Sunday, November 20, 2005

Symptomatology: Fatigue

I have been slowly making my way through the symptoms experienced at the end-of-life. The next symptom I would like to address is fatigue and an increased need for sleep.

Fatigue is a common symptom for patients at the end-of-life. Of 1000 patients with advanced cancer, 69% reported easy fatigue; 66% reported weakness; and 61% reported lack of energy (Walsh et al, 2000). Although many patients experience fatigue, the intensity and pattern of the fatigue may vary.

Fatigue may be exacerbated by disease progression, sleep disturbances, pain, poor nutrition, depression, anemia, or result from the side effects of many medications. If an underlying cause can be identified, such as sleep disturbance, depression or anemia, and the patient finds the fatigue bothersome, that underlying cause may be treated.

Fatigue at the end-of-life can exacerbate feelings of regret, sadness, and a sense of loss; therefore fatigue should be treated appropriately.

Exercise at the End-of-Life

Exercise has been shown to improve fatigue, decrease anxiety and increase quality of life in patients who are healthy as well as among patients enrolled in hospice(Yoshioka 1994). This treatment option should be considered when medically appropriate.

While exercise may be used to treat fatigue, labor saving devices, such as a bedside commode, walker, raised toilet seat, and energy-saving appliances / grabbing tools, may also be used to enable patients to continue their activities of daily living, even during their periods of lowest energy.


Many patients at the end-of-life experience anorexia; they lose an interest in eating. This is a very normal symptom at end-of-life. However, some patients may be distressed by the fatigue that may result from their decreased caloric intake. These patients may benefit from nutritional supplements such as Ensure.

Pharmacological Interventions at End-of-Life


Since many patients at the end-of-life experience anorexia in conjunction with fatigue, Megace is often used. Megace not only improves appetite, but has also been shown to decrease fatigue, improve energy, and increase a sense of well-being.

Low-dose Corticosteroids

Even for otherwise healthy adults, corticosteroids are usually taken in the morning. This is because they frequently increase energy, making it difficult for patients to sleep. This side effect can be used to an advantage for patients at the end-of-life who are experiencing fatigue. Like Megace, corticosteroids also increase appetite and improve a patient’s sense of well-being. Although corticosteroids have not been studied on fatigue specifically, they have been shown to improve pain, weakness and depression in patients at the end-of-life. Some low-dose corticosteroids that have been used to treat fatigue in this population include Dexamethasone and Prednisone.

As people get closer to the end-of-life, fatigue should no longer be treated as a symptom. Increased sleep is a very normal part of the dying process, especially in the last weeks prior to death.

Most of the information presented in this post came from the National Comprehensive Cancer Network's guidelines on the treatment of cancer-related fatigue.

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