Fatigue is associated with increased distress due to some other symptoms, including pain. It often clusters with cachexia and anorexia, and is difficult to distinguish between them (see Chapter 5). It has profound effects on everyday functioning and, perhaps consequently, service use. It reduces quality of life and increases suffering. Fatigue has been associated with hospital admission and increased stress to caregivers (Hinton 1994; Robinson and Posner 1992). The needs of lay caregivers in this context are often overlooked (see Chapter 9). A deeper comprehension of these factors is important in assessing patients, planning care, and in designing and testing future treatments for fatigue.
But do the effects of fatigue stretch even wider, reaching well beyond traditional symptom boundaries? Having energy and vitality is an important part of self-image. Fatigue is often seen as a sign of impending deterioration. So if doctors and nurses are to discuss fatigue with patients, grasping their interpretation and understanding of fatigue is essential (see Chapter 7). Fatigue can have a profound meaning for patients living with fatigue, and for their carers or family, which also need to be considered and assessed.
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