Approach to managing fatigue in palliative care

As the underlying mechanisms of fatigue are not completely understood and treatments are often ineffective, satisfactory symptom management is challenging for both healthcare professionals and patients with palliative care needs. A crucial element of management is providing an explanation of fatigue to patients, and their families and carers; this is important even in the final weeks and days of life. Clarifying the likely causes and possible treatment options helps them to set realistic expectations and adapt to living with fatigue.

Management of fatigue includes general measures and management of emotional and psychological symptoms. If appropriate, treat reversible causes of fatigue, taking into consideration the potential benefits and burdens of each intervention and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care. Drug therapy has a limited role in management of fatigue.

In patients with advanced life-limiting illness, treatment of fatigue may no longer be appropriate or indicated; the emphasis of care shifts to alleviating symptoms and distress, and focusing on meaningful interactions and promoting dignity, in line with the patient’s preferences and goals of care.

For some patients, fatigue may provide protection and a shield from suffering in the final weeks and days of life when function declines; therefore, measures to manage fatigue may be burdensome and counterproductive during this time.