Assessment of fatigue in palliative care
Specifically ask patients with palliative care needs about fatigue, as they may not report it and it may not be recognised by healthcare professionals. Patients may use other terms to describe fatigue, such as having a lack of energy or feeling tired, weak or lethargic. Assessment tools to assist with routine screening for fatigue are available—see Symptom assessment in palliative care. Once fatigue is identified, in addition to assessing severity, evaluate its impact on function and psychological, social and spiritual wellbeing.
Fatigue often accompanies the expected irreversible deterioration of a progressive life-limiting illness; however, in some patients, fatigue may be due to a concurrent treatable cause. The causes of fatigue are often multifactorial and are listed in Possible contributors to fatigue in patients with palliative care needs. Fatigue often coexists with other symptoms.
Extensive investigation of the cause of fatigue may not be appropriate for patients with advanced life-limiting illness; however, consideration of reversible causes of fatigue (eg anaemia, sleep disturbances, infection) may be worthwhile, particularly earlier in the disease trajectory.
concurrent physical symptoms—pain, breathlessness, nausea
concurrent psychological and emotional symptoms—distress, depression, anxiety
sleep disturbance—insomnia, sleep–wake phase disturbances, disturbing dreams
disease-related sequelae—anaemia, electrolyte abnormalities, dehydration, cachexia, hypoxia
disease-related muscle weakness—deconditioning, corticosteroid-induced myopathy, spinal cord compression, paraneoplastic myopathy or neuropathy (see also Motor weakness in palliative care)
other comorbid systemic disease—infection, endocrine disorder (eg hypothyroidism)
drugs—opioids, antihistamines, antiemetics, diuretics, antihypertensives, benzodiazepines, antipsychotics, other sedating drugs
disease-modifying treatments—chemotherapy, radiotherapy, hormonal antineoplastic treatments
progression of life-limiting illness