- Fatigue and tiredness are two different sensations
- Tiredness is a universal sensation, usually has an identifiable
cause, is short-lived, and is dissipated by a rest or sleep
- fatigue experienced by people with cancer is often described as
unusual or excessive whole-body tiredness, disproportionate to or
unrelated to exertion, and is not easily expelled by sleep or rest
- it can be acute or more long-term
- it can have a profound negative impact on the person's quality
of life by interfering in the ability to perform activities and
roles, as a result, care givers begin to assume many roles and
activities previously held by the patient
- many factors may contribute to fatigue, including:
- changes in energy production
- loss of weight and appetite
- decreased nutritional status
- overactive or hyper metabolic state due to tumor growth
- side effects of therapy (chemotherapy, radiation,
- neurotoxicities of cancer or its treatment
- changes in activity and rest patterns
- sleep disturbances
- instruct patient and family to keep a diary for one week to
identify time of day when they are most fatigued or have the most
- - look at the contributing factors
- be aware of warning signs of impending fatigue, including tired
eyes, stiff shoulders, decreased or lack of energy, inability to
concentrate, increased irritability, nervousness, anxiety, impatience
- identify which activities or situations make fatigue better or
- a "1 to 10" scale can be used to assess levels of fatigue, with
1 being the least amount of fatigue and 10 being the worst possible
sensation of fatigue
- develop a plan to pace activities by scheduling activities
according to fatigue/energy patterns, see Suggestions for Energy
- exercise may improve fatigue, develop an appropriate exercise
program with the physician and physical therapist
- monitor the effectiveness of medications and other strategies
that you are using to control other symptoms such as pain, nausea and
vomiting and insomnia
- encourage a balanced diet with complex carbohydrates (grains,
legumes, vegetables) that provide a more sustained source of energy
- encourage plenty of water (8-10 glasses/day if not
contraindicated) to maintain hydration and to excrete toxins that may
be associated with fatigue
- use distraction techniques to focus on things other than
tiredness, illness or disease
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McCorkle, R., Grant, M., Frank-Stromborg, M., Baird, S. Cancer
Nursing: A Comprehensive Textbook, 2nd ed. Philadelphia: WB Saunders
Nail, LM and Winningham, ML. (1995). Fatigue and weakness in
cancer patients: the symptoms experience. Seminars in Oncology
Nursing, 11 (4), 272-8.
Piper, BW., Rieger, PT., Brophy, L., Haeuber, D., Hood, LE.,
Lyver, A. & Sharp, E. (1989). Recent advances in the management
of biotherapy-related side effects: Fatigue. Oncology Nursing Forum,
16 (6), supplement.
Winningham, ML, Nail, LM, Burke, MB, Brophy, L, Cimprich, B.
Jones, LS., Pickard-Holley, S., Rhodes, V., St. Pierre, B., Beck, S.
et al. (1994). Fatigue and the cancer experience: the state of the
knowledge. Oncology Nursing Forum, 21 (1), 23-36.
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