What is fatigue and what causes it

What is meant by fatigue Fatigue can be defined in different ways. The term originates from the Latin fatigare, meaning tired out. The Oxford English Dictionary's main definitions of fatigue are (1) extreme tiredness after exertion and (2) a reduction in the efficiency of a muscle. One common definition is 'a subjective state of overwhelming, sustained exhaustion and decreased capacity for physical and mental work that is not relieved by rest' (Piper et al. 1989). In some medical texts fatigue...

Fatigue health and wellbeing

Air, rest and sleep, pleasure and food If taken in moderation, keep man in good health (Loux and Richard in Pierret 1995, p. 186) Limited energy reserves and inability to undertake valued daily activities have been identified as key manifestations of cancer-related fatigue and ill-health (see Chapters 1 and 6). Herzlich's (1973) influential study of social representations of illness and health was one of the earliest studies to demonstrate the extent to which individuals associate the absence...

Constructing the fatigue experience

As a word, it seems to be unhelpful when used to ask people, whether well or ill, to describe it. People instead tend to complain of tiredness, lack of energy, general lethargy, weakness, depression, anxiety, exhaustion, inability to sustain exertion, impaired mobility, motivation and concentration span, sleepiness, drowsiness, heaviness, apathy, an inability to carry on, as well as many other sensations (Hilfinger Messias et al. 1997 Ream and Richardson 1997...

Factors affecting carers perceptions of fatigue

The relief of debilitating and distressing symptoms is described as an essential feature of quality cancer and palliative care, and has been shown to be crucial to an individual's ability to cope with the challenges of a caregiving role (Stetz and Hanson 1992). Unrelieved symptoms are not only known to induce patient reports of reduced quality of life, but are also increasingly recognized as having profound effects on the psychological well-being of carers (Payne et al. 1999). When symptoms are...

CRF assessment algorithm

The National Comprehensive Cancer Network (NCCN) defines CRF as 'a common, persistent, subjective sense of tiredness related to cancer or cancer treatment that interferes with usual functioning' (Mock et al. 2003). CRF is a multidimensional, subjective experience that is characterized by a cluster of diverse physical, psychological, and cognitive symptoms. Assessment of CRF involves evaluating these various symptoms systematically (Naughton and Homsi 2002 Mock et al. 2003). In clinical...

Psychosocial interventions

Psychological distress is frequently reported by patients diagnosed with cancer. Psychological symptoms including depression, anxiety, and anger have been reported in 70 of cancer patient populations (Telch and Telch 1986 Derogatis 1986). These cognitions can alter their perceptions of, and reactions to, both their symptoms and any side-effects of their treatment and can tax their ability to cope with them. Patients frequently find their symptoms distressing, yet symptom distress is often...

Fatigue is common

Most community studies which have asked about fatigue report it as being among the top ten most common symptoms. In the UK a recent study on the prevalence of psychiatric symptoms found fatigue (measured on the Revised Clinical Interview Schedule (Lewis et al. 1992)) was the most common symptom present in one-third of women and a fifth of men (Meltzer et al. 1995). The Health and Lifestyles Survey (Cox et al. 1987) asked 9003 subjects 'within the last month have you suffered from any problems...

Caring in isolation

Work by Wellard (1998) and Mishel (1988) has identified uncertainty as a facet of chronic illness, noting that unpredictability, in relation to the impact illness and its treatments make on patients' lives, may be particularly difficult to cope with. However, unpredictability allows room for hope and scope for ongoing reconstruction of one's situation, and this may be particularly beneficial during the early stages of a serious illness. For the friends and relatives of patients with advancing...

Coping strategies

Children identified fewer interventions that helped decrease fatigue than adolescents. One child's description of how rest helps was, 'I usually take two naps every day and that makes me feel better'. A good night's sleep was described as something that helped the children when they were tired as indicated by one child who discussed not being tired at the time of the focus group, 'I slept good last night'. Children discussed quiet activities such as reading a book or listening to music as...

Fatigue terminology

Using the single word 'fatigue' can limit appreciation of the phenomenon and its consequences (Winningham 2001) because various other terms have been used by cancer patients to describe their CRF experience. Persons with cancer tend to describe the experience using negative expressions reflecting noticeable loss of energy (Camarillo 1992), exhaustion, increased discomfort, and inability to perform some tasks routinely done before their cancer experience (Holley 2000a Winningham 2001 Curt and...

Defining exercise

Exercise can be defined as episodic performance of repetitive bodily movements produced by skeletal muscles that requires energy expenditure. In the healthy population, exercise with a duration of 30-45 min for each episode and a frequency of at least three times a week is advocated in order to produce cardiovascular benefits. Cancer-related fatigue is characterized by a persistent, intense, and chronic sense of tiredness and exhaustion that interferes with usual functioning. Therefore the...

Introduction

Fatigue has been identified as the most distressing and prevalent cancer-related symptom in a variety of cancer populations. Incidence of cancer-related fatigue ranges from 40 to 100 , depending on cancer diagnoses, treatment modalities, and disease stages (Berger 1998 Fu et al. 2002 Hickok et al. 1996 Hinds et al. 1999 Schag et al. 1994 Porock et al. 2000 Winningham et al. 1994). People with cancer describe their fatigue experience as being different from the fatigue that healthy people...

Is fatigue a biologically appropriate response to cancer and therapy

This teleological question may appear an irrelevant question to ask of a clinical symptom, but it addresses whether non-exercise-induced fatigue may have a 'useful' (or at the least a non-disadvantageous) function to an animal otherwise why would we have the capacity to generate or express this state To illustrate the importance of this question consider the nausea and vomiting associated with cancer chemo- and radiotherapy. These symptoms are now thought to be due to inappropriate activation...

Progesterone derivatives

Weight gain and appetite stimulation are now recognized as secondary effects of treatment for hormone-sensitive cancers using progesterone derivatives (Gregory et al. 1985 Tchekmedyian et al. 1987). Randomized controlled trials have been conducted to evaluate the efficacy of megestrol acetate (MA) and medroxyprogesterone (MPA) (Downer et al. 1993) as appetite stimulants (Simons et al. 1996). In some studies weight gain seems to be related to a gain in fat mass (Lambert et al. 2002 Engelson et...

Definitions and descriptions

The work undertaken by Hockenberry and colleagues has led to an appreciation of fatigue as a debilitating, functionally limiting problem for children and adolescents with cancer, which has a negative impact on the ability to participate in normal daily activities. Descriptions and reports of fatigue found in this group were similar to those identified by children with chronic fatigue syndrome (CFS) (Walford et al. 1993 Carter et al. 1995, 1996, 1999), as well as by adults with cancer (Knoff...

A model of the relationship between capacity and performance

Figure 13.1 presents the hypothesized relationships between fatigue as a symptom experience, capacity for action, and functional performance. The symptom experience of fatigue refers to the intensity, severity, and duration of fatigue. Capacity for action includes, but is not limited to, the motor and cognitive components necessary for functional performance. Motor components include range of motion, muscle strength, A MODEL OF THE RELATIONSHIP BETWEEN CAPACITY AND PERFORMANCE 281 Fig. 13.1...

Models of fatigue

Models have been developed for the development of fatigue in non-cancer and cancer patients. Our review of fatigue unrelated to cancer indicates that predisposed individuals (perhaps with a genetic vulnerability, previous experience of ill-health in childhood, or a past psychiatric disorder) who are confronted by an acute stressor (for example a serious viral illness, surgery, or stress from a life event) may develop fatigue, and this fatigue is more likely to become chronic if they respond by...

References

Akechi, T., Kugaya, A., Okamura, H., Yamawaki, S., and Uchitomi, Y. (1999) Fatigue and its associated factors in ambulatory cancer patients a preliminary study. Journal of Pain and Symptom Management, 17,42-8. Andrykowski, M.A., Curran, S.L., and Lightner, R. (1998) Off-treatment fatigue in breast cancer survivors a controlled comparison. Journal of Behavioral Medicine, 21, 1-18. Ashbury, F.D., Findlay, H., Reynolds, B., and McKerracher, K. (1998) A Canadian survey of cancer patients'...

Beneficial effects of exercise in individuals with cancer

The benefits of exercise are the same for people with cancer as for healthy people. Research on the impact of exercise and physical activity on cancer-related fatigue has been undertaken with patients receiving, or those who have completed, treatment. Most intervention studies have been conducted with patients undergoing treatment for breast cancer and or receiving bone marrow transplantation (MacVicar and Winningham 1986 Mock et al. 1994, 1997 Schwartz 2000). All of these studies used...

Progestational steroids

Progestational steroids such as medroxyprogesterone acetate (MPA) or megestrol acetate (MA) are often used as hormone therapy for cancers of the breast, prostate, endometrium, or kidney. However, these drugs have also been used for symptomatic relief of anorexia and cachexia, and a number of randomized controlled trials have demonstrated their effectiveness for this indication (Bruera et al. 1990 Tchekmedyian et al. 1992 Downer et al. 1993 Loprinzi et al. 1993 Gebbia et al. 1996 Simons et al....

List of Contributors

Clinical Instructor Department of Pediatrics Baylor College of Medicine, Houston Texas, USA Professor of Comparative Physiology Department of Basic Medical Sciences St George's Hospital Medical School Cranmer Terrace London, UK Cancer Research UK Nursing Research Fellow Department of Palliative Care and Policy Guy's, King's and St Thomas' School of Research Coordinator Department of Pediatrics Baylor College of Medicine, Houston Texas, USA Clinical Instructor Department of Pediatrics Baylor...

Implications for practice

Fatigue assessment and prescriptions for managing fatigue should be a vital aspect of care for cancer patients and survivors during treatment and follow-up care. Exercise and physical activity should be considered as an important fatigue management strategy. Prescription of exercise or physical activities should consider individual health status, exercise type, intensity, duration, frequency, and progression. Table 14.4 lists suggested considerations when prescribing exercise and physical...

What are the conceptual similarities and differences between fatigue and depression

In order to understand the conceptual similarities and differences between depression and fatigue, it is necessary to consider how these two concepts have been defined. Our approach to this issue focuses on the different ways in which fatigue and depression have been assessed in cancer patients. Three distinct approaches to the measurement of depression can be identified the single-symptom approach, the symptom cluster approach, and the clinical syndrome approach. The single-symptom approach...

The validity and reliability of fatigue questionnaires

Nineteen self-report instruments available in English were identified in the CRF literature from 1980 to present. Table 9.1 summarizes their properties. They are grouped into multiple categories in the table, depending on whether they consist of a single fatigue item or multiple items, are incorporated in another instrument or are freestanding, and are uni- or multidimensional measures of fatigue. The four single-item measures of fatigue are the Rhoten Fatigue Scale RFS Rhoten 1982 , Visual...

HT agonists exercise duration

5-HT receptor down-regulation in trained athletes Fig. 3.5 Summary of the possible involvement of brain 5-hydroxytryptamine 5-HT and the hypothalamic-pituitary axis HPA in the genesis of fatigue induced by exercise and associated with chronic fatigue syndrome CFS . L-tryptophan the precursor for 5-HT synthesis and branched chain amino acids BCAA compete for the same transporter into the brain so that when muscles are exercising and using BCAA more L-tryptophan is able to enter the brain via the...