Cancer-Related Fatigue

ObjectiveThe learner will be able to discuss the nursing

management of cancer-related fatigue.

ProblemFatigue is a distressing, persistent, and subjective sense of tiredness or exhaustion that is not proportional to recent activity and interferes with usual functioning.

Incidence• Often cited as the most common symptom• Occurs with other symptoms in a cluster• Contributing factors:– Anemia– Sleep disturbances– Poor nutrition– Fluid/electrolyte abnormalities

Pathophysiology• Elevated cytokine release • Altered skeletal muscle metabolism• Dysregulation of the hypothalamic pituitary-

adrenal (HPA) axis • Sickness behavior

Assessment• Elevated cytokine release • Altered skeletal muscle metabolism• Dysregulation of the hypothalamic pituitary-

adrenal (HPA) axis • Sickness behavior

Evidence-Based Interventions• Recommended for practice:– Exercise

• Likely to be effective– Energy conservation– Education– Measures to optimize sleep quality– Complementary therapies (massage, relaxation)

• Balance benefit with harms.– Correction of anemia

ReferencesIrwin, M., Poirier, P., & Mitchell, S.A. (2014). Fatigue. In M. Irwin & L. Johnson (Eds.). Putting evidence into practice: A pocket guide to cancer symptom management (pp. 111-117). Pittsburgh, PA: Oncology Nursing Society.Mitchell, S.A. (2015). Fatigue. In C.G. Brown (Ed.). A guide to oncology symptom management. (2nd ed., pp. 385-407). Pittsburgh, PA: Oncology Nursing Society. National Comprehensive Cancer Network. (2015). NCCN clinical practice guidelines in oncology: Cancer-related fatigue [V.2.2015]. Fort Washington, PA: Author.