Fatigue in palliative care patients — an EAPC approach

Abstract

Fatigue is one of the most frequent symptoms in palliative care patients, reported in .80% of cancer patients and in up to 99% of patients following radio- or chemotherapy. Fatigue also plays a major role in palliative care for noncancer patients, with large percentages of patients with HIV, multiple sclerosis, chronic obstructive pulmonary disease or heart failure reporting fatigue. This paper presents the position of an expert working group of the European Association for Palliative Care (EAPC), evaluating the available evidence on diagnosis and treatment of fatigue in palliative care patients and providing the basis for future discussions. As the expert group feels that culture and language influence the approach to fatigue in different European countries, a focus was on cultural issues in the assessment and treatment of fatigue in palliative care. As a working definition, fatigue was defined as a subjective feeling of tiredness, weakness or lack of energy. Qualitative differences between fatigue in cancer patients and in healthy controls have been proposed, but these differences seem to be only an expression of the overwhelming intensity of cancer-related fatigue. The pathophysiology of fatigue in palliative care patients is not fully understood. For a systematic approach, primary fatigue, most probably related to high load of proinflammatory cytokines and secondary fatigue from concurrent syndromes and comorbidities may be differentiated. Fatigue is generally recognized as a multidimensional construct, with a physical and cognitive dimension acknowledged by all authors. As fatigue is an inherent word only in the English and French language, but not in other European languages, screening for fatigue should include questions on weakness as a paraphrase for the physical dimension and on tiredness as a paraphrase for the cognitive dimension. Treatment of fatigue should include causal interventions for secondary fatigue and symptomatic treatment with pharmacological and nonpharmacological interventions. Strong evidence has been accumulated that aerobic exercise will reduce fatigue levels in cancer survivors and patients receiving cancer treatment. In the final stage of life, fatigue may provide protection and shielding from suffering for the patient and thus treatment may be detrimental. Identification of the time point, where treatment of fatigue is no longer indicated is important to alleviate distress at the end of life.

Symptoms in the cancer patient – Of importance for their caregivers' quality of life and mental health?

“…This finding is supported by previous research (Kirkova et al, 2011a;Roscoe, 2007;Radbruch et al, 2008). In a study of 1,000 patients in an American Palliative care…”

Fatigue in hormone-naïve prostate cancer patients treated with radical prostatectomy or definitive radiotherapy

“…5 Clinically significant levels of fatigue lasting for more than 6 months have been referred to as chronic fatigue (CF) and are found in 10% of the general Norwegian male population 6 and in 17-31% of male cancer survivors. 7,8 The prevalence of fatigue as a late adverse effect after treatment for localized prostate cancer is 15-40% after RAD 9-13 and 10-17% after RP.…”

What is the Best Term in Spanish to Express the Concept of Cancer-Related Fatigue?

“…This may be because many professionals consider it to be a natural expected feature of advanced cancer. 3 The tools used to evaluate asthenia or fatigue should be adapted to the patient's environment. The working group of the European Association of Palliative Care (EAPC) recommends that systematic assessment of asthenia in a nonspecialized setting be carried out using a single question such as, ''Do you feel unusually tired or weak?''…”

“…For investigative purposes, or when asthenia is a priority symptom, specific multidimensional surveys should be completed. 3 In scientific language, the terms fatigue or asthenia [4][5][6][7][8] are used to refer to a symptom that the European Organization for Research and Treatment of Cancer (EORTC) defines as a subjective sensation of tiredness, weakness, or lack or energy. 9 In general, the symptom of fatigue is recognized by most authors as a multidimensional concept with at least one physical and one cognitive aspect; emotional state and existential and social aspects also influence the way in which it is perceived.…”