an open mind about the contributors to fatigue; see Fatigue: diagnostic process and Conditions commonly associated with fatigue.

Note: In patients with a pre-existing condition, consider all possible contributors to fatigue, including whether a new condition has developed.

In patients with cancer, fatigue is a frequent and distressing symptom. Cancer-related fatigue is more frequently reported than any other symptom (reported by 70 to 80% of patients) and interferes with function more than most other cancer-related symptoms. Fatigue should be enquired about and recognised even in cancer survivors. The cause of cancer-related fatigue is thought to be multifactorial; factors that may contribute include:

  • effects of the malignancy and metastases
  • adverse effects of treatment (eg radiotherapy, drug therapy)
  • impact on mental health
  • pain contributing to insomnia
  • loss of muscle massBerger, 2015.

Pre-existing and coincidental conditions in patients with cancer should also be considered and managed.

Interventions that are likely to be beneficial for adults with fatigue related to cancer include rehabilitation, psychoeducation, mindfulness-based stress reduction, exercise, cognitive behavioural therapy, relaxation and yogaBerger, 2015. The Royal Australian College of General Practitioners Handbook of Non-Drug Interventions (HANDI) includes a section on Exercise for cancer fatigue.

Advice on managing fatigue in patients with other pre-existing conditions is included in the following topics in Therapeutic Guidelines:

The Psychotropic guidelines include advice on anxiety and depressive disorders, which are commonly associated with fatigue.

Mood disturbance, depression and fatigue after a stroke are discussed in the Neurology guidelines.