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Palliative care: Overview of fatigue, weakness, and asthenia

Eduardo Bruera, MD
Sriram Yennurajalingam, MD
Section Editor
Robert M Arnold, MD
Deputy Editor
Diane MF Savarese, MD


Fatigue is the most common symptom in palliative care patients who have advanced cancer or other serious and/or life-threatening illnesses [1]. It is also one of the most under-reported and undertreated symptoms in such patients [2,3]. Fatigue has substantial adverse physical, psychosocial, and economic consequences for both patients and caregivers [1-3]. However, due to its subjective nature and multi-dimensional causes, assessment and treatment of fatigue in the palliative settings can be complex.

This topic review will provide an overview of the clinical evaluation and treatment of fatigue in palliative care. Although the focus is on fatigue in cancer patients receiving palliative care, the principles of assessment and management are similar in other end stage disease states. A more extensive discussion of fatigue in patients with cancer and of the assessment and management of systemic exertion intolerance disease (SEID), also known as chronic fatigue syndrome (CFS), are presented elsewhere. (See "Cancer-related fatigue: Prevalence, screening and clinical assessment" and "Cancer-related fatigue: Treatment" and "Clinical features and diagnosis of systemic exertion intolerance disease (chronic fatigue syndrome)" and "Treatment of systemic exertion intolerance disease (chronic fatigue syndrome)".)


It is important to distinguish fatigue from other common presentations in palliative care including depression, delirium, drowsiness, and weakness.

Fatigue in palliative care settings can be broadly defined as “a subjective state characterized by feelings of tiredness and a perception of decreased capacity for physical or mental work” [4]. The National Comprehensive Cancer Network (NCCN) defines cancer related fatigue as a “distressing, persistent, subjective sense of physical, emotional, and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to activity and that interferes with usual functioning”. (See "Cancer-related fatigue: Prevalence, screening and clinical assessment", section on 'Definition'.)

In the past, the terms “asthenia” and “weakness” were used to describe a subjective sensation of tiredness, while the specific term “fatigue” was used to describe a symptom of tiredness precipitated by effort. However, the terms are currently often used in the same context. The term “fatigue” has gained widespread acceptance in the medical literature and is preferentially used in the National Cancer Institute toxicity grading scale that covers fatigue, asthenia, and malaise (table 1).


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Literature review current through: Sep 2016. | This topic last updated: Jul 22, 2016.
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